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.

ES = Spanish version available.

Title
Form 1019, Opportunity to Register to Vote/Declination ES
Form 2307, Rights and Responsibilities ES
Form LSC, Lone Star Card
Form 2279, Request for Service Waiver
Form 8618, State Long-Term Care Ombudsman Program Initial Certification Training Log
Form 3625, CLASS and CFC Documentation of Services Delivered ES
Form 8001, Medicaid Estate Recovery Program Receipt Acknowledgement ES
Form 5006, Application for Hardship Waiver ES
Form 8004, Medicaid Estate Recovery Program (MERP) Authorization and Certification
Form 1005, Application for Undue Hardship Exemption - Lottery and Gambling Winnings ES
Form 1065, Breast and Cervical Cancer Services (BCCS) Program or Family Planning Program (FPP) Eligibility Application ES
Form 6325, Home and Community Support Services Agency – Medicare Certified Agency Relocation Questionnaire
Form H1010-R, Your Texas Works Benefits – Renewal Form ES
Form 1735, CDS Employer and Financial Management Services Agency Service Agreement ES
Form H1019, Report of Change ES