TX HHS Form H1016. Supplemental Security Income Referral

The TX HHS Form H1016, Supplemental Security Income Referral, is a crucial document that helps solve the problem of determining eligibility for Supplemental Security Income (SSI) benefits. This form is typically used in situations where an individual may be eligible for SSI due to their financial situation or other circumstances.

The form requires specific information, including the client's name, date of birth, social security account number, and mailing address. Additionally, it asks about medical evidence available from HHSC files, as well as whether the applicant is unable to receive their check or is under the age of 18. The representative must also provide a signature and date for certification purposes.

This form serves as a referral tool for the Social Security Administration (SSA) to determine SSI eligibility. It provides key information about the client, including their name, social security account number, and mailing address. By filling out this form, representatives can facilitate the SSA's review process and ensure that eligible individuals receive the benefits they need.

• This form is used for determining Supplemental Security Income (SSI) eligibility.
• It requires specific information about the client, including name, date of birth, social security account number, and mailing address.
• The representative must provide a signature and date for certification purposes.