TX HHS Form H1233. SMIB Memorandum

The TX HHS Form H1233, SMIB Memorandum, serves as a case review notice to help individuals assess their eligibility for continued assistance. This form is typically filled out by residents of state-supported living centers who require ongoing support.

This form requires the recipient and their spouse (if applicable) to provide detailed information about their situation, including proof of income and bank balances. The completed form must be signed by the recipient, their spouse, or authorized representative, and returned within 12 days from the date shown above. Failure to submit the form may result in denied benefits.

If you have questions or concerns, please contact my office at the address provided above. Additionally, if you believe you have been discriminated against due to race, color, national origin, age, sex, disability, or religion, you can file a complaint with the HHSC Civil Rights Office or the U.S. Department of Health and Human Services.

• This form is used for case review purposes only.
• The recipient must provide proof of income and bank balances.
• The completed form must be signed by the recipient, their spouse, or authorized representative.
• Failure to submit the form within 12 days may result in denied benefits.