Form H1300, Declaration of Texas Residency

Documents

Instructions

Updated: 10/2005

Purpose

To verify SSI eligibility for the month of the move when an SSI client moves to Texas and needs Medicaid services during that month.

Procedure

When to Prepare

Prepare Form H1300 when SSI eligibility must be verified for the month of the SSI client's move to Texas.

Number of Copies

Prepare an original.

Transmittal

Give the Form H1300 to the client to take to the Social Security office for completion.

Form Retention

Keep the form according to retention requirements of the case record.

Detailed Instructions

Complete the self-explanatory client identification information. Obtain the client's signature in the "Client Statement" section. Be sure to include the office return address.