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.

Title
Form 2059, Summary of Client's Need for Service
Form 1826-D, Case Information Release
Form 1721, Revocation of Appointment of Designated Representative ES
Form 1720, Appointment of a Designated Representative ES
Form 1580, Texas Money Follows the Person Demonstration (MFPD) Project Informed Consent for Participation ES
Form 1578, Qualified Income Trust (QIT) Copayment Agreement ES
Form 1131, Individually Identifiable Health Information Fax Transmittal
Form 1025, Request for Information Medicare Advantage Coordination
Form 1024, Individual Status Summary
Form 1023, Request for Services Funded by General Revenue
Form 8207, Telehealth Services Attestation
Form 3034, Provider Assessment Form
Form 1038, Consent for the Use of Audio-Only or Audio-Visual Communication ES
Form 1035, PASRR Consent for Use of Audio-Only and Audio-Visual Communication ES
Form H2065-A, Notification of Community Care Services ES