TX HHS Form 3068. Request for Information

The TX HHS Form 3068, Request for Information, is used to gather essential details necessary to determine eligibility for assistance through the County Indigent Health Care Program (CIHCP). This form helps solve the problem of incomplete applications by providing a clear outline of required information.

This form requires applicants to provide specific documentation, including mail addresses, federal income tax returns, identification documents, and records of self-employment or unemployment. Important sections include checkboxes for various types of identification, such as Texas driver licenses, social security award letters, and veterans' affairs award letters. The form also allows for the submission of other relevant information not listed.

This form should be used when an application for assistance is incomplete and requires additional information to determine eligibility. It is essential to provide accurate and complete information to ensure a timely and successful processing of the request. For more information, please contact P.O. Box 13247, Austin, Texas 78711-3247, or visit hhs.texas.gov.