TX HHS Form H1175. EBT Change Request

The TX HHS Form H1175, EBT Change Request, is a practical tool for resolving issues related to Electronic Benefits Transfer (EBT) accounts. This form helps users request changes to their primary cardholder records when updates cannot be made through the Texas Integrated Eligibility System (TIERS). The form is typically used by individuals who need to update their personal information or make changes to their EBT account.

The form requires specific information, including the primary cardholder's name, date of birth, social security number, and mailing address. Users must also specify the reason for the change request and indicate whether they have reviewed application and supporting documents. Key features of the form include the ability to update or split primary cardholder records, as well as merge records when necessary.

When completing this form, users should ensure that all required information is provided and follow specific procedures outlined in the document. The form also includes spaces for signatures from both the requestor (advisor) and the person completing the request. By using this form, individuals can efficiently resolve EBT account issues and maintain accurate records.

• The form is used to request changes to primary cardholder records when updates cannot be made through TIERS.
• Required information includes the primary cardholder's name, date of birth, social security number, and mailing address.
• The form allows users to update or split primary cardholder records, as well as merge records when necessary.