TX HHS Form 3058. CSHCN Regional Verification Worksheet

The TX HHS Form 3058, CSHCN Regional Verification Worksheet, is a case management tool designed to guide clients and families through the eligibility verification process for children with special health care needs (CSHCN) services. This form helps resolve issues related to proof of income and residency, ensuring that the necessary documentation is provided to support an individual's application.

The worksheet requires specific information, including names of parents or guardians listed on proofs of income and residency, which must match those on the application. Additionally, it outlines conditions for using lease agreements or rent receipts as proof of residency, such as the landlord's name, address, and/or phone number being included on the receipt or agreement. The form also emphasizes the importance of direct deposit bank statements or check/award letters showing payment history.

This form is typically used in situations where clients require verification of their eligibility for CSHCN services. By completing this worksheet, individuals can provide the necessary documentation to support their application and ensure a smoother processing experience. Key points to note include:

• The need for matching names on proofs of income and residency with those on the application.
• The use of lease agreements or rent receipts as proof of residency, subject to specific conditions.
• The requirement for direct deposit bank statements or check/award letters showing payment history.