TX HHS Form H1106. Enumeration Referral

The TX HHS Form H1106, Enumeration Referral, is a crucial document that helps solve the problem of individuals requiring Social Security Numbers as a condition of eligibility for assistance from the Texas Health and Human Services Commission. This form is typically used in situations where an applicant or recipient needs to obtain a Social Security Number to access federally funded benefits and services.

The Form H1106 requires specific information, including the person's name, date of birth, and SSN referral details. HHSC staff must only check Box 1 or 2, not both, and always check Box 3. The form also outlines conditions for issuance, such as the applicant being a U.S. citizen or legal alien with work authority who is an applicant/recipient of assistance from the Texas Health and Human Services Commission.

Key features of this form include the requirement to issue a Receipt for Application for a Social Security Number, such as Form SSA-5028 or Form SSA-5029, or other appropriate receipt. The form also highlights follow-up actions, including returning the completed form to the Texas Health and Human Services Commission upon completion. Additionally, the form reminds HHSC staff to correct the case record if the SSA changes the applicant's name or date of birth.

• This form is used for individuals who need a Social Security Number as a condition of eligibility for assistance from the Texas Health and Human Services Commission.
• The form requires specific information, including the person's name, date of birth, and SSN referral details.
• HHSC staff must only check Box 1 or 2, not both, and always check Box 3.