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The Texas 3703 form, officially known as the Application for Plan Review for a Nursing Facility, is a crucial document for anyone looking to establish or modify a nursing facility in Texas. This form collects essential information about the facility and the proposed project, including the facility name, physical address, and contact details for key personnel involved in the project. Applicants must also provide a project cost estimate and indicate whether the facility will be fully equipped with fire sprinklers. The form requires detailed applicant information, including the owner's contact person, architect, and engineering firm, along with their respective titles and contact details. Additionally, it outlines the type of application being submitted, whether for new construction, relocation, or an addition to an existing facility. The form also asks for specifics about the facility type, such as its capacity and whether it includes Alzheimer's certified areas. Finally, it details the applicable fees for plan review services, which are based on the nature of the project. Completing this form accurately is essential for compliance with Texas regulations and for moving forward with the necessary approvals.

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Application for Plan Review
for a Nursing Facility
Form 3703
September 2014
Service Code
324200100
LTC Review Fees
1. Facility/Project Information
Facility Name
Physical Address — Street
City
State
ZIP
County
Contact Person’s Title
Facility/Project Contact Person’s Telephone Number
Fax Number
Internet Address
( )
( )
Mailing Address (if different from physical address) — Street or P.O. Box
City
State
ZIP
Project Cost Estimate
Is the facility to be completely fire sprinklered?
$
Yes No
2. Applicant Information
Owner or Owner’s Contact Person
Title
Telephone Number
( )
Internet Address
Fax Number
( )
Address (if different than facility)
City
State
ZIP
Architect Firm
Telephone Number
( )
Name of Architect
Texas Registration Number
Project Manager
Title
Internet Address
Fax Number
( )
Mailing Address
City
State
ZIP
Engineering Firm
Telephone Number
( )
Name of Engineer
Texas Registration Number
Project Manager
Title
Internet Address
Fax Number
( )
Mailing Address
City
State
ZIP
3. Type of Application (check all that apply)
Initial — New Construction Initial — Relocation (New Construction)
No. of Beds:
(for fee purposes)
Addition of Wing/Building/Area Describe:
Number of beds before project:
Laundry Kitchen Living/Dining Other:
Number of beds after project:
Other details/description:
Have plans been previously submitted for this project?
Yes No
If Yes, when?
By whom?
4. Type of Facility (check all that apply)
Single-story
Multi-story; Total no. of floors:
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)
Telephone Number
$
Check Number:
( )
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 i
s 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 E-411
Austin, TX 78714-9055
Submit application and plans to:
Texas Department of Aging and Disability Services Phone: 512-438-2371
Long Term Care Regulatory Fax: 512-438-4623
Architectural Unit
Facility Enrollment, Mail Code E-250
701 West 51st Street
Austin, TX 78751
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 2/09-
2014
• 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 one-sentence description of the addition.
• “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.
• “Single-story” means a building with one floor level at grade.
• “Multi-story” means a building with two or more floor levels, including basements.
• “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) single-story facilities — $20 per bed, $2,000 minimum; and
(B) multiple-story facilities — $24 per bed, $2,500 minimum.
(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 (1)-(2) of this subsection.
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 E-411
Austin, TX 78714-9055
➤ PDF File

Form Specifications

Fact Name Details
Form Purpose This form is used to apply for plan review services for nursing facilities in Texas.
Governing Law The form is governed by the Texas Administrative Code (TAC), Title 40, Pt. 1, Ch. 19, §19.219.
Submission Requirements Applicants must submit the form along with plans and a fee to the Texas Department of Aging and Disability Services (DADS).
Contact Information The form requires detailed contact information for the facility/project contact person, owner, architect, and engineer.
Application Types Different application types include new construction, relocation, and additions to existing facilities.
Fee Structure Fees are based on the type of facility and project scope, with specific rates outlined in the TAC.

Texas 3703: Usage Guidelines

Filling out the Texas 3703 form requires careful attention to detail. This form is essential for initiating a plan review for a nursing facility. After completing the form, you will submit it along with the required payment to the appropriate department. Make sure all information is accurate to avoid delays in the review process.

  1. Facility/Project Information:
    • Enter the full name of the facility.
    • Provide the physical address, including street, city, state, ZIP code, and county.
    • List the contact person's full name.
    • Indicate the contact person's title.
    • Include the contact person's telephone number with area code.
    • Provide the contact person's fax number with area code.
    • Enter the contact person's Internet address or email.
    • 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.
  2. Applicant Information:
    • Provide the owner's or owner's contact person's full name.
    • Indicate the title of the owner's representative.
    • List the owner's representative's telephone number with area code.
    • Include the Internet address or email of the owner's representative.
    • Provide the fax number of the owner's representative with area code.
    • If different from the facility address, enter the owner's representative's address.
    • List the name of the architectural firm.
    • Provide the architectural firm's telephone number with area code.
    • Enter the full name of the architect.
    • Include the architect's Texas registration number.
    • Provide the project manager's full name and title.
    • Include the Internet address or email of the architect in charge.
    • List the architect's fax number with area code.
    • Provide the mailing address of the architect in charge.
    • List the engineering firm name.
    • Provide the engineering firm's telephone number with area code.
    • Enter the full name of the engineer.
    • Include the engineer's Texas registration number.
    • Provide the project manager's full name and title for engineering.
    • Include the Internet address or email of the engineer in charge.
    • List the engineer's fax number with area code.
    • Provide the mailing address of the engineer in charge.
  3. Type of Application:
    • Check all applicable boxes for the type of application.
    • Provide a brief description for any additions.
    • Indicate the number of proposed beds for the project.
    • Enter the number of beds before and after the project.
    • Indicate if plans have been previously submitted and provide details if applicable.
  4. Type of Facility:
    • Check the appropriate boxes for the type of facility.
    • Provide the number of floors if multi-story.
    • Indicate the capacity for Alzheimer’s certified areas.
    • Describe any locked areas that are not Alzheimer’s certified and provide their capacity.
  5. Fees:
    • Calculate the fee based on the Texas Administrative Code.
    • Provide the check number from your payment.
    • Include the remitter's name as it appears on the check.
    • List the remitter's telephone number with area code.

Your Questions, Answered

What is the Texas 3703 form used for?

The Texas 3703 form is an application for plan review services specifically for nursing facilities. It is submitted to the Texas Department of Aging and Disability Services (DADS) to ensure that the proposed plans meet state regulations and standards. This form is essential for new construction, relocations, or modifications to existing nursing facilities. It is important to note that this application does not cover the requirements for licensure or accessibility reviews by the Texas Department of Licensing and Regulation (TDLR).

What information do I need to provide on the form?

You'll need to provide detailed information about the facility, including its name, physical address, and contact details for the project manager. You must also include specifics about the project, such as the estimated cost and whether the facility will be fully fire sprinklered. Additionally, information about the owner, architect, and engineering firm is required, along with the type of application you are submitting. This includes whether it’s for new construction, relocation, or an addition to an existing facility.

Are there any fees associated with submitting the Texas 3703 form?

Yes, there are fees associated with the plan review application. The fees vary based on the type of facility and the scope of the project. For new single-story facilities, the fee is $20 per bed with a minimum of $2,000. For multi-story facilities, the fee is $24 per bed with a minimum of $2,500. If you are adding to or remodeling an existing facility, the fee is 2% of the construction cost, with a minimum of $500 and a maximum of $2,000. Additional fees apply for Alzheimer’s certification.

How do I submit the Texas 3703 form?

You can submit the Texas 3703 form by mailing it along with the required fees to the Texas Department of Aging and Disability Services. The mailing address is: Regulatory Services, P.O. Box 149055, Mail Code E-411, Austin, TX 78714-9055. Ensure that you also send any plans related to the project to the Long Term Care Regulatory Architectural Unit at 701 West 51st Street, Austin, TX 78751. For questions, you can contact them at 512-438-2371.

Common mistakes

  1. Incomplete Facility Information: Failing to provide the full name of the facility or missing any part of the physical address can lead to delays. Ensure that all details, including city, state, ZIP code, and county, are accurately filled in.

  2. Omitting Contact Information: Not including a contact person's name, title, or telephone number is a common oversight. This information is crucial for communication regarding the application.

  3. Incorrect Project Cost Estimate: Providing an inaccurate estimate can cause confusion. Make sure the project cost is realistic and clearly stated.

  4. Misunderstanding Fire Sprinkler Requirement: Not indicating whether the facility will be completely fire sprinklered can lead to compliance issues. Double-check this section before submission.

  5. Inaccurate Applicant Information: Errors in the owner's contact details, such as the name or telephone number, can hinder the processing of your application. Verify all information carefully.

  6. Failing to Specify Type of Application: Not checking the appropriate boxes for the type of application can result in misclassification. Be sure to mark all relevant options.

  7. Ignoring Previous Submissions: If plans have been submitted before, failing to indicate this can create complications. Always provide details about previous submissions, if applicable.

  8. Neglecting Facility Type Details: Not specifying whether the facility is single-story or multi-story can lead to processing delays. Ensure this information is clear and accurate.

  9. Fee Calculation Errors: Miscalculating the required fees based on the project type can result in payment issues. Review the fee structure carefully to avoid mistakes.

  10. Missing Remitter Information: Not providing the name or telephone number of the person who signed the check can lead to complications. Always include this information when submitting fees.

Documents used along the form

When submitting the Texas 3703 form for a nursing facility plan review, several other documents may be required or beneficial to include. These documents help ensure a smooth review process and provide comprehensive information to the Texas Department of Aging and Disability Services (DADS). Below is a list of commonly used forms and documents that accompany the Texas 3703 form.

  • Licensure Application: This document is essential for obtaining a license to operate a nursing facility. It provides detailed information about the facility's compliance with state regulations.
  • Architectural Plans: Detailed blueprints of the facility must be submitted. These plans should reflect the proposed construction and layout, ensuring compliance with safety and accessibility standards.
  • Engineering Plans: Similar to architectural plans, engineering plans focus on the technical aspects of the facility, such as plumbing, electrical systems, and structural integrity.
  • Fire Safety Plans: This document outlines the facility's fire safety measures, including fire sprinkler systems and evacuation routes, which are crucial for protecting residents.
  • Environmental Assessment: An environmental assessment evaluates potential impacts of the facility on the surrounding area, ensuring compliance with environmental regulations.
  • Financial Projections: This document provides an overview of the expected financial performance of the facility, including projected revenues and expenses, which can be critical for funding and planning.
  • Staffing Plan: A comprehensive staffing plan details the number of employees, their roles, and qualifications, demonstrating the facility's commitment to providing quality care.
  • Policy and Procedure Manual: This manual outlines the operational policies and procedures of the facility, ensuring compliance with state and federal regulations.
  • Community Needs Assessment: This document assesses the needs of the community regarding nursing care services, helping to justify the necessity of the facility.

Including these documents with the Texas 3703 form can streamline the review process and enhance the likelihood of approval. Each document serves a unique purpose, contributing to a comprehensive understanding of the proposed nursing facility and its alignment with regulatory standards.

Similar forms

The Texas 3703 form, used for the application for plan review for nursing facilities, shares similarities with several other legal documents related to facility planning and review. Below is a list of six documents that are comparable to the Texas 3703 form, along with an explanation of how they are similar.

  • Texas 3704 Form: This form is also used for nursing facility applications, specifically for licensure. Like the 3703, it requires detailed information about the facility and its management, ensuring compliance with state regulations.
  • Texas 3705 Form: This document is for the application for a certificate of occupancy for a nursing facility. It shares similarities with the 3703 form in that both require information about the facility's design and compliance with safety standards.
  • Texas 3706 Form: This form pertains to the application for a construction permit for health care facilities. It is similar to the 3703 in that it requires project details and fees, focusing on the construction aspect of health care facilities.
  • Texas Department of Licensing and Regulation (TDLR) Accessibility Application: This application is necessary for ensuring facilities meet accessibility standards. Both the TDLR application and the Texas 3703 form require detailed project information and plans for compliance.
  • Texas 3707 Form: This form is used for the application for a change of ownership in a nursing facility. Like the 3703, it collects comprehensive information about the facility and its management team, ensuring that new ownership complies with state regulations.
  • Facility Inspection Report: This report is generated after a facility is inspected for compliance with health and safety standards. It is similar to the 3703 form in that both documents assess the facility's readiness for operation and adherence to regulatory requirements.

Dos and Don'ts

When filling out the Texas 3703 form, attention to detail is crucial. Here are some essential dos and don'ts to consider:

  • Do provide complete and accurate facility information, including the full name and physical address.
  • Do ensure that all contact information is current, including phone numbers and email addresses.
  • Do specify the project cost estimate clearly to avoid processing delays.
  • Do check the appropriate boxes for the type of application being submitted.
  • Do include the architect and engineer's Texas registration numbers as required.
  • Don't leave any sections blank. Incomplete forms may be returned for correction.
  • Don't forget to attach the payment coupon with the required fee to your submission.
  • Don't use abbreviations or shorthand that could lead to confusion about your entries.
  • Don't submit plans without ensuring they meet the necessary standards for review.

Following these guidelines can help streamline the application process and minimize delays. Make sure to double-check your entries before submission.

Misconceptions

  • Misconception 1: The Texas 3703 form is only for new facilities.

    • This form can be used for various applications, including the relocation of existing facilities and additions to current buildings. It is not limited to new constructions.

  • Misconception 2: Submitting the Texas 3703 form satisfies all licensing requirements.

    • While the Texas 3703 form is essential for plan reviews, it does not replace the need for a separate application for licensure. Each serves a distinct purpose in the regulatory process.

  • Misconception 3: The form is not necessary if plans have been submitted before.

    • Even if plans have been submitted previously, the Texas 3703 form must be completed for any new applications or modifications to ensure compliance with current regulations.

  • Misconception 4: Fees are fixed and do not vary based on project specifics.

    • Fees for the plan review can vary based on factors such as the type of facility and the nature of the project. It’s important to review the fee schedule to understand the costs involved.

  • Misconception 5: The form does not require detailed information about the project.

    • Completing the Texas 3703 form requires comprehensive details, including the facility's address, project cost estimate, and specific types of applications being submitted. Accurate information is crucial for processing.

  • Misconception 6: There is no need for a contact person on the form.

    • A designated contact person is essential. This individual will be responsible for communication regarding the application and must be easily reachable for any follow-up inquiries.

  • Misconception 7: The Texas 3703 form is only for nursing facilities.

    • While primarily used for nursing facilities, the Texas 3703 form can also apply to certain other long-term care projects. It’s important to verify eligibility based on the specific project type.

Key takeaways

Key Takeaways for Using the Texas 3703 Form:

  • The Texas 3703 form is essential for applying for plan review services for nursing facilities.
  • Complete all sections accurately, including facility information, applicant details, and project specifics.
  • Indicate if the facility will be fully fire sprinklered, as this can affect safety compliance.
  • Provide the estimated project cost to assist in determining the applicable fees.
  • Check the appropriate boxes for the type of application, such as new construction or relocation.
  • List the number of beds before and after the project to calculate fees correctly.
  • Submit the form along with plans and payment to the Texas Department of Aging and Disability Services.
  • Ensure to include a payment coupon with the fee when mailing the application to avoid processing delays.