TX HHS Form 3051. Statement of Self-Employment Income

The TX HHS Form 3051, "Statement of Self-Employment Income", is a crucial document used to apply for health care assistance through various programs offered by Texas Health and Human Services (HHS). This form helps individuals who earn income from self-employment to demonstrate their financial situation and qualify for necessary healthcare benefits.

This form requires the applicant to provide essential information, including their name, the number of months covered by the income statement, a description of what they did to earn this money, and a list of business expenses and income. The applicant must also certify that the above information is true, correct, and complete to the best of their knowledge.

The TX HHS Form 3051 should be used when applying for healthcare assistance programs such as Primary Health Care Services, Title V Fee-for-Service Program, or Epilepsy Program. It is essential to complete this form accurately and honestly, as providing false information can result in disqualification from the program.