TX HHS Form 1065. Breast and Cervical Cancer Services (BCCS) Program or Family Planning Program (FPP) Eligibility Application

The Texas Health and Human Services (HHS) Form 1065 is an eligibility application for the Breast and Cervical Cancer Services (BCCS) Program or Family Planning Program (FPP). This form is designed to help individuals apply for these programs, which provide essential healthcare services to eligible applicants.

The purpose of this form is to gather information about the applicant's household, including demographic details, communication preferences, and income. The form also asks about adjunctive eligibility benefits, such as Children's Health Insurance Program (CHIP) or Supplemental Nutrition Assistance Program (SNAP), which may affect an individual's eligibility for BCCS or FPP services.

This application is intended for individuals seeking to access the vital healthcare services offered by the Texas HHS BCCS and FPP programs. By completing this form, applicants can provide essential information that will help determine their eligibility for these programs. The Texas HHS Form 1065 is an important tool for ensuring that eligible individuals receive the healthcare services they need.