Skip to main content
Texas flag

An official State of Texas website.

Here's how you know.

  • Apply for Benefits
  • A-Z Index
  • Connect
  • Español
  • Subscribe
  • Survey
  • Benefits
  • A-Z
  • Connect
  • Español
  • Subscribe
Dot gov

The .gov means it’s official.
State and federal government websites often end in .gov. Before sharing sensitive information, make sure you’re on an official government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Texas Health and Human Services Home Texas Health and Human Services
  • Home
    • Search Services
    • Aging
    • Disability
    • Financial
    • Food
    • Health
    • Mental Health & Substance Use
    • Questions About Your Benefits
    • Safety
    • Search Providers
    • Assistive Services Providers
    • Behavioral Health Services Providers
    • County Jail Reporting
    • Health Care Facilities Regulation
    • Health Services Providers
    • Long-term Care Providers
    • Medicaid Provider Enrollment
    • Medicaid Supplemental Payment & Directed Payment Programs
    • Protective Services Providers
    • Provider Self-reporting
    • Social Services Providers
    • Training
    • WIC Providers
    • Search Business
    • Contracting with HHS
    • Electronic Benefit Transfer Program
    • Grants
    • Licensing, Credentialing & Regulation
    • Open Enrollment Opportunities
    • Search Regulations
    • Forms
    • Handbooks
    • Legal Information
    • Policies & Rules
    • Reports and Presentations
    • Search About
    • Budget & Planning
    • Community Engagement
    • Contact Us
    • Jobs at HHS
    • Leadership
    • Live & Archived Meetings
    • Meetings & Events
    • Process Improvement
    • Records & Statistics
    • Vision & Mission
    • Your Rights
  • News
  • Contact

Breadcrumb

  1. Home
  2. Search Regulations
  3. Forms

Forms

  • English
  • Español

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.

Search for Forms

ES = Spanish version available.

Title Last updated
Form 4123, Nurse Services Delivery Log - Billable Activities May 2, 2022
Form 4120, Day Habilitation Service Delivery Log ES May 2, 2022
Form 4118, Respite Service Delivery Log May 2, 2022
Form 4117, Supported Employment/Employment Assistance Service Delivery Log May 2, 2022
Form 4122, Host Home/Companion Care Service Delivery Log ES May 2, 2022
Form 4121, Home and Community-based Services/Texas Home Living Community First Choice Personal Assistance Services/Habilitation ES May 2, 2022
Form 4100, Money Receipt ES May 2, 2022
Form 4116, Authorization for Expenditures May 2, 2022
Form 4116-Dental, Dental Summary Sheet May 2, 2022
Form 4116-DME, ICF/IID Durable Medical Equipment Summary Sheet May 2, 2022
Form 4119, Residential Support Services (RSS) and Supervised Living (SL) Service Delivery Log ES May 2, 2022
Form 4205, Consent by Foster Parents or Medical Consenters for Health Passport ES April 20, 2022
Form 4800-DA, 4800-D Addendum April 20, 2022
Form 4202, Contractor Notice of Appeal Rights (ECI) April 20, 2022
Form H4870, Client Complaint of Discrimination ES April 20, 2022

Pagination

  • Current page 1
  • Page 2
  • Page 3
  • Page 4
  • Page 5
  • Next page Next ›
  • Last page Last »

Filter by Series

  • 0 - 999 (39)
  • 1000 - 1999 (437)
  • 2000 - 2999 (200)
  • 3000 - 3999 (284)
  • (-) 4000 - 4999 (62)
  • 5000 - 5999 (117)
  • 6000 - 6999 (36)
  • 7000 - 7999 (15)
  • 8000 - 8999 (95)
  • Advance Directives (5)
  • Miscellaneous (11)
  • 211 Texas
  • Apply for Benefits
  • Compact with Texans
  • Department of State Health Services
  • Email Encryption
  • File Viewing
  • HHS Printing Services
  • Jobs at HHS
  • Notice of Privacy Practices
  • Report Fraud, Waste or Abuse
  • Statewide Search
  • Texas.gov
  • Texas Homeland Security
  • Texas Veteran's Portal
  • Website Policy
  • Website Help

© Copyright 2016-2022. Texas Health & Human Services Commission. All rights reserved.

Facebook Instagram LinkedIn Twitter YouTube