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 5871-SF, Disclosure of Ownership and Control Statement – Short Form (SF)
Form 2432, CLASS and DBMD Program Vehicle Evaluation
Form 3274, Application to Add a Mobile Stroke Unit to a Hospital License
Form 3230, Application for HHSC Approval to Operate a Hospital at Home Program
Form 2825, Youth Empowerment Services (YES) Waiver - Death Review
Form 1074, Transition Support Teams (TST) - Case Review Request
Form H1200-MBI, Application for Benefits – Medicaid Buy-In ES
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 H1072, One Time Temporary Assistance for Needy Families Acknowledgement ES
Form 1040, CFC Non-Waiver Packet Information and Checklist