This form is a Customer Contact Sheet used to record the details of a customer contact.
Texas Customer Contact Sheet
State:
Multi-State
Control #:
US-TS9065A
Format:
Word;
PDF;
Rich Text
Instant download
Description
How to fill out Customer Contact Sheet?
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FAQ
Form H1869, Renewal for Health Care Benefits | Texas Health and Human Services.
The enclosed Missing Information form (Form 1020) includes a list of documents you need to send to us so we can determine your eligibility for services.
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.
If you can't connect to 2-1-1, call us toll-free at 877-541-7905. You can also visit the 2-1-1 Texas website to find the phone number to your local 2-1-1 area information center.
To provide Texas Health and Human Services Commission (HHSC) office staff a form to record information reported by clients about changes in their circumstances. To advise the individual that the advisor can explain what type of proof is required for a reported change.
You can go to .YourTexasBenefits.com to report changes, or use Page 2 of this form. You must report the following types of changes: Address and phone: Where you live, where you get your mail or your phone numbers. Facts about you: Pregnancy, school, citizenship, felonies, health insurance policy or military status.
