TX HHS Form H1138. Living Arrangement Verification

Form H1138, titled Living Arrangement Verification, is an official document used to confirm the living situation and financial relationship between an individual applying for or receiving public assistance and the person they live with. The form helps state agencies verify whether the individual pays rent or utilities, receives financial support, or shares household expenses, which can directly affect eligibility and benefit amounts.

Purpose of the Form

The main purpose of Form H1138 is to provide accurate third-party confirmation of an applicant’s living arrangement. Many assistance programs rely on household composition and financial contributions to determine eligibility, payment levels, or cost-sharing responsibilities. This form allows the agency to document whether the individual is a tenant, a family member, or someone receiving financial help.

Who Must Complete This Form

Form H1138 is completed by the person with whom the applicant lives. This may be a landlord, relative, roommate, or any other individual providing housing or financial assistance. The applicant gives permission for information to be released, but the household contact provides the actual responses.

When This Form Is Required

This form is typically required when an agency needs verification of:

• Where the applicant lives
• Whether rent or utilities are paid
• Whether the applicant receives money from another person
• The nature of financial support (gift or loan)

If the applicant does not live with the person listed, the form must still be signed, dated, and returned to confirm that fact.

Explanation of Each Section

Header Information

This section includes the case name, case number, advisor or office contact details, and a permission statement allowing the release of information. It is important that this information matches the agency’s records to avoid delays.

Section I – Living Arrangement Details

This section confirms whether the individual lives with the respondent. If the answer is “Yes,” additional questions must be answered about:

• Family relationship, if any
• Rent payments, including amount and frequency
• Utility payments, specifying which utilities and how often they are paid

If the individual does not live with the respondent, no further questions in this section are required, but the form must still be signed and returned.

Section II – Financial Assistance

This section focuses on direct financial support. The respondent must indicate whether they give the individual money and, if so:

• The amount provided
• The frequency of payments
• Whether the money is a gift or a loan
• Whether repayment is expected and by what date

This information helps determine whether financial support counts as income or a recoverable loan.

Typical Documents That May Be Needed

• Lease or rental agreement
• Utility bills
• Written loan agreement, if applicable
• Proof of address

Common Mistakes to Avoid

• Leaving questions unanswered when “Yes” is selected
• Providing inconsistent amounts or payment frequencies
• Failing to sign and date the form
• Missing the return deadline

Practical Tips for Completing the Form

• Answer all questions honestly and clearly
• Use exact amounts and regular payment schedules where possible
• If unsure about a detail, provide a brief clarification
• Return the form promptly using the provided envelope

Real-Life Examples of When This Form Is Used

• An applicant lives with a friend and contributes to utilities but does not pay formal rent.
• An adult child lives with a parent who provides monthly financial help.
• A roommate arrangement where rent is paid weekly in cash.
• A temporary living situation while waiting for independent housing.

Legal and Program Context

Form H1138 is used to support eligibility decisions for public assistance programs that consider household income and living arrangements. Providing false or incomplete information can result in benefit adjustments, overpayment recovery, or denial of assistance.

Frequently Asked Questions

Does the person completing the form need to be related to the applicant?

No. The form can be completed by any person the applicant lives with, regardless of relationship.

What if the applicant does not live with me?

You should indicate “No,” sign and date the form, and return it as instructed.

Is giving money always considered income?

Not always. Whether money counts as income depends on whether it is a gift or a loan.

Do I need to attach bills or receipts?

Attachments are not always required, but they may be requested if clarification is needed.

What happens if the form is not returned?

The agency may delay or deny benefits due to missing verification.

Micro-FAQ

• Purpose: Verify living arrangements and financial support.
• Who files: The person the applicant lives with.
• Deadline: By the date shown on the form.
• Attachments: Sometimes requested for clarification.
• Submitted to: The advising office listed on the form.

Related Forms

• Household Composition Declaration
• Income Verification Form
• Rent or Expense Statement

Form Details

• Form Name: Living Arrangement Verification
• Form Number: H1138
• Region: United States
• Revision Date: May 2003