TX HHS Form 3047. Notice of Ineligibility

The TX HHS Form 3047, Notice of Ineligibility, is a crucial document for individuals who have applied for various health programs in Texas. This form serves as a notification to applicants that their application has been denied due to not meeting the program eligibility requirements.

The notice outlines the specific programs for which the applicant was deemed ineligible, including Primary Health Care Program, Title V Child Health and Dental Program, and Epilepsy Program. The document also provides information on the reasons why the application was denied, giving applicants a clear understanding of what they need to do differently in the future.

Applicants have the right to appeal this decision by contacting the relevant program in writing within 20 days of eligibility denial. Additionally, they can file a complaint with the HHSC Civil Rights Office regarding the handling of their application or any action taken by the program. Key points to note include:

• The applicant's address and provider office information
• The programs for which the application was denied
• The reasons why the application was denied
• The appeal process and time frame
• The option to file a complaint with the HHSC Civil Rights Office