TX HHS Form H1233. Case Review Notice

The TX HHS Form H1233, Case Review Notice, is used to review eligibility for continued assistance. It is typically used when it's time to reassess the needs of a resident in a state-supported living center.

This form requires the recipient to complete an Application for Assistance (Form 1200) and return it with proof of income and bank balances. The application must be signed by the recipient, their spouse, or authorized representative. Additionally, other forms may need to be completed, such as Form H1200, and all questions must be answered.

If the completed form is not received within 12 days from the date shown above, it will be assumed that assistance is no longer desired, and benefits may be denied. If you have questions or concerns, you can contact the HHSC office at the address provided. The form also provides information on how to file a discrimination complaint with the HHSC Civil Rights Office or the U.S. Department of Health and Human Services.