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Effective Date: 


Note: Regional offices may obtain bulk supplies of this form through the Pinnacle forms and print product ordering system.


Updated: 12/2010


To provide applicants and recipients of CCAD, CBA, IHFS, TANF, Food Stamps, and Medicaid the opportunity to register to vote and to update voter registration information.


When to Prepare

Give Form H0025 to clients who indicate an interest in registering to vote. Authorized representatives or representative payees may also receive and complete Form H0025 for the client.

Mail Form H0025 when a face-to-face interview is not conducted or a change of address is received in the mail on an agency approved change of address form.

If requested, assist in the completion of the Form H0025.

Number of Copies

Original only.


Within five calendar days of receipt of a completed Form H0025, mail or deliver to the voter registrar of the county where the DADS or HHSC office is located.

Form Retention


Detailed Instructions

Entries on Form H0025 should be printed in ink.

Residence Address — Include street address, city, state, and ZIP. If there is no street address, give a description of the location where client lives.

Completion of sections titled "Gender" and "Telephone Number" are optional. Completion of sections titled "Texas Driver's License (TDL)" or "Personal Identification Number (PID)" are required. If an applicant does not have a license or ID, enter the last four digits of the Social Security Number (SSN).

If an applicant completes a voter registration application in a DADS or HHSC office, verification of the numbers are not required. If an applicant completes the voter registration application outside of the office and mails the form on his own, he is required to submit verification of TDL, PID or last four digits of SSN (enclosed copies in the pouch of the application).

Agent — An agent may apply for voter registration for another person as long as that person is related to the applicant as husband, wife, father, mother, son, or daughter. The agent must also be a registered voter or have submitted an application for registration. Indicate the relationship of the agent on the application next to signature.

Signature — If a mark is used in lieu of a signature, a person may witness the mark. Write the name and address of the person who witnessed the mark above the signature line. If the client cannot sign his name, the witness writes on the signature line that the client could not make a mark.

General Voter Registration Information

A client must be at least 17 years and 10 months old to register to vote and may register at any time. The voter registration becomes effective 30 days after it is received or on the client's 18th birthday, whichever is later. If the client moves to another county, he must re-register in the new county of residence.

Except for minimum age requirements, staff cannot make a determination about a client's eligibility to register to vote.

The voter registration application is open to the public.

Staff are prohibited from

  • influencing a client's political preference or party registration,
  • displaying any political preference or party affiliation, and
  • making any statement to an applicant where the purpose or effect of which is to discourage the client from registering to vote.

For voter registration questions or to request a Voter Registration Application in Spanish, refer the client to the toll-free number of the Elections Division of the Secretary of State (1-800-252-8683) or the number of the local county voter registrar.