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 1055, LIDDA State Supported Living Center (SSLC) Transition Reporting ES
Form 3161, Consumer Demographic Information
Form 2027, Home-Delivered Meals Waiver Request
Form H1200, Application for Assistance – Your Texas Benefits ES
Form 2066-IDT, Interdisciplinary Team (IDT) Meeting Letter ES
Form 2001, Interagency Eye Examination Report
Form 3266, Licensed Chemical Dependency Counselor (LCDC) License Application
Form 8662, Related Conditions Eligibility Screening Instrument ES
Form H1072, One Time Temporary Assistance for Needy Families Acknowledgement ES
Form 1040, CFC Non-Waiver Packet Information and Checklist
Form 2060, Needs Assessment Questionnaire, Task and Hour Guide ES
Form 2065-A, Notification of Community Care Services
Form 6519, Deaf Blind with Multiple Disabilities (DBMD) Record of Completion for General Orientation Training
Form HRG-83, SSN Maintenance Memorandum ES
Form 1051, Request for Determination of Intellectual Disability (DID)