Texas Health and Human Services

Form 3049 is an employment verification document used in the context of health care assistance programs, specifically the Primary Health Care Services Program, Title V Fee-for-Service Program, and epilepsy benefits in the state of Texas. This form is employed to verify the earnings of an individual who is a member of a household applying for health care assistance benefits. It is designed to ensure that accurate financial information is provided to determine the household's eligibility for these assistance programs.