TX HHS Form H1155. Request for Domicile Verification

The TX HHS Form H1155, Request for Domicile Verification, is a crucial document that helps resolve domicile verification issues. This form is typically used in situations where the person listed above has reported that you are not related to them but have familiarity with their family. The purpose of this form is to gather accurate information about your physical street address, city, state, and ZIP code.

To complete this form, you will need to provide the required information on page 2 of the letter. You can return the completed form in the postage-paid envelope provided or fax it to HHSC at 887-447-2839. It is essential to return the form as soon as possible, but no later than the specified date.

Your cooperation and prompt response are greatly appreciated. To summarize, key points to keep in mind when using this form include:

• Providing accurate information about your physical street address, city, state, and ZIP code
• Returning the completed form in a postage-paid envelope or faxing it to HHSC within the specified timeframe
• Ensuring timely submission of the form to facilitate proper evaluation of the household's situation