TX HHS Form H1004. Cover Letter Authorized Representative Not Verified

Form H1004 is a notice sent by the Texas Health and Human Services Commission (HHSC) when someone submits a benefits application on behalf of another person and claims to be their authorized representative. The letter explains that HHSC cannot process the application until proof of this authorization is provided. In many cases, Form H1004 is the applicant’s first indication that additional documentation is required to validate their role.

Purpose of the Form

The primary purpose of Form H1004 is to protect applicants and ensure that only properly authorized individuals can act on someone else’s behalf. Texas law requires HHSC to verify the legitimacy of any representative who handles applications for Medicaid, SNAP, TANF, or other benefits for another person. This prevents identity misuse and ensures that confidential information is released only to someone with lawful authority.

When This Form Is Issued

HHSC sends Form H1004 when:

• A benefits application is submitted by someone who is not the applicant.
• The application indicates that the sender is an authorized representative.
• No documentation was included to prove that authorization.

If the required proof is not submitted by the stated deadline, HHSC cannot approve the application.

Who Has the Right to File as an Authorized Representative

Only specific individuals can legally act as an authorized representative, including:

• An adult named on the application who signs Form H1003 to appoint the representative.
• A person with legal authority, such as through a power of attorney, guardianship, or court order.
• A parent acting for a minor child.
• A caregiver or family member designated by the applicant.

Key Sections of the Notice Explained

Case Number and People Listed on the Application

These fields help HHSC link the notice to the correct benefits case. They also clarify on whose behalf the sender is attempting to act.

Action Needed

This section lists the exact requirement: the sender must provide proof of authorization by the deadline stated in the notice. If the proof is missing or incomplete, HHSC will not continue processing the application.

Accepted Types of Proof

• Form H1003 – Appointment of an Authorized Representative: Must be signed by an adult listed on the application.
• Legal documents: Power of attorney, guardianship order, court order, or similar documents granting authority.

How to Submit the Documentation

• Using the Your Texas Benefits mobile app (take a photo and upload).
• Uploading documents through YourTexasBenefits.com.
• Mailing the paperwork using the prepaid envelope included with the notice.

Typical Mistakes Applicants Make

• Sending Form H1003 without the required signature from an adult listed on the original application.
• Uploading unclear or incomplete legal documents.
• Missing the submission deadline, causing delays or denial of the case.
• Assuming verbal permission is enough—HHSC requires written proof.

When You Must Submit This Form — and When You Don’t

You must submit the requested authorization if you applied for benefits on behalf of someone else. You do not need to submit anything if you are:

• Applying for yourself only.
• Already listed as an authorized representative in a previous case with valid documentation.
• A parent applying for a minor child (in most cases).

Legal Requirements Behind the Form

The use of an authorized representative is regulated by HHSC policy and federal rules governing Medicaid, SNAP, and TANF. Agencies must confirm that anyone handling sensitive benefits information has explicit permission from the applicant. Form H1004 ensures compliance with these rules.

Practical Recommendations

• Submit proof as soon as possible to avoid delays.
• Use the mobile app if you need a fast upload—it’s quicker than mailing.
• Double-check that legal documents clearly show your authority.
• If using Form H1003, make sure it is signed by an adult named in the application.

Examples of Real-World Situations

• A daughter applies for Medicaid for her elderly mother: HHSC sends H1004 because no power of attorney was attached.
• A caseworker submits a SNAP application for a disabled client: H1003 must be signed by the client to authorize representation.
• A relative assists an applicant who does not speak English: Authorization must still be documented in writing.
• A guardian applies for benefits for a minor: HHSC may request the guardianship order if it wasn’t included.

Documents You May Need

• Form H1003 (signed by an adult applicant).
• Power of attorney documents.
• Guardianship or conservatorship papers.
• Relevant court orders.
• Photo ID of both applicant and representative (recommended for clarity).

FAQ

• What happens if I don’t submit proof? HHSC cannot approve the application, and processing will stop.
• Can I upload a photo of the documents? Yes, as long as the image is clear and readable.
• Do I need to send original legal papers? No, copies are acceptable.
• Can a minor appoint an authorized representative? Minors generally cannot authorize representatives; a parent or guardian must act for them.
• Is Form H1003 always required? No; it is required only when no legal authority documents are available.
• How do I know HHSC received my documents? You can check your case status on YourTexasBenefits.com or in the mobile app.
• What if the deadline has already passed? You may need to reapply or call HHSC for further instructions.

Micro-FAQ (Short Answers)

• Purpose: To request proof of authorized representation.
• Who files: Anyone submitting an application for another person.
• Deadline: By the date listed in the notice.
• Attachments: Form H1003 or legal authority documents.
• Submit to: HHSC via app, website, or mail.
• Legal basis: HHSC policy on authorized representatives.
• Effect of no submission: Application cannot be approved.

Related Forms

• Form H1003 — Appointment of an Authorized Representative
• Form H1010 — Texas Benefits Application
• Form H1020 — Request for Information

Form Details

• Form Name: Request for Proof of Authorized Representative
• Form Number: H1004
• Region: Texas Health and Human Services (HHSC)
• Edition Date: 04-2015-E
• Mailing Address: HHSC, PO Box 149029, Austin, TX 78714-9029
• Phone: 2-1-1 or 1-877-541-7905 (option 2)