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Continuing Care Retirement Communities

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TDI Form Number Description File Format Language
FIN382 CCRC Form 1 - Application for certificate of authority to do business in the State of Texas under Health and Safety Code Section 246.022
 PDF English
FIN604 CCRC Form 1a - Application for authority to offer continuing care in residence in Texas under Health and Safety Code Section 246.0025(b).
 PDF English
FIN383 CCRC Form 2 - Application for Commissioner approval to release excess loan reserve escrow fund amounts under Health and Safety Code Section 278.078
 PDF English
FIN384 CCRC Form 3 - Officers and directors page
 PDF English
FIN385 CCRC Form 4 - Biographical data form
 PDF English
FIN386 CCRC Form 4A - Biographical data form for a not-for-profit CCRC board members
 PDF English
FIN387 CCRC Form 5 - Delivery of disclosure statement
 PDF English
FIN388 CCRC form 6 - Format for disclosure statement for continuing care facility
 WORD English
FIN389 CCRC Form 6A - Instructions for preparation a continuing care retirement community disclosure statement for filing with TDI
 PDF English
FIN605 CCRC form 6B - Format for disclosure statement for continuing care facility
 WORD English
FIN390 CCRC Form 7 - Change of control statement for CCRC
 PDF English
FIN391 CCRC Form 8 - Certification of changes to disclosure statement
 PDF English
FIN392 CCRC Form 9 - Notice of request to release entrance fee escrow funds
 PDF English
FIN393 CCRC Form 10 - Notice of request to release funds from the reserve fund escrow account
 PDF English
FIN394 CCRC Form 11 - Notice by provider of re-payment of previously released funds to the reserve fund escrow account
 PDF English
FIN395 CCRC Form 12 - Affidavit of re-payment of previously released funds to the reserve fund escrow account
 PDF English
FIN396 CCRC Form 13 - Notice of lien
 PDF English
FIN397 CCRC Form 14 - Calculations concerning conditions
 PDF English
FIN607 CCRC Form 14a - Provider request for release of continuing care residence entrance fee escrow funds
 PDF English
FIN321 Company Licensing Fee Transmittal Form
 PDF English
FIN381 CCRC Filing Requirements for Certificate of Authority
 PDF English
FIN398 CCRC Name Change Checklist
 PDF English
FIN403 CCRC Release Escrow Checklist
 PDF English
FIN590 Financial Analysis Fee Transmittal Form
for MEWAs and CCRCs 		PDF English

For more information, contact: CompanyLicense@tdi.texas.gov