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 H1275, Request for Expanded Protected Resource Assessment ES
Form H1276, Burial Fund Designation Worksheet
Form H1277, Notice of Opportunity to Designate Funds for Burial ES
Form H1278, Request for Patient Trust Fund Information
Form H1279, Spousal Impoverishment Notification
Form H1280, Statement of Residence Maintenance Needs ES
Form H1298, SSI Prior Medical Coverage Notice (Certified Clients)
Form H1298-A, SSI Prior Medical Coverage Notice (Denied Applicants)
Form H1299, Request for Joint Bank Account Information
Form H1300, Declaration of Texas Residency ES
Form H1830, Application, Review, Expiration or Appointment Notice ES
Form H1861, Federal Tax Information Record Keeping and Destruction Log
Form H1862, Federal Tax Information Transmittal Memorandum
Form H1863, Federal Tax Information Removal Log
Form H1864, Federal Tax Information Fax Transmittal