TX HHS Form 3048. Notice of Eligibility

The TX HHS Form 3048, Notice of Eligibility, is a crucial document that helps individuals or households receive approved services for the Epilepsy program. This form is typically used in situations where an application has been approved, and the recipient needs to be notified of the services provided and their responsibilities.

The notice outlines key information, including the dates of service provision, copay requirements, and the importance of reporting any changes in situation, such as income, residence, health insurance, family members, or address. It also emphasizes the recipient's responsibility for renewing eligibility before certification expiration date and completing Form 3094, Application for Program Benefits, if needed.

A copy of this form must be given to the client, while the original form is kept with their record. Additionally, recipients have the right to file a complaint with the HHSC Civil Rights Office at 1-888-388-6332 regarding the handling of this application or any action taken by the program.

• This form is used for approved Epilepsy program applications
• Notifies recipients of services provided and responsibilities
• Requires reporting of changes in situation
• Emphasizes recipient's responsibility for renewing eligibility