Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 140 - HEALTH PROFESSIONS REGULATION › Subchapter B - PERSONAL EMERGENCY RESPONSE SYSTEM PROVIDERS PROGRAM › Section 140.34 - Application Requirements and Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant for a license or a
				  registration must submit all required information on official application forms
				  prescribed by the department and submit the required application fee and the
				  initial license or registration fee.
(b) The application form shall contain the
				  following information:
(1) specific
				  information regarding personal data; full legal name of individual or business
				  entity; date of birth; social security number; taxpayer identification number;
				  information regarding other licenses, registrations, permits, and
				  certifications held by applicant; and information regarding misdemeanor and
				  felony convictions of the applicant;
(2) trade names and addresses of all
				  locations and branch offices at which the applicant intends to conduct
				  business;
(3) if the applicant is a
				  corporation or other business entity, specific information regarding type of
				  ownership, registered address, and names and addresses of all officers,
				  directors, registered agents and major shareholders;
(4) if the applicant is a corporation, a
				  current Certificate of Existence or Certificate of Authority issued by the
				  Texas Secretary of State and a current letter from the Texas Comptroller of
				  Public Accounts verifying that the corporation is current in the payment of
				  franchise taxes;
(5) a statement
				  that the applicant has read the Act and these rules;
(6) a statement that the applicant, if issued
				  a license or registration, shall return the license or registration to the
				  department upon revocation or suspension of the license or registration or upon
				  lawful demand;
(7) a statement that
				  the applicant understands that fees and materials submitted in the application
				  process are nonrefundable and nonreturnable;
(8) a statement that the applicant agrees to
				  comply with all state and federal laws and regulations regarding the sale and
				  delivery of personal emergency response system services;
(9) a statement that the applicant meets the
				  qualifications prescribed by the Act for a license or registration;
(10) a statement that the information
				  contained in the application is truthful and complete;
(11) if the applicant is a corporation or
				  other business entity, evidence of a general liability insurance policy on a
				  certificate of insurance form prescribed by the department and countersigned by
				  an insurance agent licensed in this state or a certificate of insurance for
				  surplus lines coverage obtained under Insurance Code, Article 1.14-2, through a
				  licensed Texas surplus lines agent resident in this state;
(12) if the applicant is a corporation or
				  other business entity, a statement regarding the method by which monitoring
				  services will be provided; and
(13)
				  the signature of the applicant.