Licensed Provider Frequently Asked Questions

A Fact Sheet form is used for the following: 

• to establish a new site/location
• to add a new category to an existing license
• to relocate a currently licensed facility/service to another location*
• to request approval for a major renovation, expansion, or change in use or occupancy of a currently licensed facility. 

A Change of Status form is used for the following:

• Change in Chief Executive Officer or Executive Director (A Background Information form and Non-criminal Justice Privacy Rights statement must also be submitted.)
• Change in licensee name (Used for change in name only.  This is not a transfer of ownership.)
• Change in site name
• Change in licensed bed capacity
• Change affecting current life safety occupancy classification such as adding or deleting safety occupancy classification to serve mobile non-ambulatory, hearing impaired, blind, or individuals incapable of self-preservation or imposing security measures upon persons which are beyond their control (e.g., exit doors or windows locked against egress, restraints, seclusion, etc.
• Closure of license
• Closure of category(ies) only
• Closure of license due to relocation*

*Licenses are address-specific requiring a new license before a relocation may occur.  For relocation of a facility or service, submit a Fact Sheet form for the new location AND a Change of Status form to close out the old location.

See the TDMHSAS Office of Licensure Administrative Rules

To inform TDMHSAS of an incident, use this form: Reportable Incident Form

Incident Reporting Requirements

For additional documentation and information around reporting, please see the following links:

Personal Support Service Agency license category
Residential and all other non-residential license categories

Use the following table to determine which TDMHSAS Licensure Regional Office serves your county.  Just type your county's name into the search box.  You can also view a map of TDMHSAS Licensure Regions at this link.