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

The TX HHS Form 1065, Breast and Cervical Cancer Services (BCCS) Program or Family Planning Program (FPP) Eligibility Application, is a crucial document for individuals seeking to access essential healthcare services. This form helps solve the problem of determining eligibility for these programs by gathering necessary information about the applicant and their household.

The application requires applicants to provide personal information, including name, date of birth, sex, race or ethnicity, primary and secondary phone numbers, email address, and preferred language. Additionally, applicants must list all household members, providing their names, dates of birth, and relationships. The form also asks about adjunctive eligibility, such as benefits received from other programs like Children's Health Insurance Program (CHIP) or Supplemental Nutrition Assistance Program (SNAP). This information helps determine the applicant's eligibility for BCCS or FPP services.

To complete this application, applicants should be prepared to provide detailed household income information, including names of household members, employers, and amounts received. The form also asks about deductions and type of income received per month. By filling out this form, individuals can ensure they are eligible for the necessary healthcare services provided by the Texas Health and Human Services (HHS) or other programs.

• This application is typically used by individuals seeking to access breast and cervical cancer services or family planning services.
• The form requires applicants to provide personal information, household member details, and adjunctive eligibility information.
• Applicants must also provide detailed household income information to determine their eligibility for the programs.