When managing or operating nursing facilities or intermediate care facilities for individuals with intellectual disabilities or related conditions in Texas, one might encounter the need to report a change in facility administrators. This is where the Form 3722 N comes into play, serving as an essential document for ensuring that such changes are formally recognized and recorded by the Texas Department of Aging and Disability Services (DADS). This application process, outlined in the form, requires the submission of detailed information about the facility, including its name, ID number, and address, alongside personal data concerning the new administrator, such as their name, social security number, and license details. Additionally, there is a necessity for a $20 application fee alongside an affirmation that the information provided is accurate under the risk of denial, suspension, or revocation of the state license if found fraudulent. Furthermore, this document underscores the rights of individuals to request and be informed about the collected information, as well as the potential correction of any inaccuracies, highlighting DADS' commitment to transparency and lawful administration within the realm of care facilities.
| Question | Answer |
|---|---|
| Form Name | Form 3722 N |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | illinois change of administrator form, change of administrator form illinois, application for change of nursing facility administrator form texas, nursing facility change of administrator form |