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 applicants meet the necessary requirements.

Key features of this form include the requirement for names on proofs of income/residency to match those listed on the application, as well as the need for direct deposit documentation showing recent check/award letters or bank statements. The form also emphasizes the importance of including the client's name, address, and phone number, along with that of their parent(s) or guardian.

This worksheet is intended for use in regional verification processes, particularly when verifying eligibility for CSHCN services. It is essential to follow the instructions carefully, ensuring that all required information is provided and that the form is completed accurately. By using this form, clients and families can efficiently navigate the verification process and ensure a smoother application experience.