TX HHS Form H4800. Fair Hearing Request Summary

The TX HHS Form H4800, Fair Hearing Request Summary, is a crucial document for resolving disputes related to health and human services in Texas. This form helps individuals appeal decisions made by the agency, ensuring that their concerns are heard and addressed promptly.

This summary form requires essential information from both the agency representative and the appellant. The agency representative must provide their name, phone number, fax number, and mailing address, while the appellant must supply their name, date of birth, phone number, fax number, and mailing addresses for both physical and county locations. Additionally, the form asks about program details, including whether benefits or services are continued as a result of the appeal, and if so, whether the household has waived continued benefits.

The TX HHS Form H4800 is used in situations where an individual disagrees with a decision made by the agency regarding health and human services. This form helps facilitate the fair hearing process, ensuring that all necessary information is gathered to make an informed decision. Key features of this form include the requirement for expedited processing, notification of appeal, and good cause for requesting an appeal within 10 calendar days.

• This form is used in situations where an individual disagrees with a decision made by the agency regarding health and human services.
• The form requires essential information from both the agency representative and the appellant.
• The form asks about program details, including whether benefits or services are continued as a result of the appeal.