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 H0011, Texas Simplified Application Project (TSAP) for SNAP Food Benefits ES
Form 2110, Community Care Intake
Form 7277, Child Care Regulation Plan of Action
Form 3256, Chemical Dependency Treatment Facility Variance Request Application
Form H1836-B, Medical Release or Physician's Statement ES
Form 2273, Caregiver Assessment ES
Form H1103, Verification of TANF Eligibility ES
Form H2111, Interested List Notification – HCBS ES
Form H2065-D, Notification of Managed Care Program Services ES
Form H1173, EBT Card Issuance Log
Form H1028, Employment Verification ES
Form H0926, Sharing Facts About Me and My Case with a Community Partner ES
Form 3048, Notice of Eligibility ES
Form 3244, Clinical Training Institution Application
Form 3238, Licensed Chemical Dependency Counselor or Counselor Intern Name Change or Duplicate License Application