TX HHS Form H1214. Request for Pension Information

The TX HHS Form H1214, Request for Pension Information, is a crucial document that helps determine an individual's eligibility for medical assistance. This form is typically completed by individuals who have applied for medical assistance and need to provide additional information to support their claim.

This form requires the applicant to provide specific details, including their name, social security number, mailing address, and other identifying information. The RESPONSE section at the bottom of the letter needs to be completed with information such as gross monthly benefit, net monthly check amount, income taxes withheld, effective date of benefit, health insurance deduction, and life insurance deduction.

To facilitate a prompt response, applicants are encouraged to provide their telephone number and signature. The issuing agency, Texas Health and Human Services (HHS), appreciates timely submissions as it enables efficient processing of applications. Key points to note include:

• The form is used for medical assistance applications.
• Applicants must provide required information to support their claim.
• A prompt response is appreciated by the issuing agency, HHS.