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  • Authorization To Furnish Information Autorizaci N Para Dar Informaci N - Dads State Tx

Get Authorization To Furnish Information Autorizaci N Para Dar Informaci N - Dads State Tx

Nombre del Solicitante o Cliente) (Name of Spouse) (Nombre del C nyuge) living at con residencia en (Address/Direcci n) do hereby authorize persons, organizations, or establishments having information or records concerning me/us (or) my/our circumstances, to furnish such information to a representative of the Texas Health and Human Services Commission. Exception: This authorization does not grant permission for my doctor or other health care provider to release my personal health informatio.

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Contact support

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 .

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).

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

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.

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 Do I Apply for HHSC Benefits? Find a community partner to help you sort through which benefits you can get and help you apply for them. ... Apply for many programs on the Your Texas Benefits website. Go to a local office and apply either on a lobby computer or with a live person.

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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