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. Find a testing site. 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.
Effective Date:
1/2003Documents
-
Document
-
Document
Instructions
Updated: 10/2002
Purpose
To request information about an applicant's/recipient's mineral rights.
Procedure
When to Prepare
If the applicant/recipient reports ownership of or income from mineral rights, the eligibility worker sends Form H1242 to a knowledgeable source to verify the fair market value and income.
Number of Copies
The eligibility worker completes an original and one copy.
Transmittal
The eligibility worker sends the original to the knowledgeable source and retains the copy in the case record. After the original is returned to HHSC, the eligibility worker files the original in the case record and destroys the copy.
Form Retention
Keep the original copy according to the retention requirements of the case record.
Detailed Instructions
Inside Address — Enter the name and address of the verification source.
Enter the date, name of the eligibility specialist, and the office mailing address and telephone number.
Signature — Obtain the signature of the client or his representative.
Date — Self-explanatory.
Enter the client's name, address, Social Security number, and any available property information.