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 3006, No Reject Appeals
Form 3022, Provider Selection
Form 3021, Consent for Eligibility Determination and Enrollment
Form 3020, Uniform Assessment
Form 1271, Youth Referral Packet
Form 3107, Resident Site Modification Waiver and Agreement
Form 5401, Media Release – Authorization to Photograph or Record a Resident of a State Supported Living Center (SSLC) or Patient of a State Hospital (SH) ES
Form 8614, Grievance Regarding Ombudsman Certification Decision
HHS Information Security and Privacy Initial Inquiry (SPI)
Form 5916, Applicant/Contractor Screening Criteria
Form 1059, Family Planning Program Professional Development Activities Annual Report
Form 4700, Request for Records of Texas Health and Human Services
Comptroller Form AP-152, Application for Texas Identification Number
Comptroller Form 74-176, Direct Deposit Authorization
Comptroller Form 74-157, Payee Change Request