Texans can dial 2-1-1 (option 6) for information on COVID-19 and local community resources on health care, utilities, food, housing and more. Wait times are currently higher than normal. More COVID-19 information.
Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
If still having trouble viewing or downloading a form, click here.
- Health and Human Services Commission (HHSC) staff to request information from a collateral source about client's eligibility.
- a collateral source to release to HHSC information about client's eligibility.
When to Prepare
If the client agrees, and verbal authorization is insufficient, HHSC staff complete Form H0003 to obtain eligibility information.
Note: Do not use Form H0003 to request release of personal health information from health care providers.
Number of Copies
Staff obtain the client's signature on an original of the form during the application process or at the time of the periodic review.
Staff send the form to the person providing information.
There is no retention requirement.
Staff complete the identifying information at the top of the form. The client and spouse must sign the form.