TX HHS Form 3094. Application for Program Benefits

The TX HHS Form 3094, Application for Program Benefits, is a crucial document that helps individuals apply for healthcare assistance through the Epilepsy Program. This form can be used to request benefits and services, and it's essential to complete every field unless instructed otherwise.

Key features of this form include required information such as Primary Responsible Adult or Adult Applicant details, household members' information, and communication preferences. The form also allows applicants to specify their preferred method of contact, spoken language, and written correspondence. Additionally, the form inquires about immediate medical needs and whether the applicant is a veteran.

This form should be used by individuals seeking healthcare assistance through the Epilepsy Program. It's particularly useful for those who require comprehensive health care coverage, including Medicare, Medicaid, CHIP, veterans' benefits, TRICARE, private insurance, or other forms of coverage. The form can also help applicants navigate important information about nutrition services (WIC and SNAP) that are not considered comprehensive healthcare.