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 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
Form 2151, Sample List
Form 2149, Requested Documents List
Form 2033, Requested Documents List
Form 5026, HIPP Summary of Insurance Expenditure Request ES
Form 5025, HIPP Authorization for Use and Release of Health Insurance Information ES
Form 5024, HIPP Change of Address ES