Outline
The Texas 3703 form is a critical document for anyone involved in the development or renovation of nursing facilities in Texas. This application, formally known as the Application for Plan Review for a Nursing Facility, serves several essential purposes. First and foremost, it allows facility owners and project managers to submit their plans for review by the Texas Department of Aging and Disability Services (DADS). The form collects vital information about the facility, including its name, physical address, and contact details for key personnel. It also requires details about the project, such as the estimated cost and whether the facility will be fully equipped with fire sprinklers. Additionally, the form distinguishes between various types of applications, such as new constructions, relocations, or expansions, and it gathers information on the facility’s capacity and layout. Understanding how to accurately complete this form is crucial, as it not only initiates the review process but also ensures compliance with state regulations. Timely submission can significantly impact project timelines and, ultimately, the ability to provide care in a safe and compliant environment.
Sample - Texas 3703 Form
Application for Plan Review
for a Nursing Facility
Form 3703
September 2014
Service Code
324200100
LTC Review Fees
1.Facility/Project Information
Facility Name
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Is the facility to be completely fire sprinklered? |
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2. Applicant Information |
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3. Type of Application (check all that apply)
Initial — New Construction |
Initial — Relocation (New Construction) |
Addition of Wing/Building/Area |
Describe: |
Laundry Kitchen Living/Dining Other:
Other details/description:
No. of Beds: |
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Number of beds before project:
Number of beds after project:
Have plans been previously submitted for this project?
Yes No
If Yes, when?
By whom?
4. Type of Facility (check all that apply)
Alzheimer’s Certified
Capacity: beds
Locked Area NOT Alzheimer’s Certified Describe:
Capacity: beds
5. Fees
Fee Enclosed (see Texas Administrative Code [TAC], Title 40, Pt. 1, Ch. 19, §19.219) Remitter Name (who signed check)
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Check Number: |
Telephone Number
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Instructions for Completing Form 3703
Application for Plan Review for a Nursing Facility
PROCEDURE
Complete this form to apply for optional plan review services for a nursing facility.
Note: This application is for a plan review by the Texas Department of Aging and Disability Services (DADS). A separate application is required for licensure. This plan review does not satisfy the requirements for a plan review by the Texas Department of Licensing and Regulation (TDLR) for accessibility.
Mail attached payment coupon with fee to:
Texas Department of Aging and Disability Services
Regulatory Services
P.O. Box 149055, Mail Code
Austin, TX
Submit application and plans to:
Texas Department of Aging and Disability Services |
Phone: |
Long Term Care Regulatory |
Fax: |
Architectural Unit |
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Facility Enrollment, Mail Code |
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701 West 51st Street |
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Austin, TX 78751 |
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1.Facility/Project Information
•Facility Name — Enter the full name of the facility.
•Physical Address — Enter the address of the facility, including the city, state, ZIP code and county where the facility is physically located.
•Facility/Project Contact Person — Full name of the person in charge of the building project.
•Contact Person’s Title — Provide the facility/project contact person’s title.
•Facility/Project Contact Person’s Telephone Number — Provide the telephone number, including area code.
•Fax Number — Provide the facility/project contact person’s fax number, including area code.
•Internet Address — Provide the Internet address or email address of the facility/project contact person.
•Mailing Address — Provide the facility/project contact person’s mailing address, including city, state and ZIP code (if different from the physical address).
•Project Cost Estimate — Provide the estimated cost of the project in dollars.
•Is the facility to be completely fire sprinklered? — Check Yes or No.
2.Applicant Information
•Owner or Owner’s Contact Person — Provide the full name of the owner’s representative.
•Title — Provide the title of the owner’s representative.
•Telephone Number — Provide the owner’s representative’s telephone number, including area code.
•Internet Address — Provide the Internet address or email address of the owner’s representative.
•Fax Number — Provide the owner’s representative’s fax number, including area code.
•Address — Provide the address for the owner’s representative, including city, state and ZIP code (if different from the facility address).
•Architect Firm — Provide the name of the firm or individual who produced the construction documents.
•Telephone Number — Provide the architectural firm’s telephone number, including area code.
•Name of Architect — Provide the full name of the architect whose seal is affixed to the drawings.
•Texas Registration Number — Provide the architect’s registration number with the Texas Board of Architectural Examiners.
•Project Manager — Provide the full name of the architectural project manager in charge of the project.
•Title — Provide the architectural project manager’s title.
•Internet Address — Provide the Internet address or email address of the architect in charge of the project.
•Fax Number — Provide the architect’s fax number, including area code.
•Mailing Address — Provide the mailing address, including city, state and ZIP code, of the architect in charge of the project.
•Engineering Firm — Provide the full name of the firm or individual who produced the construction documents.
•Telephone Number — Provide the engineering firm’s telephone number, including area code.
Form 3703 — Instructions
Page
•Name of Engineer — Provide the full name of the engineer whose seal is affixed to the drawings.
•Texas Registration Number — Provide the engineer’s Texas registration number with the Texas Board of Professional Engineers.
•Project Manager — Provide the full name of the engineering project manager in charge of the project.
•Title — Provide the engineering project manager’s title.
•Internet Address — Provide the Internet address or email address of the engineer in charge of the project.
•Fax Number — Provide the engineer’s fax number, including area code.
•Mailing Address — Provide the mailing address, including city, state and ZIP code, of the engineer in charge of the project.
3.Type of Application
•Check the appropriate boxes for the type of application being submitted.
•“Initial” means new facility or the conversion of an existing building into a licensed facility.
•“Initial — Relocation” means relocating an existing licensed facility.
•“Addition of Wing/Building/Area” means making an addition to a licensed facility.
•Provide a
•“Laundry” means construction of a new laundry or renovation of or addition to an existing laundry in a licensed facility.
•“Kitchen” means construction of a new kitchen or renovation of or addition to an existing kitchen in a licensed facility.
•“Living/Dining” means construction of new living or dining space or renovation of or addition to an existing dining or living space in a licensed facility.
•Check the box for Other and enter a brief description of other items included in the project.
•No. of Beds — Provide the number of proposed beds for this project (for calculation of the plan review fee).
•Number of beds before project — Provide the licensed capacity (number of beds) before this project.
•Number of beds after project — Provide the proposed licensed capacity (number of beds) after this project.
•Have plans been previously submitted for this project? — Check Yes or No.
•If Yes, provide the date of last submittal and the remitter’s name.
4.Type of Facility
•Check the appropriate boxes for the type of facility being submitted.
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•“Alzheimer’s Certified” means a building, unit or wing that is certified to meet the requirements of 40 TAC §19.2208, Standards for Certified Alzheimer’s Facilities.
•Capacity — Provide the number of beds in the existing or proposed Alzheimer’s certified facility, unit or wing.
•“Locked Area NOT Alzheimer’s Certified” means a building, unit or wing that is locked for the protection of the residents.
•Describe the locked area.
•Capacity — Provide the number of beds in the existing or proposed locked area.
5.Fees
•Compute the fee from 40 TAC §19.219.
•Check Number — Provide the check number from the fee check.
•Remitter Name — Provide the full name of the person whose signature is on the fee check.
•Telephone Number — Provide the remitter’s telephone number, including area code.
§19.219 Plan Review Fees
(a)The Texas Department of Human Services (DHS) charges a fee to review plans for new buildings, additions, conversion of buildings not licensed by DHS, or remodeling of existing licensed facilities.
(b)The fee schedule follows:
(1)Facilities – new construction:
(A)
(B)
(2)Additions or remodeling of existing licensed facilities — 2% of construction cost with $500 minimum fee and a maximum not to exceed $2,000.
(3)Alzheimer's certification — $550 in addition to the fees specified in paragraphs
Payment Coupon for Facility Enrollment
Plan Review (324200100)
Facility Name and Address
Print Remitter’s Name (person signing check):
Make check or money order payable to:
Texas Department of Aging and Disability Services
Attach check or money order to this coupon and return to:
Texas Department of Aging and Disability Services
Regulatory Services
P.O. Box 149055, Mail Code
Austin, TX
Form Information
| Fact Name | Details |
|---|---|
| Form Title | Application for Plan Review for a Nursing Facility |
| Form Number | Texas Form 3703 |
| Last Updated | September 2014 |
| Service Code | 324200100 |
| Governing Law | Texas Administrative Code (TAC), Title 40, Pt. 1, Ch. 19, §19.219 |
| Application Purpose | This form is used to apply for optional plan review services for nursing facilities. |
| Submission Requirements | Submit the application and plans to the Texas Department of Aging and Disability Services. |
| Fee Structure | Fees vary based on facility type and construction costs, with minimums set in TAC §19.219. |
Detailed Guide for Filling Out Texas 3703
Filling out the Texas 3703 form is an important step in the application process for plan review services for a nursing facility. This form gathers essential information about the facility, the project, and the individuals involved. Once completed, it should be submitted along with the necessary fees to the appropriate department for review.
- Facility/Project Information:
- Enter the full name of the facility.
- Provide the physical address, including street, city, state, ZIP code, and county.
- List the full name of the facility/project contact person.
- Include the contact person’s title.
- Provide the contact person’s telephone number, including area code.
- Include the contact person’s fax number, including area code.
- Provide the Internet address or email address of the contact person.
- If different from the physical address, provide the mailing address.
- Estimate the project cost in dollars.
- Indicate whether the facility will be completely fire sprinklered by checking Yes or No.
- Applicant Information:
- Provide the full name of the owner or owner’s contact person.
- Include the title of the owner’s representative.
- Provide the owner’s representative’s telephone number, including area code.
- Include the Internet address or email address of the owner’s representative.
- Provide the owner’s representative’s fax number, including area code.
- If different from the facility address, provide the address for the owner’s representative.
- List the name of the architectural firm.
- Provide the architectural firm’s telephone number, including area code.
- Include the full name of the architect.
- Provide the architect’s Texas registration number.
- List the project manager’s full name and title.
- Include the Internet address or email address of the architect in charge.
- Provide the architect’s fax number, including area code.
- List the mailing address of the architect.
- Provide the name of the engineering firm.
- Include the engineering firm’s telephone number, including area code.
- Provide the full name of the engineer.
- Include the engineer’s Texas registration number.
- List the project manager’s full name and title for engineering.
- Provide the Internet address or email address of the engineer in charge.
- Include the engineer’s fax number, including area code.
- List the mailing address of the engineer.
- Type of Application:
- Check the boxes for the type of application being submitted (Initial, Initial - Relocation, Addition of Wing/Building/Area).
- Provide a brief description of the addition, if applicable.
- Indicate the number of proposed beds for the project.
- Provide the number of beds before and after the project.
- Indicate if plans have been previously submitted for this project by checking Yes or No.
- If Yes, provide the date and remitter’s name.
- Type of Facility:
- Check the appropriate boxes for the type of facility (Single-story, Multi-story).
- Provide the total number of floors for multi-story facilities.
- Indicate if the facility is Alzheimer’s Certified and provide the capacity.
- Describe any locked areas that are not Alzheimer’s Certified and provide their capacity.
- Fees:
- Compute the fee based on the Texas Administrative Code.
- Provide the check number from the fee check.
- List the full name of the remitter (the person who signed the check).
- Include the remitter’s telephone number, including area code.
Once you have completed the form, ensure that all required information is accurate and legible. The next steps involve submitting the application and any accompanying plans to the Texas Department of Aging and Disability Services, along with the payment for the review fees.
Obtain Answers on Texas 3703
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What is the Texas 3703 form?
The Texas 3703 form is the Application for Plan Review for a Nursing Facility. It is used to request optional plan review services for nursing facilities by the Texas Department of Aging and Disability Services (DADS).
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Who needs to complete the Texas 3703 form?
This form must be completed by individuals or entities planning to construct, relocate, or modify a nursing facility. This includes owners, architects, and project managers involved in the project.
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What information is required on the form?
The form requires detailed information including:
- Facility name and address
- Contact person details
- Project cost estimate
- Type of application (new construction, relocation, etc.)
- Type of facility (single-story, multi-story, etc.)
- Fee information
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What types of applications can be submitted with this form?
Applicants can submit for:
- Initial new construction
- Initial relocation of an existing facility
- Addition of a wing, building, or area
- Remodeling of existing facilities
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Are there fees associated with submitting the Texas 3703 form?
Yes, there are fees based on the type of project. For new construction, fees vary based on whether the facility is single-story or multi-story. Remodeling and additions also have specific fee structures. Refer to the Texas Administrative Code for detailed fee information.
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Where do I send the completed form and payment?
Submit the completed form and plans to:
Texas Department of Aging and Disability Services
Long Term Care Regulatory Architectural Unit
701 West 51st Street
Austin, TX 78751Mail the payment coupon with the fee to:
Texas Department of Aging and Disability Services
Regulatory Services
P.O. Box 149055, Mail Code E-411
Austin, TX 78714-9055 -
Can I submit plans that have been previously submitted?
If plans have been submitted before, you must indicate this on the form and provide the date and name of the remitter. This helps the review process and ensures all information is current.
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Is this form sufficient for licensure?
No, the Texas 3703 form is specifically for plan review services. A separate application is required for licensure of the nursing facility.
Common mistakes
Filling out the Texas 3703 form requires attention to detail. One common mistake is omitting the facility name. This information is essential for identifying the project. Without it, the application may be delayed or rejected.
Another frequent error involves the physical address. Applicants sometimes fail to provide the complete address, including the city, state, ZIP code, and county. Incomplete information can lead to confusion and unnecessary back-and-forth communication.
Some individuals neglect to include the contact person's title. This detail helps clarify the role of the individual responsible for the project. Without it, reviewers may find it challenging to assess the application effectively.
Providing an incorrect or incomplete telephone number is another mistake. It's crucial to include the area code and ensure the number is accurate. An incorrect number can hinder communication between the Texas Department of Aging and Disability Services and the applicant.
Another common oversight is failing to check the box indicating whether the facility will be completely fire sprinklered. This information is vital for safety assessments and regulatory compliance.
Some applicants do not provide a project cost estimate. This estimate is necessary for calculating fees and understanding the scope of the project. Without it, the application may be deemed incomplete.
When indicating the type of application, some individuals forget to check all applicable boxes. This can lead to misunderstandings about the nature of the project. Clearly marking the correct options helps ensure the application is processed accurately.
Failing to specify the number of beds before and after the project is another mistake. This information is crucial for determining the facility's capacity and compliance with regulations.
Some applicants overlook the requirement to indicate if plans have been previously submitted for the project. This information is essential for tracking the project's history and ensuring all necessary documentation is accounted for.
Finally, not including the remitter's name on the fee check can cause delays. This detail is necessary for processing payments and linking them to the correct application. Ensuring that all information is complete and accurate will facilitate a smoother review process.
Documents used along the form
When submitting the Texas 3703 form, several other documents and forms may be necessary to ensure a comprehensive application process for nursing facilities. Each of these documents serves a specific purpose and helps streamline the review and approval process. Below is a list of commonly used forms that accompany the Texas 3703 form.
- Texas Department of Aging and Disability Services (DADS) License Application: This form is required to obtain the official license to operate a nursing facility. It includes detailed information about the facility's operations, staff, and compliance with state regulations.
- Architectural Plans: Detailed architectural drawings must be submitted, illustrating the layout and design of the nursing facility. These plans help the review team assess compliance with safety and accessibility standards.
- Engineering Plans: Similar to architectural plans, these documents focus on the engineering aspects of the facility, such as plumbing, electrical systems, and structural integrity, ensuring they meet state codes.
- Fire Safety Plan: A comprehensive fire safety plan outlines the measures in place to protect residents and staff in case of a fire. This plan must comply with local fire codes and regulations.
- Environmental Assessment: This document evaluates the potential environmental impact of the facility. It ensures that the project complies with environmental regulations and does not harm the surrounding community.
- Health and Safety Inspection Report: A report from a qualified inspector detailing the facility's compliance with health and safety standards. This report is essential for demonstrating that the facility meets all necessary regulations.
- Staffing Plan: This document outlines the proposed staffing structure, including qualifications and roles of staff members. It is crucial for ensuring adequate care and compliance with staffing requirements.
- Financial Viability Statement: A statement providing an overview of the financial stability of the facility. This document is often required to demonstrate that the facility can sustain operations over time.
- Certificate of Insurance: Proof of insurance coverage for the facility, including liability and property insurance. This document protects both the facility and its residents in case of unforeseen events.
Submitting the Texas 3703 form alongside these additional documents can significantly enhance the chances of a smooth review process. Each form plays a vital role in demonstrating compliance with state regulations and ensuring the safety and well-being of residents in the nursing facility.
Similar forms
The Texas Form 3703 is an application for plan review specifically for nursing facilities. Several other documents serve similar purposes in the context of facility planning, construction, and licensing. Here are six documents that are comparable to the Texas 3703 form:
- Building Permit Application: This document is required to obtain permission from local authorities before beginning construction. Like Form 3703, it collects information about the facility, including its location, purpose, and design specifications.
- Certificate of Occupancy Application: This application is necessary to certify that a building meets all safety and zoning requirements. Similar to Form 3703, it ensures that the facility complies with relevant regulations before it can be occupied.
- Licensure Application for Nursing Facilities: This document is required to obtain a license to operate a nursing facility. While Form 3703 focuses on plan review, this application addresses operational standards and regulatory compliance.
- Fire Safety Plan Review Application: This application is submitted to ensure that the facility meets fire safety codes. Like Form 3703, it requires detailed information about safety measures, including fire sprinkler systems.
- Environmental Impact Assessment (EIA): This document evaluates the potential environmental effects of a proposed facility. Similar to Form 3703, it involves detailed planning and compliance with regulations to protect public health and safety.
- Accessibility Compliance Application: This application ensures that facilities meet accessibility standards set by the Americans with Disabilities Act (ADA). Like Form 3703, it requires detailed information about the facility's design to ensure compliance with legal requirements.
Dos and Don'ts
When filling out the Texas 3703 form, it’s important to approach the task with care. Here’s a list of things you should and shouldn’t do to ensure a smooth application process.
- Do: Provide complete and accurate information for all fields, including the facility name, address, and contact details.
- Do: Double-check the project cost estimate to ensure it reflects the actual anticipated expenses.
- Do: Indicate whether the facility will be completely fire sprinklered, as this is a crucial safety detail.
- Do: Clearly check all applicable types of applications to avoid confusion during processing.
- Do: Include the correct fee based on the type of facility and project, ensuring you refer to the fee schedule.
- Do: Use clear and concise descriptions when specifying the type of facility and any additions being made.
- Do: Submit the application and payment coupon to the correct address to avoid delays.
- Don’t: Leave any fields blank; incomplete forms can lead to processing delays.
- Don’t: Forget to include the remitter’s name and check number when submitting your payment.
- Don’t: Use abbreviations or unclear terms in your descriptions; clarity is key.
- Don’t: Submit the application without reviewing it for errors or omissions.
- Don’t: Assume that previous submissions or plans are still valid without checking; provide updated information if necessary.
- Don’t: Ignore the requirement for a separate application for licensure; this is distinct from the plan review.
- Don’t: Overlook the importance of including contact information for all key personnel involved in the project.
Misconceptions
- Misconception 1: The Texas 3703 form is only for new facilities.
- Misconception 2: Completing the Texas 3703 form guarantees approval.
- Misconception 3: Only architects need to fill out the form.
- Misconception 4: The fees associated with the Texas 3703 form are the only costs involved.
- Misconception 5: The form is only for nursing homes.
- Misconception 6: Submitting the form is the same as applying for a license.
- Misconception 7: Once submitted, the application cannot be changed.
This form can be used for various applications, including relocations and additions to existing facilities. It is not limited to new constructions.
Submitting the form does not ensure that the project will be approved. It is just the first step in the review process.
While architects play a significant role, the form requires input from various stakeholders, including owners and engineers.
The fees listed are specific to the plan review process. Additional costs may arise during construction and licensing.
The Texas 3703 form is applicable to various types of long-term care facilities, not just nursing homes.
This form is specifically for plan review. A separate application is required for licensure.
Applicants can revise their submissions if necessary, but they must follow the proper procedures to do so.
Key takeaways
Here are some key takeaways for filling out and using the Texas 3703 form:
- Ensure all sections are completed accurately, including facility details, contact information, and project specifics. Missing information can delay the review process.
- Understand the types of applications available, such as new construction or relocation. Selecting the correct type is crucial for proper processing.
- Check the fee requirements carefully. Fees vary based on the type of facility and the nature of the project. Be prepared to include the correct payment with your application.
- Submit the application and plans to the appropriate department. Use the provided mailing address to ensure your documents reach the Texas Department of Aging and Disability Services.