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Continuing Care Retirement Communities

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TDI form number Description Format Language
CCRA01/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
CCRC01a/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
CCRC02/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
CCRC03/FIN384 CCRC Form 3 - Officers and directors page
 PDF English
CCRC04/FIN385 CCRC Form 4 - Biographical data form
 PDF English
CCRC04a/FIN386 CCRC Form 4A - Biographical data form for a not-for-profit CCRC board members
 PDF English
CCRC05/FIN387 CCRC Form 5 - Delivery of disclosure statement
 PDF English
CCRC06/FIN388 CCRC form 6 - Format for Disclosure Statement for Continuing Care Facility
 WORD English
CCRC06a/FIN389 CCRC Form 6A - Instructions for preparation a continuing care retirement community disclosure statement for filing with TDI
 PDF English
CCRC06b/FIN605 CCRC form 6B - Format for Disclosure Statement for Continuing Care Facility
 WORD English
CCRC07/FIN390 CCRC Form 7 - Change of control statement for CCRC
 PDF English
CCRC08/FIN391 CCRC Form 8 - Certification of changes to disclosure statement
 PDF English
CCRC09/FIN392 CCRC Form 9 - Notice of request to release entrance fee escrow funds
 PDF English
CCRC10/FIN393 CCRC Form 10 - Notice of request to release funds from the reserve fund escrow account
 PDF English
CCRC11/FIN394 CCRC Form 11 - Notice by provider of re-payment of previously released funds to the reserve fund escrow account
 PDF English
CCRC12/FIN395 CCRC Form 12 - Affidavit of re-payment of previously released funds to the reserve fund escrow account
 PDF English
CCRC13/FIN396 CCRC Form 13 - Notice of lien
 PDF English
CCRC14/FIN397 CCRC Form 14 - Calculations concerning conditions
 PDF English
CCRC14a/FIN607 CCRC Form 14a - Provider request for release of continuing care residence entrance fee escrow funds
 PDF English
CCRCFR/FIN381 CCRC Filing Requirements for Certificate of Authority
 PDF English
CCRCRE/FIN403 CCRC Release Escrow Checklist
 PDF English
CCRCNC/FIN398 CCRC Name Change Checklist
 PDF English
FIN321 Company Licensing Fee Transmittal Form
 PDF English
FIN590 Financial Analysis Fee Transmittal Form
For MEWAs and CCRCs 		PDF English

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