Form H1010, Texas Works Application for Assistance - Your Texas Benefits

Instructions for Opening a Form

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Effective Date: 4/2024


Updated: 7/2024

English and Spanish forms can be found under the title "Form to apply for Food Benefits (SNAP), Healthcare (Medicaid and CHIP), or cash help for families (TANF) " under section "Forms to apply for benefits".


Can be used to apply for the following benefits:

  • SNAP food benefits;
  • TANF cash help for families; and
  • health care for:
    • children;
    • adults caring for a child;
    • adults not caring for a child;
    • pregnant women;
    • people under 26 who were in foster care in Texas and receiving federally funded Medicaid at 18 or older; and
    • people under 21 who were in foster care in Texas or had an ICPC agreement at 18 or older.

To provide applicants and recipients the opportunity to register to vote and serve as a:

  • Screening document for SNAP clients who may be entitled to expedited service.
  • Document for an AR’s acknowledgement of their responsibilities.
  • Request to renew benefits for Medical Programs, SNAP and TANF.
  • Screening document for staff to make necessary referrals to other agencies.

The addendum to Form H1010 captures information needed to make an eligibility determination for Medicaid or the Children's Health Insurance Program (CHIP).


When to Prepare

The household completes the form when applying or reapplying for Medical Programs, SNAP and TANF.

If a person needs help completing the application packet, a volunteer or staff member must help. Anyone who helps complete the application must initial the part they helped complete, or sign the form to show they helped complete it.

Applications must be given to anyone who requests the form. Each household has the right to file an application on the same day the household contacts the office during office hours.

Number of Copies

Save a copy in the electronic case record and upon request provide the household with a copy or a Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change (PDF).


Applications can be submitted:

Households may fax the form to 877-477-2839 or mail it to:

Texas Health and Human Services Commission
P.O. Box 149025
Austin, TX 78714-9025

Detailed Instructions

The household may file an incomplete application if the form contains the applicant's name, address and signature.

The client completes the form. To evaluate specific answers, refer to policies in the Texas Works Handbook.

Voter Registration – Give Form H0025, Voter Registration Application, to clients who indicate an interest in registering to vote and who meet the voting registration requirements. ARs or representative payees also may take Form H0025 to the client to complete. Mail Form H0025 when the client does not have a face-to-face interview or the client reports a change of address by phone or by mail. If requested, help clients complete Form H0025.

If the applicant or recipient declines to register to vote during a face-to-face interview, ask the client to sign Form H1350, Opportunity to Register to Vote. Mail Form H1350 to a client who did not have a face-to-face interview who declines the opportunity to register to vote based on receipt of Form H0025.

Voter Registration Status – Check the appropriate box under Agency Use Only and sign.