Name Change and/or Duplicate License CSOT PLCU HHSC Mail Code 1470 PO Box 149055 Austin, Texas 787149055 Phone: (512) 8344530 Fax: (512) 8346677 Email: csot dshs.texas.govBUDGET: ZZ118 FUND: 087 Submit.

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How to fill out the TX DSHS Name Change And/or Duplicate License Form online

Filling out the Texas Department of State Health Services (TX DSHS) Name Change And/or Duplicate License Form online is a straightforward process. This guide will walk you through each component of the form, ensuring you can complete it accurately and confidently.

Follow the steps to successfully complete the form online.

  1. Click the 'Get Form' button to access the form and open it in your preferred editor.
  2. Provide your licensee profile data: Input your ASOTP or LSOTP number, the date issued, and the expiration date in the respective fields.
  3. Enter your current name: Fill in your last name, first name, and middle name as they appear on your current license.
  4. If you are requesting a name change, enter your new name: Fill in the last name, first name, and middle name that you wish to be recognized by.
  5. Complete your address details: Provide your street address, city, state, and ZIP code.
  6. Add your email address: Ensure it is accurate so that you can receive confirmation or any further communication.
  7. Attach the required verifying documents: If you are requesting a name change, include supporting documents such as a photocopy of your new social security card, driver's license, or marriage certificate.
  8. Include the payment: A $10 fee must accompany your application for a duplicate license or name change. Ensure this is submitted with your form.
  9. Review your entire form: Check all the information for accuracy to prevent any delays in processing.
  10. After reviewing, save your changes, and download the completed form. You may also print or share it as necessary.

Complete your TX DSHS Name Change And/or Duplicate License Form online today.

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How do I change my name on Texas Medicaid?

Go to YourTexasBenefits.com, log in to your account and find the case you want to make changes to. Select Details, then Open Change Report. Or use the Your Texas Benefits app to log in to your account and select the case you want to make changes to. Select Open Change Report.

Go to YourTexasBenefits.com, log in to your account and find the case you want to make changes to. Select Details, then Open Change Report. Or use the Your Texas Benefits app to log in to your account and select the case you want to make changes to. Select Open Change Report.

Name changes may not be completed online. All name changes must be submitted in writing to the licensing board or program office. You must provide any documentation required by the licensing board or program. For further information, please contact your licensing board or program.

When you're ready to report a change: Log in to your account. Select 'Manage' Find the case you want to make changes to and select 'Details' Select 'Report a change'

Most people who have Medicaid in Texas get their coverage through the STAR managed care program. STAR covers low-income children, pregnant women and families. STAR members get their services through health plans they choose.

Call toll-free at 800-252-8263, 2-1-1 or 877-541-7905. Choose English or Spanish. Choose option 2.

Name Change Written notification of name changes must be mailed or faxed to TDLR and must include a copy of a marriage certificate, court decree evidencing such change, or a social security card reflecting the new name.

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