The 2021 blank Annual Statement of Community Benefits Standard (ASCBS) form is used in collecting charity care and community benefits information from Texas nonprofit hospitals, public hospitals and for-profit hospitals participating in the Disproportionate Share Hospital Program.

Survey Forms

2021 ASCBS form for Nonprofit Hospitals:

2021 ASCBS form for Public Hospitals and For-Profit Disproportionate Share Hospitals:

Lists of hospitals required to report and hospitals exempt from reporting charity care
and community benefits information for the 2021 reporting period:

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