Your preparation questionnaire
Answer five short questions to build a document checklist for your situation. Then create an account to save your answers and progress.
Status: To gather
FREE PREPARATION CHECKLISTYour preparation
Your preparation
checklist.
Need to apply or meet a deadline? Use Your Texas Benefits or call 1-877-541-7905. This checklist does not submit an application.
01 / GET ORGANIZED
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Identity and Texas residence
Locate the identity and residence information requested by the application. Keep original documents in a safe place.
View document examples
- Photo identification
- A driver’s license or state-issued identification card is an example of identity evidence. A U.S. passport can document both citizenship and identity.
- Citizenship records
- A birth certificate is an example of citizenship evidence; it does not replace separate identity evidence when that is required. HHSC may verify information electronically first.
- Texas address information
- Have your current living address ready. The illustrated utility bill is an address-record example, not a statement that it is required or sufficient. Follow any specific residence-evidence request from HHSC.
These are examples; HHSC may already verify some information electronically or request different evidence.
Status: To gather
Help from a representative
If someone is helping, check the application’s representative instructions and requested authorizations.
Download representative form
Form H1003 · January 2026 · PDF
- Enter the applicant’s and representative’s details in Section 1.
- Review the authority described on the form. Both the applicant and the representative sign and date Section 2; the representative must be at least 18.
- If the representative is legally appointed, include proof of that appointment. Return the completed form to HHSC with the application or as HHSC directs.
Status: To gather
Income records
Examples include benefit award letters, pension statements and pay stubs. Check the requested periods.
View document examples
- Benefit award letter
- A Social Security or other benefit letter showing the payment amount and frequency.
- Pension or retirement statement
- A statement or payment stub showing retirement income and deductions.
- Pay stubs
- Recent pay stubs or an employer statement for the periods HHSC requests.
- Other income records
- Records of rent, interest or other income, such as receipts, statements and relevant agreements.
These are examples; HHSC may already verify some information electronically or request different evidence.
Status: To gather
Accounts and other resources
Examples include bank and investment statements, insurance policies and burial contracts. Check ownership and requested periods.
View document examples
- Bank statements
- Statements showing account ownership, balances and transactions for the requested periods.
- Investment and retirement statements
- Statements for stocks, bonds, retirement accounts and other investments.
- Life insurance policy
- The policy and available information about its face amount, ownership and cash value.
- Burial contract
- Your existing prepaid burial contract, burial-fund record or plot ownership document.
- Trust or annuity documents
- Existing agreements and current statements. Gather the records without changing ownership or arrangements.
These are examples; HHSC may already verify some information electronically or request different evidence.
Status: To gather
Property records
Locate relevant ownership and value records, such as deeds and mortgages. This checklist does not classify property.
View document examples
- Deed or ownership record
- Records identifying the property and its owners.
- Tax appraisal or value record
- A property tax statement or appraisal documenting value.
- Mortgage or loan statement
- A current statement showing any outstanding loan secured by the property.
These are examples; HHSC may already verify some information electronically or request different evidence.
Status: To gather
Health coverage and expenses
Locate coverage information, premiums and the medical expense records requested in the application.
View document examples
- Medicare information
- Your Medicare coverage information and any premium records HHSC requests.
- Health insurance card or policy
- Coverage details from your insurance card, policy or insurer statement.
- Premium and medical expense records
- Premium statements, medical bills and proof of payment for expenses HHSC asks you to document.
These are examples; HHSC may already verify some information electronically or request different evidence.
Status: To gather
Submission and follow-up
Review the official signing and submission instructions. Keep copies and watch for HHSC requests and deadlines.
How to submit and follow up
- Complete the official application. Use Your Texas Benefits online or obtain the current H1200 paper form.
- Review and sign. Complete the required sections and signatures. Include requested copies of evidence and any representative authorization.
- Send it to HHSC. Submit online, or use the mailing, fax or office instructions on the current application. This checklist does not send anything.
- Keep a record. Save a copy of what you submitted and any receipt or confirmation.
- Watch for follow-up. Check Your Texas Benefits and your mail. Respond to requests by the date shown. Call 2-1-1 or 1-877-541-7905 if you need help.
Status: To gather
Before you continue
What does an account save?
Your questionnaire choices and checklist progress. Save after editing, then return here after signing in. Documents, identification numbers and application forms are not collected by this checklist.
Does completing the checklist mean I qualify?
No. HHSC decides eligibility. Your answers help select document categories; they do not verify evidence or complete an application.
Can I upload documents or buy application help?
Not yet. Document uploads, paid application assistance and official form generation are still in development.
Official sources for these examples
Reviewed September 23, 2026. Identity and citizenship evidence · Document verification guide · H1003 representative form · H1200 application