TX HHS Form H4806. Request for Another Appointment Request to Withdraw

The TX HHS Form H4806, Request for Another Appointment or Request to Withdraw, helps individuals who are unable or unwilling to attend a scheduled hearing. This form allows them to request a new appointment date or withdraw their appeal altogether.

This form requires the appellant's name and address, as well as the reason for requesting another appointment or withdrawing from the hearing. The signature of the appellant or representative is also necessary. Additionally, the form provides information on an individual's rights regarding access to and correction of personal information obtained by the Texas Health and Human Services Commission (HHSC).

Key features of this form include:

• A request for another appointment date or withdrawal from a scheduled hearing
• Required information: appellant's name, address, reason for request, and signature
• A statement on an individual's rights regarding access to and correction of personal information obtained by HHSC