TX HHS Form 0003. Authorization to Furnish Information

The Texas Health and Human Services (HHS) Form 0003, Authorization to Furnish Information, is used by applicants or recipients to authorize the release of personal information to representatives of the Texas HHS Commission. This form enables individuals to grant permission for relevant parties to share information that may impact their eligibility for assistance programs.

The form requires the applicant or recipient to provide their name, address, and signature, as well as the signatures of their spouse and any authorized guardians or power of attorney. The authorization does not extend to the release of personal health information from medical records, ensuring confidentiality is maintained in this regard.

This Form 0003 serves as a crucial tool for individuals seeking assistance from the Texas HHS Commission, allowing them to control the flow of relevant information necessary for determining their eligibility and processing applications. By completing this form, applicants or recipients can streamline the application process and ensure that all necessary information is shared with the issuing agency.