Form 3031, Children with Special Health Care Needs (CSHCN) Program Application

Instructions

Updated: 10/2025

Purpose

Anyone in Texas interested in the Children with Special Health Care Needs (CSHCN) Program completes Form 3031 to apply for services.

Procedure

When to Prepare

Case managers may help applicants complete Form 3031 or someone may complete the form on behalf of the person who needs help.

Transmittal

The completed and signed Form 3031, and completed and signed Form 3034, Provider Assessment Form, and any necessary documents should be submitted to a CSHCN regional office. Regional office locations and phone numbers are listed on the form.

Detailed Instructions

Complete all sections of Form 3031. If completing by hand, print and use dark ink. Note: If you need assistance or require language services, call 800-222-3986.

• If you are self-employed, provide the most recent tax return that shows adjusted gross income, receipts for expenses from the last 60 days, and the Self-Employment Income form. Call a regional office or 800-222-3986 if you need this form.
• Sign and date Form 3031.
• Have a doctor or dentist, or their appropriate delegate, complete Form 3034, Provider Assessment Form.
• Attach all necessary documents.
• Return Form 3031 and all documents to a CSHCN regional office. Regional office locations and phone numbers are listed on the form, or call 800-222-3986 if you have any questions.