Form 4700, Request for Records of Texas Health and Human Services

Instructions for Opening a Form

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Effective Date
4700.pdf (116.65 KB)



Updated: 4/2006



The purpose of Form 4700 is to provide

  • a record of information released to the public.
  • a record of requests for copies of department information.
  • a statement of charges for copies/material of any information requested.


When to Prepare

Anyone who requests to see department records or who requests copies of department records/material or handbooks must complete the form.

A written request may be accepted in lieu of Form 4700, but information must be transferred to the form when the request is processed.

Number of Copies

The person requesting the information/material completes an original only.


The employee, in consultation with the divisional or region open records liaison and the open records attorney, determines whether or not the information can be released.

If an employee cannot reproduce a record, cannot determine whether the information can be released, or has questions about release, contact the divisional or regional open records liaison and the open records attorney, as appropriate.

If the record can be released and copies are requested, the employee completes the HHS USE ONLY section of the form including the calculation of fees. The requester pays the computed amount by cashier's check, money order, or other negotiable instrument. The employee completes Form 4100, Money Receipt, for the amount collected, and gives the requester the information and a machine copy of the request as receipt for payment.

If the requester wants only to see the record, the department may charge to make a copy of a page from which the information must be edited. The department may charge for programming or manipulation of data when necessary to provide inspection of information in other than standard form. Otherwise, there is no charge for inspection of information. Records will be controlled by the employee while being viewed by the requester.

Also, no charge is applied to a request from any level of government: local, state, or federal.

After receiving management approval, the employee sends the original of Form 4100, the Fiscal Management Services copy, and the payment to the Cash Control Section in Fiscal Management Services, Mail Code E-411.

However, the original of Form 4100 must be retained at the originating level if (a) the request is denied, or (b) the requester wishes only to see the record.

Form Retention

Fiscal Management Services keeps cash receipts from fiscal year end plus five years. Duplicate copies may be destroyed when no longer needed.

Originals of denied request must be retained at the originating level for two years from the date of notification that records are exempt, then destroyed.

Request only to see the record will be retained at the originating level for one year from the date request fulfilled, then destroyed.

Detailed Instructions


If there are requests for subscriptions or other material not listed or covered, contact the regional administrator's office.