TX HHS Form H0926. Sharing Facts About Me and My Case with a Community Partner

The TX H0926 Form, "Sharing Facts About Me and My Case with a Community Partner", is a crucial document for individuals seeking assistance from the Texas Health and Human Services Commission (HHSC) in applying for benefits. This form enables applicants to authorize community partners to share their personal information and case details, facilitating the application process.

This form requires applicants to provide essential information, including their name, date of birth, and Social Security Number or case number. By signing this form, applicants understand that they are allowing their community partner to access their case record, which may include private facts about their health. The form also outlines the responsibilities of both the applicant and the community partner, emphasizing the importance of maintaining confidentiality.

The TX H0926 Form is typically used by individuals applying for HHSC benefits, such as SNAP, TANF, Medicaid, and CHIP. By completing this form, applicants can work with staff or volunteers to understand and apply for these benefits through the Your Texas Benefits website or paper application. Key features of this form include authorization to release case information or facts, which can be withdrawn at any time using the Your Texas Benefits website.

• This form is used by individuals applying for HHSC benefits, such as SNAP, TANF, Medicaid, and CHIP.
• Applicants must provide their name, date of birth, and Social Security Number or case number.
• The form authorizes community partners to access the applicant's case record, which may include private facts about their health.