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 H1030, Supplemental Nutrition Assistance Program (SNAP) Lone Star Card Assistance ES
Form H1029, Notice of Case Action
Form H1027-F, Proof of Health Care Coverage
Form H1021, Payment Agreement – Verbal Authorization for One-Time Debit of an Active Lone Star Food Account
Form H1018, Overpayment Claim
Form H1017, Notice of Benefit Denial or Reduction ES
Form H1015, Electronic Correspondence Failed Delivery ES
Form H1014-A, Children's Health Care Benefits – Final Reminder ES
Form H1012, Immunization Record
Form H1010-MR, MAGI Renewal Addendum ES
Form H1009, TANF or SNAP Benefits Notice of Eligibility
Form H0901, HHSC Enhanced Data Gathering Worksheet
Form H0070, Food Stamps Streamlined Reporting (Income Calculation Worksheet)
Form 6506, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) Employment Readiness Service Delivery Log
Form 6104, Freestanding Emergency Medical Care Facility Incident Report