Forms

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.

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ES = Spanish version available.

Title
Form 3031, Children with Special Health Care Needs (CSHCN) Program Application ES
Form 1058, Request for Home and Community-based Services Crisis Diversion Slot
Form 4211, Respite Funding Agreement ES
Form 8623, State Long-Term Care Ombudsman Program Certified Ombudsman Application
Form 1052, Public Provider Choice Request ES
Directive to Physicians and Family or Surrogates (Living Will) ES
Form 1353, OxyContin Standard PA Addendum (Medicaid)
Form 3051, Statement of Self-Employment Income ES
Form 8206, Service Area Change Request
Form 2125, Home and Community-based Service (HCS), Texas Home Living (TxHmL) and Community First Choice (CFC) Implementation Plan
Form 3048, Notice of Eligibility ES
Form 8400, Consumer-Directed Services (CDS) Support Advisor Applicant
Form 8571, Request to Change Interest List Information for Home  and Community-based Services (HCS) or Texas Home Living (TxHmL)
Form 3033, Hemophilia Assistance Program (HAP) Application
Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order ES