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  • Form 4122 2020

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Documents needed when applying include: Copies of recent medical bills or pharmacy statements to verify medical expenses. Award letters or similar statements that verify any pension, retirement or disability income. Current bank statements.

For questions regarding: State or federal regulations or regulatory policy, call 512-438-3161 or email PolicyRulesTraining@hhsc.state.tx.us . Contracting to provide services and receive reimbursement, call 512-438-3234 or email IDDWaiverContractEnrollment@hhsc.state.tx.us .

Possess a high school diploma or a high school equivalency certificate, or a successfully complete a written competency-based assessment demonstrating the ability to provide Host Home or Companion Home and submit three written personal references which evidence the applicant's ability to provide a safe and healthy ...

Fax: 1-877-447-2839. If your form is 2-sided, fax both sides. In person: At a benefits office. To find one near you, go to YourTexasBenefits.com or call 2-1-1 (after picking a language, press 1).

Uploading your files may help us review your case faster. Online: Click here to see instructions on how to upload documents online. You can also send us copies by: Fax: 1-877-447-2839 (toll-free). Write your Social Security number on each item. Mail: HHSC. P.O. Box 149027. Austin, TX 78714-0927.

How to send it in: Mail: HHSC, PO Box 14600, Midland, TX 79711-4600.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232