Office of Licensure
Useful Licensure Forms
- TDMHDD Initial Application for License (MH-4385)
- Application for License Renewal (MH-4457)
- Application Fee Schedule and Invoice (MH-4453)
- TDMHDD Notification of Civil Penalty MH-5330 Interactive Form (for use by Office of Licensure
staff only) - TDMHDD Allegation/Suspicion of Neglect/Abuse/Dereliction MH5375 Interactive Form
- TDMHDD Licensure Application Fact Sheet (MH-4386)
- Application Financial Statement (MH-4466)
- Change of Status Form (MH-4454)
- TDMHDD Notification of Civil Penalty MH-5330 Printable Blank Form (for use by Office of Licensure staff only)
- TDMHDD Title VI Monitoring Guide printable blank form (for use by Office of Licensure staff only)
Licensure Links
