TX HHS Form H0003. Agreement to Release Your Facts

The Agreement to Release Your Facts (Form H0003) is a crucial document for individuals seeking or receiving benefits from the Texas Health and Human Services Commission (HHSC). This form enables HHSC to verify facts about you or your spouse, facilitating the application process and ensuring accurate benefit disbursement.

This agreement allows HHSC to share information with various organizations, including employers, government agencies, insurance companies, building associations, real estate companies, and banks. The agreement remains in effect until one of three conditions is met: cancellation or non-approval of your benefits application, termination of health-care benefits through HHSC, or a written request from you to stop sharing your facts.

To complete this form, you will need to provide your name (and spouse's name if applicable) and agree to the terms outlined above. You can submit the form using the Your Texas Benefits app, uploading it on YourTexasBenefits.com, faxing it to 1-877-447-2839, or mailing it to HHSC at PO Box 149027, Austin, TX 78714-9027.

• This form is typically used by individuals applying for or receiving benefits from the Texas Health and Human Services Commission (HHSC).
• The agreement allows HHSC to share information with various organizations, including employers, government agencies, insurance companies, building associations, real estate companies, and banks.
• The form remains in effect until one of three conditions is met: cancellation or non-approval of your benefits application, termination of health-care benefits through HHSC, or a written request from you to stop sharing your facts.