TX HHS Form 8590. Request for Approval to Withdraw an Enrollment Offer
Form 8590 is an official Texas Health and Human Services Commission (HHSC) document used by Local Intellectual and Developmental Disability Authorities (LIDDAs).
TX HHS Form 1025. Request for Information Medicare Advantage Coordination
Form 1025, titled Request for Information – Medicare Advantage Coordination, is an official Texas Health and Human Services Commission (HHSC) document used to verify community-based services received by an individual.
TX HHS Form 4205. Consent by Foster Parents or Medical Consenters for Health Passport
Form 4205 is a Texas Early Childhood Intervention (ECI) document used to record a foster parent’s or medical consenter’s consent (or refusal) to include certain ECI records in the Texas Health Passport system.
TX HHS Form 8571. Request to Change Interest List Information for Home and Community-based Services (HCS) or Texas Home Living (TxHmL)
Form 8571 is an official Texas Health and Human Services Commission (HHSC) document used by Local Intellectual and Developmental Disability Authorities (LIDDAs) to request corrections or changes to a person’s interest list information for Home and Community-based Services (HCS) or Texas Home Livi
TX HHS Form 3242. Military Member. Military Spouse and Military Veteran Supplemental
Form 3242, titled Military Member, Military Spouse and Military Veteran Supplemental, is a Texas-specific supplemental application used by individuals with military connections who are seeking licensure as a Licensed Chemical Dependency Counselor (LCDC) or a
TX HHS Form H3034. Disability Determination Socio-Economic Report
Form H3034, titled Disability Determination Socio-Economic Report, is a Texas Health and Human Services Commission (HHSC) document used to collect personal, educational, employment, and background information as part of a disability-related eligibility review.
TX HHS Form H1049. Client's Statement of Self-Employment Income
Form H1049, titled Facts About Self-Employment Income, is used by the Texas Health and Human Services Commission (HHSC) to collect detailed information about income earned from self-employment.
TX HHS Form 0007. Notification of County Jail Confinement and Release
Form 0007, titled “Notification of County Jail Confinement and Release”, is an official Texas Health and Human Services Commission (HHSC) form used by county jails to report when an individual receiving HHSC health care coverage is confined or released.
TX HHS Form H1138. Living Arrangement Verification
Form H1138, titled Living Arrangement Verification, is an official document used to confirm the living situation and financial relationship between an individual applying for or receiving public assistance and the person they live with.
TX HHS Form H1009. TANF or SNAP Benefits Notice of Eligibility
Form H1009 is an official notice issued by the Texas Health and Human Services Commission (HHSC) to inform applicants and recipients about their eligibility for Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP) benefits.