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The Your Texas Benefits form is a crucial document for individuals seeking to renew their benefits in Texas. This form, also known as Form H-1010R, allows you to provide necessary information to continue receiving assistance. If you need to renew your benefits, please fill out the form by clicking the button below.

Content Overview

The Your Texas Benefits form is a crucial tool for individuals and families seeking to access various state assistance programs. This form, officially known as Form H-1010R, is designed to facilitate the renewal of benefits such as food assistance (SNAP), cash help (TANF), and health care for children and adults, including those who are pregnant or have disabilities. To streamline the renewal process, applicants can choose to complete the form online or submit it via fax or mail. The form requires essential personal information, including case numbers, household details, and income sources. Applicants must also provide documentation related to their financial situation, such as bank statements and proof of income. Additionally, the form addresses special circumstances that may affect eligibility, such as living conditions, medical expenses, and any additional support received from other states. For those who need assistance while filling out the form, resources are available, including a dedicated helpline and access to language interpreters. Overall, understanding the components of the Your Texas Benefits form can significantly ease the renewal process and ensure that individuals receive the support they need.

Your Texas Benefits: Renewal Form

Form H-1010R

December 2012

Case Number: 1234567890

How to Renew

Questions

You can renew online at

Call 2-1-1 or 1-877-541-7905.

www.YourTexasBenefits.com.

After you pick a language, press 2 to:

If you don't want to renew online, fill out this form:

Ask question about this form.

1. If you need to correct anything on this form:

Find where to get help filling out this form.

(a) cross it out, and (b) update it.

Check the status of this form.

2. Sign and date page(s) 9,10

Ask questions about benefit programs.

3. Attach the items we need.

To learn more about benefits, you also can go to

Items are listed next to the questions.

www.hhsc.state.tx.us and www.CHIPMedicaid.org.

4. Send in this form by fax, mail, or in person:

Report waste, fraud, and abuse

Fax: 1877-447-2839. If the form is 2-sided fax both

If you think anyone is misusing HHSC benefits, call

sides

1-800-436-6184.

Mail: HHSC, P.O. Box 14700, Midland, TX 79711-9907

Medicaid for people age 65 or older and for adults

In person: At a benefit office. Call 2-1-1 to find one

who have a disability:

near you.

If you want to apply for Medicaid for the Elderly and

All phone and fax numbers on this form are free to

People with Disabilities, call 2-1-1. Ask for a different

form.

call.

First Name:

Middle initital:

Last name:

John

Doe

Home address (street and apartment number)

City

State

ZIP

County

2250 Ridgepoint Dr, APT 123

Austin

78754

Travis

Home phone

Cell or daytime phone

234-234-3456

Mailing address (if different from home address)

City

State

ZIP

Most people applying for benefits must be interviewed. We often interview people on the phone. It helps to know if any of the following reasons make it hard for you to get to a benefits office:

• You live more than 30 miles from the closest benefits		• Your work or training hours don't allow you to get to a
office.		benefits office when it's open.
• You can't get a ride.		• You can't travel because you are age 60 or older, or
• The weather is bad.		you have a disability.
• You are sick.		• You are a victim of family violence.
• You take care of someone in your home.

Do any of the above reasons apply to you?			YES	NO

You said you speak Spanish	during your interview. If you want to speak a different language,
which one?	Do you need an interpreter? We can get one for free.		YES	NO

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Form H-1010R

December 2012

The people on your case get the benefits marked below. If you want to apply for another program, check the box next to that program

Pregnant women

People renewing their benefits

Everyone on your benefits case should be listed below.

First name	Last name	This person's relationship	Birth date	Is this person still
First name	Last name	to you	Birth date	living in your home?
		to you		living in your home?

John	Doe	Self	01/01/1988	YES	NO
John	Doe	Self	01/01/1988
Jane	Doe		03/01/1990	YES	NO
				YES	NO
				YES	NO

				YES	NO

				YES	NO

				YES	NO
				YES	NO
				YES	NO

				YES	NO

List anyone who lives with you, but isn't listed above.

		This person's	Social			If not a U.S. citizen, tell us:		Is this
Name	Male or	This person's	Social	Birth	U.S.	Immigrant	Date this	Is this
		relationship to	Security				Date this	person
		relationship to	Security				person entered	person
(first and last)	female?	you	number	date	citizen	registration	person entered	applying for
						number	the United	benefits?
						number	States



	M				YES			YES	NO
	N				NO

	M				YES			YES	NO
	N				NO

Other facts

Is anyone who has been charged with or convicted of a felony fleeing the police? Or has anyone broken a rule of their probation or parole?

If yes, who? __________________________________________________

YES NO

Has anyone been convicted of a felony for conduct that: (1) took place after August 22, 1996, and

(2) involved illegal drugs?

YES NO

If yes, who? ___________________________________________________

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Form H-1010R
December 2012

Is anyone getting cash help, food, or health-care benefits from another state?
	YES	NO
If yes, who? __________________________________ Which state? ______________________

Is anyone living in the homes: (1) age 18 years or older, and (2) a student?	YES	NO

Is anyone in your home pregnant?
If yes, who? _____________________________________________	YES	NO
	YES	NO
Due date (mm/dd/yyyy) ______________Number of babies expected_______
What is the first and last name of the unborn child's father?
First: _______________________________ Last: ___________________________

Does anyone have a disability?
	YES	NO
If yes, who? __________________________________

Is anyone an unaccompanied refugee minor?
This means a person is: (1) not living with a relative, (2) age 18 or younger, and (3) a refugee.	YES	NO
If yes, who? __________________________________

Health insurance

Does anyone have health insurance other than Medicare, Medicaid, or CHIP? If yes, who? __________________________________

Send a copy (front and back) of the insurance card.

YES NO

Things you are paying for or own

Does anyone own or is anyone paying for a: car, truck, boat, motorcycle, or other vehicle? If yes, give facts below:

YES NO

Year

Make

Model

Monthly Payment

Monthly Insurance

Payment

Money still owed

Does anyone have cash, bank accounts, homes, or other property?
If yes, write the amount or value below. Write “none” if no one has any of these items.		YES NO

Send the most recent statement for all accounts
Cash: $______________	Other: $_____________
Bank accounts: All savings $__________	All Checking $_____________
Property if you don't live on it: $___________	Homes if you don't live in them: $__________

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Form H-1010R

December 2012

Money coming into your home

List all money everyone living in your home gets or will get. Include money from job or self-employment, unemployment benefits, Social Security, Supplemental Security Income (SSI), child support, student financial aid, Veteran's Benefits, or cash loans.

Send pay stubs or statement from the last 60 days. If you work for yourself, attach proof of money you get (income), taxes and job costs. Add more pages if you need more room.

	Person, company, or				Amount you get
	agency paying the	Hours			Amount you get
Name of person	agency paying the	Hours			paid (before taxes
Name of person	money. If you were	worked	How often paid?		paid (before taxes
getting this money	money. If you were	worked	How often paid?		and deductions
getting this money	working for yourself,	per week			and deductions
	write “self.”				are taken out)
	write “self.”

			no longer working	once a week
			no longer working	once a week
			every 2 weeks	once a month
			every 2 weeks	once a month
			daily	other
			daily	other
			no longer working	once a week


			every 2 weeks	once a month
			every 2 weeks	once a month
			daily	other
			daily	other


			no longer working	once a week
			every 2 weeks	once a month
			every 2 weeks	once a month
			daily	other
			daily	other


			no longer working	once a week
			every 2 weeks	once a month
			every 2 weeks	once a month
			daily	other
			daily	other

Housing costs

Does anyone pay any of the costs listed below for the home they are living in? Or for a home they plan to return to?

Rent or home payment $ _____	Natural gas/propane $ _____	Taxes on home $ _____
Phone $ _____	Water or sewer $ _____	Electricity $ _____
Insurance on home $ _______	TV cable $ _____	Other $ _____

YES NO

Send statements or bills showing your name and address.

Costs for people who depend on you

Does anyone pay child care costs so they can work, look for work, go to training or go to school?	YES	NO
If yes, $ _________	YES	NO
If yes, $ _________
Send statements or bills showing your name and address.

Does anyone pay child support payments, medical bills, and health insurance for a child outside	YES	NO
your home?
If yes, $ _________
Send statements or bills showing your name and address.

Does anyone pay for costs for people with disabilities or adults who can't take care of themselves?	YES	NO
If yes, $ _________	YES	NO
If yes, $ _________
Send statements or bills showing your name and address.

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Form H-1010R
December 2012
Other costs

Does anyone in the home pay alimony?	YES	NO
	YES	NO
If yes, how much do you pay each month? $ _________

Does anyone in the home pay credit card costs?	YES	NO
	YES	NO
If yes, how much do you pay each month? $ _________

Does anyone in the home pay other regular monthly costs?	YES	NO
	YES	NO
If yes, how much do you pay each month? $ _________

Does another person not on your case help anyone on your case pay for any of the above costs?	YES	NO
	YES	NO
If yes, who? ______________________________

Medical costs

Does anyone in the home age 60 or older, or anyone with a disability, pay medical costs: doctor, hospital, or medicine?

If yes, send bills, receipts, or statements.

YES NO

Legal Information

Discrimination:	Social Security numbers:
In accordance with Federal law and U.S. Department of Agriculture	You only need to give the Social Security
(USDA) and U.S. Department of Health and Human Services (HHS)	numbers (SSN) for people who want benefits.
policy, this institution is prohibited from discriminating on the basis of	Giving or applying for an SSN is voluntary;
race, color, national origin, sex, age, or disability. Under the Food	however, anyone who doesn't apply for an SSN
Stamp Act and USDA policy, discrimination is prohibited also on the	or doesn't give an SSN can't get benefits. If
basis of religion or political beliefs.	you don't have an SSN, we can help you apply
	for one if you are a U.S. citizen or a legal
To file a complaint of discrimination, contact USDA or HHS. Write	immigrant. You must be a U.S. citizen or a
USDA, Director, Office of Civil Rights, 1400 Independence Avenue,	legal immigrant to get an SSN. You can get
S.W., Washington D.C. 20250-9410 or call (800) 795-3272 (voice)	benefits for your children if they have SSNs
or (202) 720-6382 (TTY). Write HHS, Office for Civil Rights, 1301	and you don't. We will not give SSNs to the U.
Young Street #1169, Dallas, TX 75202-5433. Or call	S. Immigration and Citizenship Services. We
1-214-767-4056 or 1-214-767-8940 (TTY). USDA and HHS are	will use SSNs to check the amount of money
equal opportunity providers and employers.	you get (income), if you can get benefits, and
You also can contact the Texas HHSC Civil Rights Office. Write to:	the amount of benefits you can get. (7 C.F.R
HHSC Office of Civil Rights, 701 W. 51st St., MC W206, Austin,	273.6 for food benefits; 45 C.F.R 205.52 for
Texas 78751. Or call toll-free 1-888-388-6332 or 1-877-432-7232	TANF; and 42 C.F.R 435.910 for health care.)
(TTY).

Citizenship and Immigration status:

You can get benefits for your children who are U.S. citizens or legal immigrants even if you are not a U.S. citizen or a legal immigrant. You do not have to give your citizenship or immigration status to get benefits for your children. You only have to give the citizenship or immigration status of people who want benefits. If you are not a U.S. citizen or a legal immigrant, the only benefits you might be able to get are emergency Medicaid services. Getting long-term care (Medicaid for the Elderly and People with Disabilities) or cash help (TANF) could affect your immigration status and your chances of getting a Permanent Resident Card (green card). Getting other benefits will not affect your immigration status and your chances of getting a Permanent Resident Card. You might want to talk to an agency that helps immigrants with legal questions before you apply. If you are a refugee or have been given asylum, getting benefits will not affect your chances of getting a Permanent Resident Card or becoming a citizen.

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Form H-1010R

December 2012

Statement of Understanding

Read the box marked “All Benefit Programs.” Then read the boxes about each of the benefits anyone is applying for.

All Benefit Programs

	Facts HHSC has about me	I might have to pay to get a copy of these facts. I can ask
	HHSC uses facts about people applying for benefits to	HHSC to fix anything that is wrong. I do not have to pay to
	decide: (1) who can get benefits, and (2) the amount of	fix a mistake. To ask for a copy or to fix a mistake, I can
	benefits.	call 2-1-1 or my local HHSC benefits office.
	HHSC checks facts with the federal Income and Eligibility	Keeping my facts private
	Verification System. If any facts don't match, HHSC will
	check other sources (banks, employers, etc.).	HHSC will keep my facts private if they were collected:
	If anyone applying for benefits has an immigration	• By HHSC staff or contracted provider staff.
	registration number, HHSC must check with the U.S.	• To find out if I can get state benefits.
	Citizenship and Immigration Service (USCIS) system.
	HHSC will not give anyone's facts to USCIS.	HHSC can share facts about me:
	In most cases, I can see and get facts HHSC has about	• When needed for me to get state health care
	In most cases, I can see and get facts HHSC has about	benefits.
	me. This includes facts I give HHSC and facts HHSC gets	benefits.
	me. This includes facts I give HHSC and facts HHSC gets
	from other sources (medical records, employment	• With phone and utility companies. They will find out
	records, etc.).	if my bill amount can be lowered. HHSC will give
		them my name, address, and phone number.

SNAP food benefits: (SNAP)

Read this box if you are applying for food benefits.

Telling the truth	Facts anyone tells or gives HHSC
Telling the truth
	HHSC uses the facts anyone tells or gives HHSC,
Anyone who applies for or gets SNAP must:	including Social Security numbers to:
• Tell the truth.	•	Check if that person can get benefits.
• Never trade or sell SNAP benefits, Lone Star	•	Make sure that person is following benefit
Cards, or other devices that allow people to get		program rules.
SNAP.	•	Help other agencies check if that person can get
• Never use or have Lone Star Cards or other		other benefits.
devices if they don't belong to that person.	•	Recover benefits that person wasn't supposed to
		get.
	• Share facts about that person with other state
Anyone who chooses not to tell the truth might:		and federal agencies (for example, the Texas
Anyone who chooses not to tell the truth might:		Workforce Commission, the Social Security
		Workforce Commission, the Social Security
• Not get SNAP for a year or more.		Administration, and the Internal Revenue
• Not get SNAP for a year or more.		Service).
• Be fined up to $250,000, jailed up to 20 years,		Service).
• Be fined up to $250,000, jailed up to 20 years,	•	Share facts with law enforcement officials so
or both.	•	Share facts with law enforcement officials so
or both.		they can find people on that person's benefits
• Lose income tax refunds.		they can find people on that person's benefits
• Lose income tax refunds.		case (the household) who are wanted for
• Be charged with other crimes.		case (the household) who are wanted for
• Be charged with other crimes.		fleeing the law.
• Have to repay benefits.		fleeing the law.
• Have to repay benefits.	•	Share facts with federal, state, and private
• Never get SNAP again.	•	Share facts with federal, state, and private
• Never get SNAP again.		claims collecting agencies for food benefit
		claims collecting agencies for food benefit
The same is true if anyone lets someone else use their		overpayment claims collection action.
The same is true if anyone lets someone else use their	•	Check that person's facts with computer
Lone Star Card.	•	Check that person's facts with computer
Lone Star Card.		matching programs and credit reporting
		matching programs and credit reporting
		agencies.
	(Food Stamp Act of 1977, as amended, 7 U.S.C.
	2011-2036.)

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Form H-1010R

December 2012

Medicaid:

Read this box if you are applying for Medicaid benefits.

Giving out facts about me

I agree to let Medicaid health care providers (doctors, drug stores, hospitals, etc.) give out any facts about me to HHSC. This will allow the providers to be paid by Medicaid.

If I give false information

If I choose not to tell the truth, I might:

•Be charged with a crime.

•Have to repay benefits.

The same is true if I let someone else use my medical card or Medicaid ID.

Medical and child support payments

Depending on my benefits case, the Attorney General (the state) might check that I am getting the right amount of child or medical support payments and coverage.

•If only my child gets Medicaid, I can decide if I want the state to help get any payments and coverage we should get, but don't get right now.

•If my child and I both get Medicaid, I must:

Help the state get any payments and coverage we should get, but don't right now. If I don't help the state, my child can get Medicaid, but I might not.

Identify who the child's other parent is.

Allow the state to keep any medical support payments.

If I get Medicaid, HHSC will keep medical service payments I can get from other sources, such as:

•My health insurance.

•Money I got because of injuries.

•Money collected for me or my children by the Office of Attorney General.

I must tell HHSC about these sources. If I don't, I am breaking the law.

HHSC will only keep the amount of medical support and service payments allowed by law. I will work with HHSC to get these funds.

TANF cash help for families (TANF):

Read this box if you are applying for TANF.

Child support or alimony	If I give false information
I agree to:	If I choose to not tell the truth, I might:
• Let the state keep any child support or alimony
money owed to anyone during the time they get	• Be charged with and punished for a crime. (This
TANF.	could include going to prison for up to 10 years
• Let the state keep this money after TANF	or community supervision.)
benefits end, if the TANF amount anyone got	• Have to repay benefits.
still needs to be paid off.	• Never get TANF again.
• Tell HHSC about money anyone gets.
• Work with HHSC to get this money; if I don't, I
am breaking the law.
The state will only keep the amount allowed by law.

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T-01010-1234567890

Form H-1010R

December 2012

People helping you

Did someone help you fill out this form?

If yes, tell us about that person:

Name
	(		)	-
Relationship or organization		Phone

YES

Address

Authorized Representative

An Authorized Representative can act for the person applying for benefits by:

•Giving and getting facts related to the application.

•Taking any action needed to complete the application process. This includes appealing an HHSC decision.

•Taking any action related to getting benefits. This includes reporting changes.

Do you want to give someone the right to act for you to be your authorized representative? If yes, tell us about that person (the authorized representative)

YES

Name of authorized representative

Address

( ) - Phone

*** You must sign and date the next page.***

Signing up to vote

Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency.

If you are not registered to vote where you live now, would you like to apply to register to vote here today?

YES

IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS TIME.

If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private. If you believe that someone has interfered with your right to register or to decline to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with the Elections Division, Secretary of State, PO Box 12060, Austin, TX 78711.

Phone: 1-800-252-8683.

Agency Use Only: Voter Registration Status

Agency registered

Client declined

Agency transmitted

Client to mail

Mailed to client

Other

Agency staff signature

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Form H-1010R

December 2012

By signing below, I agree:

•To let HHSC and other state, federal, and local agencies check, share, and get facts about anyone on my benefits case (the household).

•To let other people, businesses, and organizations share facts they have about anyone on my benefits case (the household) with HHSC.

•The facts to be checked and shared include anything that helps decide: (1) who can get benefits, and

(2)amount of benefits.

My answers are true: I certify under penalty of perjury that the information I have provided on this application is true and complete to the best of my knowledge. If it is not, I may be subject to criminal prosecution.

Sign here to show you agree:

Person applying or the authorized representative for the person applying for benefits:

Sign here

Date

Witness only needed if anyone above signed with an “X” or other mark:

Sign here

Date

Printed name of witness

Parent, guardian, or power of attorney for the person applying you must give proof of this right:

Sign here

Date

Phone Number

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Form H-1010R

December 2012

Help you can get without filling out this form

Services in your Area		Family Violence Program		Alcohol and Drug Abuse
Services in your Area				Prevention Program
				Prevention Program
Do you need help finding		Are you afraid for your children's or
Do you need help finding		your safety?		Do you or someone you know want to
services?		your safety?		Do you or someone you know want to
services?				stop using alcohol or drugs?
				stop using alcohol or drugs?
Call 2-1-1 (if you can't connect, call		You can get help to:		You can get help:
1-877-541-7905).		• Getting a ride to a safe		You can get help:
1-877-541-7905).			place.	• Quitting.
After you pick a language, press 1.			place.	• Quitting.
After you pick a language, press 1.		• Finding shelter, legal help,		• Dealing with a crisis.
		• Finding shelter, legal help,		• Dealing with a crisis.
			and a job.	• Keeping others from using drugs
		•	Getting counseling.	or alcohol.
		Call the hotline anytime at		Call 1-877-966-3784
		1-800-799-7233 (1-800-799-SAFE)		(1-877-9-NO DRUG).
		(TTY 1-800-787-3224).

Texas Workforce Network		Adult Education and Family		Health Insurance Premium
Texas Workforce Network		Literacy Program		Payment Program
		Literacy Program		Payment Program
Are you looking for work?		Do you want help learning to		Do you need help paying for your health
You can get help:		Do you want help learning to		Do you need help paying for your health
You can get help:		read or getting a GED? Do you		insurance?
		read or getting a GED? Do you		insurance?
• Applying for a job.		need help with job skills? Or
• Applying for a job.		learning to speak English?		Call 1-800-440-0493.
•	Finding a job.	learning to speak English?		Call 1-800-440-0493.
•	Finding a job.			Or write:
				Or write:
Call 2-1-1 to find a Texas		Call 1-800-441-7323
Call 2-1-1 to find a Texas		(1-800-441-READ).		Texas Health and Human
Workforce Center.		(1-800-441-READ).		Texas Health and Human
Workforce Center.				Services Commission
				Services Commission
				TMHP-HIPP
				PO Box 201120
				Austin, Texas 78720-1120

Family Planning		Women, Infants and Children
		program (WIC)
Do you need help with family
planning?		Are you pregnant or a new
Men and women can get help with:		mother?
•	Birth control supplies.	You can get help:
•	Other health care.	1.	Getting food for you and your
		children.
Call 2-1-1 to find a clinic.		2.	Getting vaccines.
Women with low income might be
able to get free services in the			Call 1-800-942-3678.
Women's Health Program. To learn
more, call 1-866-993-9972.

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➤ PDF File

Fact Name	Description
Form Title	Your Texas Benefits: Renewal Form (Form H-1010R)
Version Date	December 2012
Case Number	A unique identifier for each application, e.g., 1234567890.
Renewal Process	Renew online at www.YourTexasBenefits.com or call 2-1-1 or 1-877-541-7905.
Submission Methods	Forms can be submitted via fax, mail, or in person at a benefit office.
Governing Laws	Regulated under Texas Health and Safety Code, Title 2, Chapter 32.
Interview Requirement	Most applicants must participate in an interview, often conducted by phone.
Language Assistance	Free interpreter services are available for applicants needing language support.
Eligibility for Benefits	Benefits are available for various groups including children, pregnant women, and individuals with disabilities.
Fraud Reporting	Report waste, fraud, and abuse by calling 1-800-436-6184.

Filling out the Your Texas Benefits form is an important step in renewing your benefits. To ensure a smooth process, it’s essential to provide accurate and complete information. Below are the steps you need to follow to fill out the form correctly.

Begin by entering your Case Number at the top of the form.
Fill in your First Name, Middle Initial, and Last Name.
Provide your Home Address, including street and apartment number, City, State, ZIP Code, and County.
List your Home Phone and Cell or Daytime Phone numbers.
If your mailing address is different from your home address, fill in the Mailing Address, City, State, and ZIP Code.
Answer the questions about your ability to attend an interview and indicate if any reasons apply to you.
Indicate your preferred language for the interview and whether you need an interpreter.
List all individuals who are part of your benefits case, including their First Name, Last Name, Relationship to you, Birth Date, and whether they are still living in your home.
Provide information about anyone living with you who is not listed in the previous section.
Answer the questions regarding felony charges, benefits from another state, and any other relevant details about individuals in your household.
Detail any health insurance coverage other than Medicare, Medicaid, or CHIP.
List any vehicles owned or being paid for, including details like year, make, model, monthly payment, and insurance payment.
Provide information about cash, bank accounts, homes, or other property owned by anyone in your household.
List all sources of income received by anyone living in your home, including job income, benefits, and other financial assistance.
Detail housing costs, including rent or mortgage, utilities, and other related expenses.
Include any costs related to child care, child support, or medical expenses for individuals in your household.
Answer questions regarding alimony, credit card payments, and other monthly costs.
Provide details about any medical costs incurred by individuals aged 60 or older or those with disabilities.
Fill in the Social Security numbers for individuals applying for benefits, if applicable.
Sign and date the form on pages 9 and 10.
Attach any required documents as listed in the form.
Submit the completed form by fax, mail, or in person at your local benefits office.

After completing these steps, your form will be ready for submission. Ensure that all information is accurate to avoid delays in processing your renewal. If you have any questions while filling out the form, don’t hesitate to reach out for assistance.

What is the Your Texas Benefits form and why do I need it?

The Your Texas Benefits form is a crucial document for individuals seeking to renew their benefits in Texas. This form is necessary for programs such as SNAP (food benefits), TANF (cash help for families), and health care coverage for children and pregnant women. Completing this form accurately ensures that you continue to receive the benefits you are entitled to. It gathers essential information about your household, income, and expenses, which helps the state determine your eligibility for assistance programs.

How can I renew my benefits using the Your Texas Benefits form?

You have several options for renewing your benefits. The easiest way is to complete the renewal online at www.YourTexasBenefits.com. If you prefer to speak with someone, you can call 2-1-1 or 1-877-541-7905 for assistance. If you do not wish to renew online, you can fill out the paper form, which you can obtain from various locations or download from the website. Once completed, you can submit the form by fax, mail, or in person at a benefits office. Make sure to sign and date the required pages and attach any necessary documents as indicated on the form.

What should I do if I need to correct information on the form?

If you find that you need to make corrections on the Your Texas Benefits form, you can do so easily. Simply cross out the incorrect information and write the correct details next to it. Ensure that any changes are clear and legible. After making corrections, it is important to sign and date the relevant pages to confirm that the information is accurate. If you require assistance with filling out the form or making corrections, there are resources available to help you.

What happens after I submit the Your Texas Benefits form?

After submitting your completed Your Texas Benefits form, the state will review the information provided to determine your eligibility for benefits. You may be contacted for additional information or to schedule an interview, which is often done over the phone. It is important to keep track of your application status, which you can do by calling the appropriate number or checking online. If approved, you will continue to receive your benefits without interruption. If there are any issues, the state will inform you of the necessary steps to resolve them.

Not providing complete information on all household members. Ensure every individual living in the home is listed.
Failing to sign and date the form. Remember to sign and date the required pages, usually pages 9 and 10.
Omitting necessary attachments. Include all required documents, such as proof of income and identity.
Incorrectly marking yes or no answers. Review questions carefully to ensure accurate responses.
Not updating incorrect information. If you need to make changes, cross out the old information and write the correct details.
Forgetting to include contact information. Provide current phone numbers and mailing addresses to ensure communication.
Neglecting to report all income sources. Include income from jobs, benefits, and any other financial support.
Not indicating if an interpreter is needed. If language assistance is required, mark that option clearly.
Failing to check for additional forms needed. If applying for multiple programs, ensure to select all relevant boxes.
Not following the submission guidelines. Make sure to send the form via the correct method, whether by fax, mail, or in person.

When renewing benefits through the Your Texas Benefits form, several other forms and documents may also be required. These documents help ensure that all necessary information is collected for a complete application. Here’s a list of commonly used forms and documents that may accompany the Your Texas Benefits form:

Form H-1010: This is the initial application form for benefits. It collects detailed information about the applicant’s household, income, and expenses.
Form H-1200: Used for reporting changes in circumstances that may affect eligibility for benefits, such as changes in income or household size.
Form H-3030: This form is for individuals applying for Supplemental Nutrition Assistance Program (SNAP) benefits. It provides specific questions related to food assistance.
Form H-1020: This is a request for a hearing if an applicant disagrees with a decision made regarding their benefits. It is essential for ensuring due process.
Form H-3200: This form is used to report any medical expenses that may be relevant for Medicaid eligibility, especially for individuals with disabilities.
Verification Documents: These may include pay stubs, bank statements, or tax returns that verify income and financial status.
Proof of Residency: Documents such as utility bills or lease agreements that confirm the applicant's current address may be required.
Identification Documents: A government-issued ID or Social Security card may be needed to verify identity and eligibility.
Form H-3034: This form is used specifically for the Temporary Assistance for Needy Families (TANF) program, detailing family circumstances and needs.
Medical Records: If applicable, these documents can provide necessary information about health conditions that may impact eligibility for health-related benefits.

Gathering these documents in advance can streamline the renewal process and help avoid delays in receiving benefits. It is crucial to ensure that all required information is complete and accurate to facilitate a smooth review of your application.

Medicaid Application Form: Similar to the Your Texas Benefits form, the Medicaid Application collects personal and financial information to determine eligibility for Medicaid benefits. Both require details about household members and their income.
SNAP Application: The Supplemental Nutrition Assistance Program (SNAP) application is also focused on gathering information about household income and expenses to assess eligibility for food assistance, similar to how Your Texas Benefits evaluates financial need.
TANF Application: The Temporary Assistance for Needy Families (TANF) application seeks information about family composition and income, much like the Your Texas Benefits form, to determine eligibility for cash assistance.
CHIP Application: The Children's Health Insurance Program (CHIP) application requires information about family income and household size, paralleling the Your Texas Benefits form's approach to assessing eligibility for health care benefits.
WIC Application: The Women, Infants, and Children (WIC) application gathers data on family income and nutritional needs, similar to how Your Texas Benefits assesses eligibility for nutritional assistance programs.
Housing Assistance Application: The application for housing assistance collects personal and financial details to evaluate eligibility for subsidized housing, akin to the information required in the Your Texas Benefits form.
Unemployment Benefits Application: This application requires information about employment history and income, similar to the Your Texas Benefits form's focus on financial stability and household income.
Social Security Benefits Application: The Social Security application collects personal and financial information to determine eligibility for benefits, much like the Your Texas Benefits form does for various assistance programs.

When filling out the Your Texas Benefits form, it's important to follow certain guidelines to ensure your application is processed smoothly. Here are eight things you should and shouldn't do:

Do read the entire form carefully before starting.
Don't leave any required fields blank; this can delay your application.
Do provide accurate information, especially regarding your income and household members.
Don't use correction fluid or tape to make changes; simply cross out the mistake and write the correct information.
Do sign and date the form where indicated.
Don't forget to attach any required documents, such as proof of income or identification.
Do keep a copy of your completed form for your records.
Don't hesitate to ask for help if you're unsure about any part of the form.

Following these guidelines can help you avoid common pitfalls and ensure a smoother application process. Good luck!

Understanding the Your Texas Benefits form is crucial for anyone seeking assistance. However, several misconceptions can lead to confusion. Here are nine common misconceptions about this form, along with clarifications:

It can only be submitted by mail. Many people believe that the form can only be sent through the postal service. In fact, you can also submit it by fax or in person at a benefits office.
You must renew your benefits in person. Some think that in-person renewal is mandatory. You can renew online or by phone, making the process more convenient.
Corrections must be made in a specific way. There is a belief that corrections on the form must be done in a formal manner. You can simply cross out the incorrect information and update it as needed.
All household members must apply for benefits. Many assume that everyone in the household needs to apply. Only those who are seeking benefits need to be listed on the form.
You cannot get help if you have a felony conviction. Some individuals think that a felony conviction disqualifies them from receiving assistance. While there are restrictions, many may still qualify for certain benefits.
Language assistance is not available. There is a misconception that language support is not offered. The program provides free interpreters for applicants who need help in different languages.
Health insurance must be disclosed only if it is Medicare or Medicaid. It is often misunderstood that only Medicare or Medicaid coverage needs to be reported. Any health insurance, regardless of the type, must be disclosed on the form.
You cannot apply for benefits if you are not a U.S. citizen. Many believe that only U.S. citizens can apply for benefits. However, legal immigrants can also qualify for certain programs.
Submitting the form is the only step in the process. Some think that completing the form is the final step. In reality, you may need to provide additional documentation and possibly attend an interview.

Clarifying these misconceptions can help ensure a smoother application process for those seeking assistance through the Your Texas Benefits program.

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TANF cash help for families

Health care for:

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Your Texas Benefits form is essential for accessing various assistance programs in Texas. Here are key takeaways for effectively filling out and using this form:

Renewal can be completed online at www.YourTexasBenefits.com or by calling 2-1-1 or 1-877-541-7905.
Ensure all required items are attached to the form, as specified next to the questions.
For corrections, cross out the incorrect information and update it directly on the form.
Submit the completed form via fax, mail, or in person at a local benefits office. The fax number is 1-877-447-2839.
Be prepared for an interview, which may be conducted over the phone, especially if you face challenges getting to an office.
Make sure to provide accurate Social Security numbers for individuals applying for benefits, as this is necessary for processing.