An official State of Texas website.
ES = Spanish version available.
| Number | Title | |
|---|---|---|
| H0003 | Agreement to Release Your Facts | ES |
| H0004 | Consent for a Person Sponsoring an Immigrant | ES |
| H0005 | Policy Clarification Request | |
| H0011 | Texas Simplified Application Project (TSAP) for SNAP Food Benefits | ES |
| H0011R | Texas Simplified Application Project (TSAP) for SNAP Food Benefits Renewal | ES |
| H0025 | HHSC Application for Voter Registration | ES |
| H0050 | Parent Profile Questionnaire | |
| H0070 | Food Stamps Streamlined Reporting (Income Calculation Worksheet) | |
| H0599 | SNAP Expungement Notice | |
| H0901 | HHSC Enhanced Data Gathering Worksheet | |
| H0920 | Notice from the Community Organization Helping You | |
| H0926 | Sharing Facts About Me and My Case with a Community Partner | ES |
| H1003 | Appointment of an Authorized Representative | ES |
| H1004 | Cover Letter: Authorized Representative Not Verified | ES |
| H1008-A | Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-receipt of Warrant | |
| H1009 | TANF/SNAP Benefits Notice of Eligibility | |
| H1010 | Texas Works Application for Assistance - Your Texas Benefits (English and Spanish) | ES |
| H1010-MR | MAGI Renewal Addendum | ES |
| H1010-R | Your Texas Benefits: Renewal Form | |
| H1012 | Immunization Record | |
| H1013 | Electronic Correspondence Confirmation Letter | ES |
| H1014-A | Children's Health Care Benefits - Final Reminder | ES |
| H1015 | Electronic Correspondence Failed Delivery | ES |
| H1016 | Supplemental Security Income Referral | |
| H1017 | Notice of Benefit Denial or Reduction | |
| H1017-B | Transitional Medicaid | |
| H1017-P | Notice of Benefit Denial/Personal Responsibility Agreement (PRA) Reasons | ES |
| H1018 | Overpayment Claim | |
| H1019 | Report of Change | ES |
| H1019-F | Reporting Changes to Your Case | ES |
| H1020 | Request for Information or Action | ES |
| H1020-A | Sources of Proof | |
| H1021 | Payment Agreement - Verbal Authorization for One-Time Debit of an Active Lone Star Food Account | |
| H1024 | Subject: Self-Declaration Notice | |
| H1026 | Verification of Railroad Retirement Benefits | |
| H1026-FTI | Verification of Railroad Retirement Benefits - FTI | |
| H1027-A | Medicaid Eligibility Verification | |
| H1027-B | Medicaid Eligibility Verification - MQMB | |
| H1027-C | Medicaid Eligibility Verification - QMB | |
| H1027-F | Proof of Health Care Coverage | |
| H1028 | Employment Verification | ES |
| H1029 | Notice of Case Action | |
| H1030 | Supplemental Nutrition Assistance Program (SNAP) Lone Star Card Assistance | ES |
| H1036 | Refugee Cash Assistance Verification Form | |
| H1038 | Medical Facility Referral | |
| H1039 | Medical Insurance Input | |
| H1040-A | Application Suspense File Card | |
| H1040-B | Review Suspense File Card | |
| H1040-C | Change Suspense File Card | |
| H1041 | Worker Activity Log | |
| H1042 | Modified Adjusted Gross Income (MAGI) Worksheet: Medicaid and CHIP | |
| H1044 | Standby Log | |
| H1046 | Inpatient Medical Services Certification | ES |
| H1049 | Client's Statement of Self-Employment Income | ES |
| H1050 | Check Verification | |
| H1057 | Declaration of Informal Marriage | |
| H1059 | Interview Observation Instrument | |
| H1060 | Case Preparation Guide | |
| H1061 | Birth Outcome Letter | ES |
| H1062 | Birth Outcome Reminder Letter | ES |
| H1063 | Request for Review Outcome Letter | ES |
| H1064 | CHIP Continued Enrollment Letter | ES |
| H1065 | Tuition and Fee Exemption Letter | |
| H1071 | Family Violence Exemption for Medicaid and CHIP | ES |
| H1072 | One Time Temporary Assistance for Needy Families (OTTANF) Acknowledgement | |
| H1073 | Personal Responsibility Agreement | ES |
| H1074 | SNAP Force Change Request | |
| H1076-A | Notice of TANF State Time Limits | |
| H1076-B | Notice of TANF State Time Limit Months Used/Changed/Corrected | |
| H1076-C | Notice of End of TANF State Time Limit/Hardship Exemption | |
| H1077 | Notice of TANF Federal Time Limits | |
| H1079 | Qualifying Quarters of Social Security Earnings | |
| H1084 | Certification for Warrants Lost, Destroyed, Stolen or Not Received | |
| H1086 | School Attendance Verification | |
| H1087 | Verification of Texas Health Steps Checkup | |
| H1088 | Verification of Parenting Skills Training | |
| H1093 | Texas Health Steps Extra Effort Referral | |
| H1094 | Notice of TANF-SP Time Limit | ES |
| H1095 | Treatment Facility Fraud Referral | |
| H1096 | Notification Letter | |
| H1097 | Affidavit for Citizenship/Identity | ES |
| H1100 | Addendum Income Worksheet | |
| H1101 | TANF Worksheet | |
| H1102 | TANF Worksheet for Special Reviews and Denials | |
| H1103 | Verification of TANF Eligibility | |
| H1104 | 90% Earned Income Deduction (EID) Eligibility and Tracking | |
| H1105 | SNAP Expedited Screening Sheet | |
| H1106 | Enumeration Referral | ES |
| H1106-A | Proofs You Need to Apply for a Social Security Number Card | |
| H1107 | Request for Forced Change of Medical Coverage | |
| H1111 | Card Order Discrepancy Verification | |
| H1113 | Application for Prior Medicaid Coverage | |
| H1119 | Medical Programs Income Worksheet | |
| H1120 | Medical Bills Transmittal/Insurance Information | |
| H1122 | Medicaid Action Notice | |
| H1131 | Individually Identifiable Health Information Fax Transmittal | |
| H1133 | Account Verification | |
| H1134 | Help Statement Verification | |
| H1135 | Child Care Expense Verification | |
| H1136 | Child Support Verification | |
| H1137 | Confirmation of Office Visit Work/School Excuse | |
| H1138 | Living Arrangement Verification | |
| H1139 | Medical Expense Verification | |
| H1140 | Verification of Benefits | |
| H1146-M | Medicaid Report (Manual) | |
| H1155 | Request for Domicile Verification | |
| H1163 | TWC Employment Registration | |
| H1172 | EBT Card, PIN and Data Entry Request | ES |
| H1173 | EBT Card Issuance Log | |
| H1174 | Inventory of EBT Cards | |
| H1175 | EBT Change Request | |
| H1177 | Transmittal and Receipt for Controlled EBT Documents | |
| H1184 | Here Is Your Lone Star Card | ES |
| H1185 | Important Information About Your Lone Star Card | |
| H1187 | Welcome to Texas Health Steps Medicaid! | |
| H1188 | Common Questions Asked About Texas Health Steps and Your Child's Medicaid | |
| H1190 | Ending TANF Five Year Freeze Out Disqualification | |
| H1205 | Texas Streamlined Application | ES |
| H1213 | Children's Health-Care Benefits: More Facts Needed from the Parent Who Has Custody | ES |
| H1240 | Request for Information from Bureau of Veterans Affairs and Client's Authorization | |
| H1265 | Presumptive Eligibility (PE) Worksheet | |
| H1266 | Short-term Medicaid Notice: Approved | ES |
| H1267 | Short-term Medicaid Notice: Not Approved | ES |
| H1350 | Opportunity to Register to Vote | |
| H1550 | Out of State NBCCEDP Verification | |
| H1551 | Treatment Verification | |
| H1701 | Child Support, TANF Foster Care and TANF/Medicaid Case Information Exchange | |
| H1706 | Good Cause Recommendation and Family Violence Exemption | |
| H1708-A | Report of Noncooperation (Automated) | |
| H1710 | Payment Identification | ES |
| H1712 | Explanation of Child/Medical Support, Family Violence and Good Cause | ES |
| H1713 | Service Plan for Family Violence Option and Report of Good Cause | ES |
| H1800 | Receipt for Application/Medicaid Report/Verification/Report of Change | |
| H1801 | SNAP Worksheet | |
| H1802 | Voluntary Withdrawal from Temporary Assistance for Needy Families (TANF) | |
| H1805 | SNAP Food Benefits: Your Rights and Program Rules | ES |
| H1806 | Parole/Community Supervision Report | ES |
| H1808 | SNAP Work Rules | ES |
| H1816 | SNAP E&T Noncompliance Report | |
| H1817 | SNAP Information Transmittal | |
| H1822 | ABAWD E&T Work Requirement Verification | |
| H1825 | Entitlement to Restored Benefits | ES |
| H1826 | Case Information Release | ES |
| H1830 | Application/Review/Expiration/Appointment Notice | |
| H1830-I | Interview Notice (Applications or Reviews) | |
| H1830-R | Texas Works Renewal Notice | |
| H1832 | Affidavit for Meal Providers to the Homeless | |
| H1833 | Your Medicaid Benefits Are Ending - Cover Letter | ES |
| H1833-L | Your Medicaid Benefits Are Ending | ES |
| H1834 | Your Medicaid Benefits Have Ended - Cover Letter | ES |
| H1834-L | Your Medicaid Benefits Have Ended | ES |
| H1836-A | Medical Release/Physician's Statement | ES |
| H1836-B | Medical Release/Physician's Statement | ES |
| H1837 | Physician's Statement of Permanent Disability | |
| H1841 | SNAP-CAP Application | ES |
| H1842 | SNAP-CAP Renewal Application | ES |
| H1843 | Your SNAP-CAP Benefits Have Changed | |
| H1845 | Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facility Review | |
| H1846 | Facility Authorized Representative Interview | |
| H1847 | Reminder to Submit Form H1852 | |
| H1851 | Reference Guide for Drug and Alcohol Treatment (D&A)/Group Living Arrangement (GLA) Facilities | |
| H1852 | List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP) | |
| H1853 | Documentation of Findings for Form H1852 | |
| H1854 | Affidavit for Unauthorized Use of Electronic (EBT) Benefits | |
| H1855 | Affidavit for Nonreceipt or Destroyed Supplemental Nutrition Assistance Program (SNAP) Benefits | |
| H1856 | SNAP Out-of-State Intentional Program Violations | |
| H1857 | Landlord Verification | |
| H1858 | Items We Might Need from Anyone on Your Case | ES |
| H1859 | Social Security Administration Benefits for People with Disabilities Receiving TANF | |
| H1860 | TANF Social Security Outreach Letter | |
| H1861 | Federal Tax Information Record Keeping and Destruction Log | |
| H1862 | Federal Tax Information Transmittal Memorandum | |
| H1863 | Federal Tax Information Removal Log | |
| H1864 | Federal Tax Information Fax Transmittal | |
| H1866 | Federal Tax Information Visitor Access Log | |
| H1869 | Renewal for Health Care Benefits | ES |
| H1870 | School Enrollment Verification Form | ES |
| H1898 | Restored Benefits Documentation | |
| H1899 | Unauthorized Use Replacement Benefit Eligibility Notice | |
| H1901 | TIERS Data Collection Worksheet | |
| H2067 | Case Information | |
| H2340-OS | Medicaid for Breast and Cervical Cancer | ES |
| H2580 | TANF Employment Services Notice | ES |
| H2581 | Choices Noncooperation Report | |
| H2583 | Choices Information Transmittal | |
| H2588 | Workforce Orientation Referral | |
| H2776 | Job Search Worksheet for TANF Employment Hardship Exemption | ES |
| H3037 | Report of Pregnancy | |
| H3038 | Emergency Medical Services Certification | ES |
| H3038-P | CHIP Perinatal – Emergency Medical Services Certification | ES |
| H4100 | Money Receipt | |
| H4701 | HHSC Out Card | |
| H4800 | Fair Hearing Request Summary | |
| H4800-A | Fair Hearing Request Summary (Addendum) | |
| H4803 | Notice of Hearing | |
| H4807 | Action Taken on Hearing Decision | |
| H4837 | Fair Hearings Evidence Packet Cover Letter | |
| H4857 | Notice of Decision, Administrative Disqualification Hearing | |
| H4870 | Client Complaint of Discrimination (English-Spanish Version) | |
| H5799 | TANF Warrant/Envelope | |
| HRG-83 | SSN Maintenance Memorandum | |
| SCR | Secondary Cardholder Request | |
| SSA-2853 | Message From Social Security | |
| SSA-3288 | Social Security Administration Consent for Release of Information |