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Forms

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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 2960, Application for a License to Operate a Residential Child Care Facility June 24, 2022
Form 1321, Synagis Standard Prior Authorization Addendum (Medicaid) June 24, 2022
Form H1010, Texas Works Application for Assistance - Your Texas Benefits ES June 23, 2022
Form 2247, Interest List Contact Notification ES June 20, 2022
Form 1346, Makena Standard PA Addendum (Fee for Service Medicaid) June 14, 2022
Form 2031, Designation of Authorized Individual(s) - Business Entity June 14, 2022
Form 2097, Provider Contract Assignment Notification ES June 9, 2022
Form 1312, Growth Hormone Products Authorization Request (CSHCN) June 7, 2022
Form 1143, Cystic Fibrosis Treatment Products Authorization Request (CSHCN) June 7, 2022
Form 2125, Implementation Plan — HCS/TxHmL/CFC June 1, 2022
Form H1038, Medical Facility Referral May 26, 2022
Form 1739, Service Provider Agreement ES May 26, 2022
Form 1123, Review of Assisted Living Facility Type C May 26, 2022
Form 2463, Emergency Dental Services May 26, 2022
Form H1225, Restitution ES May 26, 2022

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