TX HHS Form 2247. Interest List Contact Notification

The TX HHS Form 2247, Interest List Contact Notification, is a crucial document that helps individuals remain on the Community Services Interest List for various programs or services offered by Texas Health and Human Services (HHS). This form is typically used in situations where an individual wants to continue receiving information about available programs or services.

The form requires essential contact information, including name, address, phone numbers, and alternate contact person details. It also includes a section for the HHSC Case Worker and Office Address. The document emphasizes the importance of updating one's record by either completing and returning the form or contacting the listed phone number. A signature is required to remove an individual's name from the interest list.

To keep their name on the interest list, individuals must confirm their interest in the program(s) or service(s) listed above. They can do this by calling the listed phone number or checking the appropriate box. If contact information has changed, users are required to complete the corresponding box and sign the form before returning it.

• This form is used for individuals who want to remain on the Community Services Interest List for various programs or services offered by Texas Health and Human Services (HHS).
• The form requires essential contact information, including name, address, phone numbers, and alternate contact person details.
• A signature is required to remove an individual's name from the interest list.