HHS forms are used every day to perform tasks such as applying for benefits, contracting to provide goods or services, reporting incidents, declaring end of life wishes, and conducting other business.
Forms
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- Comptroller Form AP-152, Application for Texas Identification Number
- Form 1325, Synagis Prior Authorization Addendum (CSHCN)
- Form 4700, Request for Records of Texas Health and Human Services
- Form 1059, Family Planning Program Professional Development Activities Annual Report
- Form 2324, First Level Appeal of Provider Investigation Finding
- Form 2349, Second Level Appeal of Provider Investigation Finding
- Form 1143, Cystic Fibrosis Treatment Products Authorization Request (CSHCN)
- Form 5916, Applicant/Contractor Screening Criteria
- Form 1327, Growth Hormone Agents Standard PA Addendum (CSHCN)
- Form 1826-D, Case Information Release
- Form 1321, Synagis Standard Prior Authorization Addendum (Medicaid)
- Form 1317, Pharmacy Eligibility Verification Portal Access Form
- Form 1318, Medicaid Retroactive Claim
- Form 1319, Pharmacy Claims Billing Request
- Form 1312, Growth Hormone Products Authorization Request (CSHCN)
- Form 1322, Texas Medicaid Prior Authorization Reconsideration Request
- Form 1315, Drug Shortage Notification
- Form 1316, Pharmacy Electronic Remittance Advice Agreement
- Form 2033, Requested Documents List
- Form 2149, Requested Documents List
- Form 2151, Sample List
- Comptroller Form 74-157, Payee Change Request
- Comptroller Form 74-176, Direct Deposit Authorization
- Form 2963, Admission of a Child from a Law Enforcement Officer
- Form 3050, DAHS Health Assessment/Individual Service Plan