TX HHS Form H0003. Agreement to Release Your Facts

The TX H0003 Agreement to Release Your Facts is a crucial document that enables individuals to share their personal information with the Texas Health and Human Services Commission (HHSC) for the purpose of determining eligibility or maintaining benefits. This form is essential when applying for or receiving healthcare benefits through HHSC.

This agreement allows the individual to authorize the release of facts or records to various organizations, including employers, government agencies, insurance companies, building associations, and financial institutions. The agreement does not involve sharing personal health information from doctors or other healthcare providers. It remains in effect until one of three conditions is met: the application for benefits is cancelled or not approved, the individual no longer receives healthcare benefits through HHSC, or a written statement is submitted to HHSC revoking permission.

To complete this form, applicants must provide their name and that of their spouse (if applicable), as well as agree to allow HHSC to obtain facts or records. The form can be returned via the Your Texas Benefits app, uploaded on YourTexasBenefits.com, faxed to 1-877-447-2839, or mailed to HHSC at PO Box 149027, Austin, TX 78714-9027.