TX HHS Form H1010-R. Your Texas Works Benefits Renewal Form

This page explains Form H-1010R — “Your Texas Benefits: Renewal Form” — a renewal and update form used by the Texas Health and Human Services Commission (HHSC). The form helps current benefit recipients confirm or update household, income, and contact information so HHSC can keep benefits active or decide continued eligibility. The guidance below interprets the form’s sections, highlights common pitfalls, and gives practical tips for completing and returning the form on time.

Purpose and when to use this form

Form H-1010R is used to renew or update ongoing public-benefit cases such as SNAP (food benefits), TANF (cash assistance), Medicaid and CHIP. If HHSC sends this renewal form, you must either renew online at YourTexasBenefits.com or complete and return this form by fax, mail, or in person. The form is the official vehicle HHSC uses to verify household composition, income, assets, expenses, and program-specific eligibility facts.

Where and how to return the form

The form lists specific submission channels. You can renew online through YourTexasBenefits.com. To submit the paper form, fax both sides to 1-877-447-2839, mail to HHSC (P.O. BOX 149025, AUSTIN, TEXAS 78714-9025), or deliver in person at a benefit office (call 2-1-1 for locations). Page 9 must be signed and dated by the applicant or authorized representative before submission.

Regulatory and legal context

Renewal processing is governed by HHSC rules and by federal program regulations. The form specifically references federal rules used to verify eligibility and to collect Social Security numbers (for example, 7 C.F.R. §273.6 for SNAP; 42 C.F.R. §435.910 for Medicaid verification). HHSC uses income and eligibility verification systems and may check banks, employers, and federal databases. The form explains that providing false information can result in penalties, repayment of benefits, and possible criminal charges.

Section-by-section explanation

Cover and instructions (pages 1–2)

Explains how to correct errors (cross out and update), sign page 9, attach required documents listed next to specific questions, and where to send the completed form. It also gives contact phone numbers for help (2-1-1 and 1-877-541-7905) and a fraud hotline (1-800-436-6184).

Household and personal information (pages 2–4)

Lists everyone in the benefits case with names, birth dates, relationships, and whether each person still lives in the home. It asks about citizenship or immigration status for people who want benefits and about additional facts such as felony drug convictions that may affect eligibility.

Programs and benefits selection (page 4)

Indicates which programs household members receive or are applying for (SNAP, TANF, Medicaid/CHIP). Check boxes carefully: marking additional programs can start a new application or trigger additional verification requests.

Income and resources (pages 5–6)

Requests detailed income sources and supporting documents (pay stubs, benefit statements, proof of self-employment). It also asks about vehicles, bank accounts, property, and other assets — HHSC uses these to determine resource limits and benefit amounts.

Expenses and deductions (pages 6–7)

Records housing costs, utilities, childcare, medical expenses, and other recurring outlays. Relevant receipts, bills, or statements should be attached when the form requests them to validate allowable deductions.

Privacy, SSNs, and legal statements (pages 7–9)

Explains what personal facts HHSC will check and how they may share or use information for eligibility and program integrity. Social Security numbers are required only for people who want benefits; the form explains consequences for false statements and details how to request corrections of HHSC records.

Authorized representative and signatures (pages 9–10)

Provides the option to name an authorized representative who can act on the applicant’s behalf for renewals, appeals, and enrollment. If an authorized representative signs, proof of legal authority may be requested. The applicant or authorized representative must sign page 9 (witness signature required only if signing with an “X”).

Help and services (pages 11–13)

Lists local resources such as family violence hotlines, workforce centers, WIC, Veterans’ services, and other community supports. These resources are for applicants who need help with transportation, shelter, or filling out paperwork.

Typical mistakes applicants make

• Failing to sign and date page 9 — unsigned forms are often rejected or delayed.
• Not attaching requested supporting documents (pay stubs, account statements) — missing documents trigger follow-up requests and delays.
• Leaving household members off the form or failing to report household changes promptly.
• Providing inconsistent dates or mismatched Social Security numbers compared to other agency records.
• Using unclear corrections (scribbles) instead of clearly crossing out and writing updates as instructed.

Who can complete and submit the form

The person whose benefits case it is should complete and sign the form. An authorized representative, parent, legal guardian, or someone with power of attorney may complete and sign on behalf of the applicant if proper proof of authority is provided. If someone helped fill out the form, the helper’s name and contact must be listed in the “People helping you” section.

When submission is mandatory vs optional

If HHSC mails this renewal form to you, responding is required to maintain benefits for programs listed. Failure to return the form or renew online by the deadline can result in case closure or interruption of benefits. If you already renewed online, you should follow the online confirmation; do not submit duplicate paper forms unless instructed.

Practical tips for faster processing

• Sign page 9 before scanning or faxing; ensure both sides of two-sided pages are included when faxing.
• Attach clear copies of requested documents next to the questions they support (e.g., pay stubs for income, bank statements for assets).
• If you have trouble getting documents, call 2-1-1 for assistance or to request additional time or alternative verification methods.
• Note preferred language or interpreter needs on the form and press the listed phone prompts when calling for help.
• Keep a copy (digital or paper) of everything you send and record the date and method of submission.

Real-life examples

• Example 1 — Working parent renewal: A parent receives SNAP and CHIP and must report updated hours and recent pay stubs. Attaching the last two pay stubs avoids a follow-up verification call and prevents any interruption in benefits.
• Example 2 — Household change: A household member moved out. The applicant lists the change on page 2, indicates the person is no longer living in the home, and provides the effective date to ensure correct benefit calculation.
• Example 3 — Authorized representative: An elderly beneficiary names a trusted family member as an authorized representative and attaches a power of attorney document or proof of guardianship so that the representative can complete renewals and handle communications.

Documents you may need to attach

• Pay stubs or employer statements (last 60 days recommended).
• Bank and account statements (most recent).
• Proof of property, vehicle registration, or other assets.
• Medical bills or receipts for allowable medical deductions (for elderly or disabled claims).
• Proof of immigration status or immigrant registration number for non-citizen applicants who apply for benefits.
• Documentation proving authorized representative status (power of attorney, guardianship paperwork) if applicable.

Frequently Asked Questions (extended)

When do I need to sign the form?

Sign and date page 9 before sending the form; unsigned forms often require follow-up and can delay renewal.

Can I renew online instead of using this form?

Yes. You can renew at YourTexasBenefits.com; online renewal is usually faster. If you choose paper, follow the form instructions and include attachments.

What happens if I don’t return this form?

If you fail to return the renewal form or complete the online renewal, HHSC may close your case or stop benefits after required notices. Contact 2-1-1 immediately if you cannot meet the deadline.

Who should I list on the form?

List everyone on your benefits case and anyone living in the home as requested. Omitting household members can lead to incorrect eligibility determinations.

How do I report language or accommodation needs?

Indicate interpreter needs on the form and call 2-1-1 for language support. HHSC provides free interpreters upon request.

Can someone else fill out the form for me?

Yes — but you must list who helped and sign the appropriate sections. If someone is acting as an authorized representative, provide proof of authority when requested.

What if I need help finding documents?

Call 2-1-1 for local assistance and community resources (transportation, document retrieval services, family violence support). The form lists several programs and hotlines for immediate help.

Micro-FAQ (ultra-short answers for quick reference)

• Purpose: Renew benefits and update case facts.
• Who files: The person on the benefits case or an authorized representative.
• Deadline: As shown on the renewal notice — respond promptly to avoid interruption.
• Signature: Sign and date page 9.
• How to submit: Online, fax to 1-877-447-2839, mail to HHSC P.O. BOX 149025, or deliver in person.
• Proof of income: Send pay stubs or employer letters for the last 60 days.
• Interpreter: Call 2-1-1 and press the language option.
• Authorized rep: Provide proof of authority when asked.
• Consequences of false info: Possible repayment, penalties, or criminal charges.
• Help line: Call 2-1-1 or 1-877-541-7905.

Related forms and resources

• Renewal and application forms for SNAP, TANF, Medicaid, and CHIP on YourTexasBenefits.com
• Voter registration information and state voter application
• Family Violence Exemption guidance and local family violence resources
• Forms for authorized representative documentation and power of attorney verification
• Texas Workforce Network and WIC application resources

Final details and form identification

Form name: Your Texas Benefits: Renewal Form

Form number / code: H-1010R (T-01010-3446055931871)

Region / issuer: Texas Health and Human Services Commission (HHSC)

Revision / edition: Sept 2025 (form pages reference Dec 2018 content in some sections; follow the edition date shown on your copy)

Contact for help: Call 2-1-1 or 1-877-541-7905; fax submissions to 1-877-447-2839; mail to HHSC, P.O. BOX 149025, AUSTIN, TEXAS 78714-9025.