Form H0004, Consent for a Person Sponsoring an Immigrant

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Effective Date: 6/2014


Updated: 6/2014


To authorize the Texas Health and Human Services Commission (HHSC) to use electronic data sources to verify income and resource information from an individual sponsoring an immigrant who has submitted an application for benefits.


When to Prepare

If the sponsor agrees and verbal authorization is insufficient, HHSC staff complete Form H0004 to obtain authorization.

Number of Copies

Staff obtain the sponsor’s signature on the original form during the application process or at the time of the redetermination.


Staff send the form to the person providing information.

Form Retention

There is no retention requirement.


Staff complete the identifying information at the top of the form. The sponsor and spouse (if applicable) must sign the form.