Effective Date: 
4/2018

Documents

Instructions

Updated: 8/2015

Purpose

  • To notify Texas Women's Health Program (TWHP) recipients of the expiration of their 12-month continuous eligibility period.
  • To serve as a renewal application for the Texas Women's Health Program.
  • This form is only issued when a woman is adjunctively eligible. A woman is adjunctively eligible if she is included in an active eligibility determination group (EDG) in the application month or in the ninth month of the 12-month certification period.

Procedure

When to Prepare

The Texas Integrated Eligibility Redesign System (TIERS) sends Form H1831/H1831-S during the 10th month of the 12-month continuous eligibility period if it is determined that the TWHP recipient is adjunctively eligible.

The individual completes one copy of the form when renewing her Texas Women's Health Program coverage.

The individual must complete and sign the form.

Staff must help the individual if she is unable to complete the form and has no one else to help. If staff make entries on the form, both staff and the individual must initial the entries.

Number of Copies

TIERS mails Form H1831/H1831-S to the individual in the 10th month of the 12-month certification period. If the advisor needs to give a form to the individual, the advisor must issue a manual form.

Transmittal

Give or mail the original form to the individual. She must fax or mail the completed form to the Document Processing Center (DPC). Include a fax number and a return stamped envelope with the renewal application.

Texas Health and Human Services Commission
P.O. Box 149024
Austin, TX 78714-9024
Fax Number: 1-877-447-2839

Form Retention

See the Texas Works Managers Guide.

Detailed Instructions

Enter the individual's name and address. Also enter the EDG number at the top of the form. Enter the DPC's mailing address and fax number.

  1. Enter the year, month and day of the last certification month of the continuous eligibility period.
  2. Enter the year, month and the first day of the last certification month of the continuous eligibility period by which the individual has to return the form.

Voter Registration — Give Form H0025, Voter Registration Application, to individuals who indicate an interest in registering to vote and who meet the voting registration requirements. Authorized representatives or representative payees may also get and complete Form H0025 for the individual. Mail Form H0025 when the individual does not have a face-to-face interview or reports a change of address by telephone or mail. If asked, help the individual complete Form H0025.

If the individual declines to register to vote during an in-person interview, ask the individual to sign Form H1350, Opportunity to Register to Vote. Mail Form H1350 to an individual who did not have a face-to-face interview who declines the opportunity to register to vote, based on receipt of Form H0025.

Voter Registration Status — Check the appropriate box under Agency Use Only and sign.

The TWHP recipient completes the remainder of the form, which is self-explanatory.

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