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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 1595, Billing Resolutions Request
Form 1070, Offer of Texas Home Living Program ES
Form 1069, Withdrawal of Offer of Texas Home Living Program ES
Form 1068, Withdrawal of Offer for Home and Community-based Services (HCS) Program ES
Form 1067, Offer of Home and Community-based Services (HCS) Program ES
Form 1058, Request for Home and Community-based Services Crisis Diversion Slot
Form 1052, Public Provider Choice Request ES
Form 1049, Initial Documentation of Provider Choice ES
Form 1045, Request for Extension of Enrollment Offer Due Date
Form 1019, Opportunity to Register to Vote/Declination ES
Form 1044, Refusal of Habilitation Coordination ES
Form 1046, Request for HCS Adult NF Transition Slot
Form 1047, Request for HCS Targeted NF Diversion Slot
Form 1048, Summary Sheet for Services to Individuals with IDD in a Nursing Facility
Form 1054, Community Living Options
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