Your Texas Benefits: Getting Started

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B B j C*cNK8Gd R B B B B j C*cNK8Gd R B B # 2 6 "YAM7}9 sNVY 1 6 / 6# 2 6 "YAM7}9 sNVY 1 6 / 652F1w VP m85H@U T.N 4s A52F1w VP m85H@U T.N 4s A@!///!@ w 5 1rI x ) } n @!///!@ w 5 1rI x ) } n AAAAAAA AA AAA AA A A A AAAAAAA AA AAA AA A A A GettingStarted CREASE AND TEAR AT dCHIPMedicaidandandCHIPbe calledStamps.)(This(Thisused usedto betocalledFoodFoodStamps.)buy foodfor goodhealth.SomepeopleHelpsHelpsbuy foodfor ght get help the next work day.Helpsmedicalas billsHelpswithwithmedicalbillsbillssuchsuchas billsfor fordoctors,hospitals,andmedicines.doctors, hospitals, and medicines.Peoplehealth-carebenefitsPeoplewhowhocan canget gethealth-carebenefitsare:are: Children20 andyounger Childrenage age20 andyoungerwhowholivelivewithyou.with you. Pregnantwomen. Pregnantwomen. Adultseither:caring Adultswhowhoeither:(1) (1)are arecaringfor fora childin theirhomeor (2)werea childin theirhomeor (2)werein infostercareatage18orolder.foster care at age 18 or older.TANFCashHelpTANFCashHelpforFamiliesfor FamiliesTANF: Temporary Assistance for NeedyTANF: Temporary Assistance for NeedyFamiliesFamiliesHelps pay for things like food, clothing,Helps pay for things like food, clothing,and housing.and housing. TANF: Helps families with children TANF: Helps families with childrenage 18 and younger pay for basic needs.age 18and younger pay for basic needs.TANF gives monthly cash payments.TANF gives monthly cash payments. One-Time TANF: Helps families with One-TimeTANF:familiesinwithchildrenage 18 Helpsand youngercrisis.childrenageinclude18 andlosingyoungerin notcrisis.Crisesa job,findingCrisesincludelosinga job,ornotfindinga job,losinga home,a medicala job,emergency.losing a home,oramedicalThis help is given onlyemergency.This12helpis given onlyonce everymonths.once every 12 months. One-Time TANF Grandparent: One-TimeTANF Grandparent:Helps grandparentscaring for aHelpschildgrandparentscaring for awho gets TANF.child who gets TANF.HowApplyHowto toApplyWhat to do:Whatto do:1. Fill out this form.1. Fill out this form.2. Sign and date pages 1 and 18.2. Signand date pages 1 and 18.3. Send “Items we need.”3. SendSee“ItemsweCneed.”pagesand D.See pages C and D.If you want to apply for Medicaid for theIf you want to apply for Medicaid for theElderly and People with Disabilities, youElderly and People with Disabilities, youneed a different form. To get that form,need a different form. To get that form,call 2-1-1 (after you pick a language,call 2-1-1 (after you pick a language,press 2).press 2).All phone and fax numbers on this form areAll phone and fax numbers on this form arefree to call. If you are deaf, hard of hearing,free to call. If you are deaf, hard of hearing,or speech impaired, you can call any numberor speech impaired, you can call any numberby calling 7-1-1 or 1-800-735-2989.by calling 7-1-1 or 1-800-735-2989.How to send it:How to send it:Mail: HHSC, PO Box 149024,Mail: Austin,HHSC,TXPO78714-9968Box 149024,Austin, TX 78714-9968Fax: 1-877-447-2839. If yourFax: 1-877-447-2839.If yourform is 2-sided, faxboth sides.form is 2-sided, fax both sides.In person: At a benefits office.In person:Atonea benefitsoffice.To findnear you,go toTo findone near you, go to or call 2-1-1YourTexasBenefits.comYourTexasBenefits.comor callpress2-1-11).(after picking a language,(after picking a language, press 1).YourTexasBenefits.comYourTexasBenefits.comOn this website you can:On this website you can: Apply for benefits. Applyforoutbenefits. Findif you should apply Findforoutif you should applybenefits.for benefits.Report changes. Reportchanges. Uploaditems we need Uploadfromitemsyou. we needfromyou. benefits. Renew Renew benefits.Don’t send this page with your form. Keep for your records. Page ADon’t send this page with your form. Keep for your records. Page A

cNK8Gd R B B B B j H B B j H cNK8Gd R B B ' ,: 5 8I R 9 sNVY 9 6 / 6' ,: 5 8I R 9 sNVY 9 6 / 6 zW{ V3x @caH@U T.N 4s A zW{ V3x @caH@U T.N 4s A@!///!@ w SnG 2rI x ) } n @!///!@ w SnG 2rI x ) } n AAAAAAA A A AA A A A AAAAAAA A A AA A A A exasHealthandHumanServicesCommission Therein the Thereare aretipstipsin theleftleftsideofeachpage.Theyside of each page. Theytime.cancanhelphelpyouyousavesavetime. Signpages Signandanddatedatepages1and18.1 and 18. Send“Itemswe need.” Send“Itemswe need.”pagesC andSeeSeepagesC andD. sectionsyouneedtofillsections you need to fill out.out.example,ForForexample,if ifthis:youyouseeseethis:It meansonlypeopleIt meansthatthatonlypeopleapplyingSNAPfoodapplyingfor forSNAPfoodbenefitsneedtofillbenefits need to fill outoutsection.thatthatsection.Howto filea complaintReportwaste,fraud,abuse Howto filea complaintReportwaste,fraud,and andabuseIf youa complaint,try talkingto yourbenefitsadvisorIf you think anyone is misusing HHSC If youhavehavea complaint,firstfirsttry talkingto yourbenefitsadvisorIf you think anyone is misusing HHSCor theirsupervisor.If youhelp,1-877-787-8999.benefits, call 1-800-436-6184.or theirsupervisor.If enefits, call ourareaServicesininyourareaServices in your ly Violence oland DrugAbusePreventionProgramPrevention ProgramAreyouyouafraidafraid forfor youryour children’sorDoyouyou need ildren’Programyou afraidforyourchildren’sor s or PreventionDo youneed needhelp ,Do youyouknowCall 2-1-1 (if you can’t connect,your safety? You can get help:your safety? You can get help:Call 2-1-1(if you can’t connect,wantstop usingalcohol or drugs?Do youor tosomeoneyou knowcall 1-877-541-7905).1-877-541-7905).callwantcanto stopalcohol or drugs?l Getting a ride to a safe place.Gettinga rideto aplace.safe place.Youget usinghelp:call 1-877-541-7905). Gettingaridetoasafewanttostopusingalcoholor drugs?After youyou pick aalanguage,press 1.language,l Finding shelter, legal help, and a job.can get help:Quitting.AfterAfteryou pick apicklanguage,press 1.press 1. FindingFindingshelter,a job. lYoushelter,legallegalhelp,help,and anda job.Youlcanget help: Getting counseling.Dealingwith a crisis.l Network Gettingcounseling.TexasNetworkl Quitting.Keepingothers from usingTexas Workforce NetworkCall the hotline anytime at Dealing with a crisis.Are you looking for nytimeatwith alcohol.a crisis.you lookingfor work?Are Areyouwork?1-800-799-7233 (1-800-799-SAFE). DealingYoulookingcan get forhelp: Keepingothers from FE).1-800-799-7233(1-800-799-SAFE).canhelp:get help:You Youcan get Keepingothersfrom using Applying for a job.drugs or alcohol.(1-877-9-NODRUG).l Applyingfor aa job.job.or alcohol.for a job.AdultEducationEducationandFamily drugsCall ApplyingFindingAdultand nsurance Premiuml Findinga job.a cyProgramCall 2-1-1 to find a Program2-1-1toCenter.finda TexasCallCall2-1-1to finda Texas(1-877-9-NO DRUG).Doyouyou wantwant helpto toDohelplearninglearningWorkforceDo you need help paying forDo readyouhelp learningWorkforceCenter.WorkforceCenter.readwantor gettinggettingaaGED?DoneedorGED?toDoyouyouneed ttingaGED?DoyouneedInsurancePremiumFamily Planninghelp withwith joblearningto to anninghelpspeakwith jobskills? Or learning tospeakEnglish?English?PaymentProgram(HIPP)Do you need help with family planning?OrTexasEnglish?Do write:you needhelpHealthpaying andfor HumanDo thelpwith: -441-7323your health 0-441-7323PO Box 201120andwomengetwith:help with:Call (1-800-441-READ). BirthcontrolyourTMHP-HIPP,health insurance?(1-800-441-READ).Austin,Texas 78720-1120 Birthcontrolsupplies.(1-800-441-READ).Call 1-800-440-0493. BirthcontrolOtherhealth supplies.care.CallImportant1-800-440-0493. Othercare. Otherhealthcare.Women,InfantsWomen,InfantsOr write: Information for FormerCallhealth2-1-1tofinda clinic.Military Service Membersto finda clinic.Women,InfantsCallCall2-1-12-1-1to finda IC) Or write:Texas Health and HumanWomen age 15 to 44 who can’t get and Children program (WIC)TexasHealthCommissionandmenHumanWomenandwho served inServicesWomenage1544whocan’tgetAreyouyou pregnantpregnant orora anewmother?Womenage 15toCHIP44towhocan’tnewmother? anyMedicaidormightbegetable toget Arebranchofthe United ?TMHP-HIPPMedicaidmightableYoucancan getget help:Medicaidor CHIPmightbe TexasablebetoWomenget toYouhelp:Armed Forces, including Army, Navy,servicesinortheCHIPHealthyTMHP-HIPPcanget help:PO Box 201120get inservicesin theTexasHealthyTexas Youl Marines,Air Force, Coast Guard,GettingfoodservicestheHealthyWomenprogram. A parent or legal guardianGetting foodforforyouyouandandPO ReservesBox 201120or NationalGuard may 0 alwomenguardianyour 120additional benefits en.must 15applyfor Toyoungwomenl Getting vaccines.to 17.learnmore, agego toservices. For more information pleaseGetting vaccines.age 15to 17.goTotolearn more, Gettingvaccines.15 towomen17. To learnmore,visit www.tvc.texas.gov, the TexasHealthyTexasWomen.orgor callCall1-800-942-3678.go to HealthyTexasWomen.org orVeterans Portal.Call1-800-942-3678.HealthyTexasWomen.orgor call1-866-993-9972.Call 1-800-942-3678.call 1-866-993-9972.1-866-993-9972.Don’t send this page with your form. Keep for your records. Page BDon’t send this page with your form. Keep for your records. Page B HelpfulTipsHelpfulTips to YourTexasBenefits.com. Go toGoYourTexasBenefits.com.oror 2-1-1Call 2-1-1(ifcan’tyou can’tconnect, Call(if youconnect,call1-877-541-7905).call 1-877-541-7905).you apicka language,AfterAfteryou picklanguage,presspress2 to:2 to:–Askquestionsaboutthisform.– Ask questions about this form.– Findget help– Findwherewhereto gettohelpfillingfillingoutthisform.out this form.– Checkthe statusof form.this form.– Checkthe statusof this– questionsAsk questionsbenefit– Askaboutaboutbenefitprograms.programs.CREASE AND TEAR AT PERFORATIONQuestionsaboutQuestionsaboutthis thisformformor aboutbenefitsor aboutbenefits

B B j LWhcNK8Gd R B B B B j LWhcNK8Gd R B B ' 22 #OEu*%9 sNVY 1 6 / 6' 22 #OEu*%9 sNVY 1 6 / 6eRs V yD I H@U T.N 4s AeRs V yD I H@U T.N 4s A@!///!@ w x m 1rI x ) } n @!///!@ w x m 1rI x ) } n AAAAAAA A A A AA A A A AAAAAAA A A A AA A A A ononyourcase CREASE AND TEAR AT PERFORATION andtheonnextthe nextfor itemswe mightIf youbringor sendcopiesLookLookbelowbelowand onpagepagefor itemswe mightneedneedfromfromyou.you.If youbringor elpus.Ifyousendanyitemstous,sendonlycopies.of these items with your application, it might help us. If you send any items to us, send only copies.the originalsfor yourrecords.KeepKeepthe originalsfor yourrecords.We onlyto anyoneon yourFor example,no onea bankaccount,We onlyneedneeditemsitemsthat thatapplyapplyto anyoneon yourcase.case.For example,if noif onehas hasa bankaccount,wedonotneedbankstatements.we do not need bank statements.If youare applyingIf youare applyingfor forAnyBenefitProgramAnyBenefitProgrambringingor sendingcopiesof itemsapplyto anyoneon yourmightus reviewit fasterbringingor sendingcopiesof itemsthatthatapplyto anyoneon yourcasecasemighthelphelpus reviewit faster. . Identityof youwho are)you –are)– Currentdriver’s Identity(proof(proofof whoCurrentdriver’s license or Department of Public Safety ID card.license or Department of Public Safety ID card.If a person has the right to act for you (as yourIf a person has the right to act for you (as yourauthorized representative), that person also needsauthorized representative), that person also needs to give proof of identity.to give proof of identity. Immigration status – Resident card (I-551), arrival/ Immigration status – Resident card (I-551), arrival/departure form (I-94). Or papers from the U.S.departure form (I-94). Or papers from the U.S. Citizenship and Immigration Services. We needCitizenshipand Immigration Services. We needcopies of the front and back of these forms.copies of the front and back of these forms. Legal representative (a person who has the right Legaltorepresentativepersonwho–hasthe ofrightact for you on(alegalissues)Powerattorneyto actpapers,for youguardianshipon legal issues)–Powerofattorneyorder, court order, or similarpapers,guardianshiporder, court order, or similar courtdocuments.court documents. Veterans benefits, workers’ compensation, Veteransbenefits, workers’compensation,or unemployment– Awardletter or pay stubs.or unemployment – Award letter or pay stubs. SupplementalSecurityIncome (SSI), or pension benefits – Award letter orIncome (SSI), or pension benefits – Award letter orpay stubs.pay stubs. Military service – Current Military IDMilitary service – Current Military ID(Form DD-2), military orders, or separation(Form DD-2), military orders, or separationpapers (Form DD-214).papers (Form DD-214). Loans and gifts (includes someone payingLoans and gifts (includes someone payingbills for you) – Loan agreements or statement frombills thefor personyou) – givingLoan agreementsor statement fromyou money or paying your bills.the persongivingyoumoneyorpayingyourphonebills.Must show that person’s name, address,Mustnumber,show thatperson’sname,address,phoneand signature.number, and signature. Residence (proof you live in Texas) – Utility bill,Residenceyoulive Departmentin Texas) – tyID, rent receipt, letter from landlord (can’tbeID, rentreceipt, letter from landlord (can’t bea relative).a relative).If you are applying forIf you are applying forSNAPfoodbenefitsSNAPfoodbenefitsbringing or sending copies of items that apply to anyone on your case might help us review it faster.bringing or sending copies of items that apply to anyone on your case might help us review it faster. Proof of income from your job – Last 3 pay stubs Dependent care expenses – Receipts, canceled Prooforofpaychecks,income fromyour jobfrom– Last3 paystubs or Dependentexpenses– Receipts,a statementyouremployer,checks, careor a signedstatementfromcanceledthe personor paychecks,a statementfrom your employer, orchecks,a ords.youorpay.A signedstatementmustwhen andself-employment uchyoupay. Bank accounts – The most current statementhowmuchyoupay. Bankforaccounts–Themostcurrentstatement Child support anyone pays – Court papers that showall accounts. Childwhatsupportanyone– Courtpapersshowfor allMedicalaccounts.you mustpay paysfor childsupport.Forthatexample:costs – Bills, receipts, or statements cedecree,courtorder,ordistrictclerkrecord. th-care providers (doctors, hospitals, drugdivorcedecree,courtorder,getsor ospitals, Childsupportanyone– Districtclerkrecord.stores, etc.).Theseitems shouldshowdrugcosts you omtheparentwhopaysshowinghownow and costs you expect in the future.Or suallypaid. Rent or mortgage costs – Recent checks, checkmuch,howoftenandhavethe thedatename,it is usuallypaid.Thelettermustaddress,phone Rent stubs,or mortgagecosts from– Recentchecks, checkor statementthe mortgagebank signatureoftheparentwhopays.stubs,landlord.or statementfromalsotheneedmortgageorRentersto givebankthe landlord’snumber, and signature of the parent who name, address, and phone number.name, address, and phone number.More on theMorenexton theTo get SNAP, a person must be a U.S. citizen or legal resident.pageTo get SNAP, a person must be a U.S. citizen or legal resident.next pageIf you need help getting these items, let us know. Don’t send this page with your form. Keep for your records. Page CIf you need help getting these items, let us know. Don’t send this page with your form. Keep for your records. Page C

B B :9Vih1"Wn#VA B B B B :9Vih1"Wn#VA B B }A b IK 63h? )1 / }A b/ IK 63h? )1 P V \V rlk[ & S P j@ .P V \V rlk[ & S P j@ .@!///!@ A, i jny , { b B@!///!@ A, i jny , { b BAAAAAAA A AAAA A A AAAA AAAAAAA A AAAA A A AAAA MoreitemsneedfromyouMoreitemsweweneedfromyouIf youare applyingIf youare applyingfor for Proofof income– Lastpay stubs Proofof incomefromfromyouryourjob –jobLast3 pay3 stubsorpaychecks,astatementfromyouremployer,or paychecks, a statement from your employer,or self-employmentrecords.or self-employmentrecords. Bankaccounts– Mostcurrentstatement Bankaccounts– Mostcurrentstatementfor for allaccounts.all accounts. Proofa childis relatedto you– Legal Proofa childis relatedto you– ospital, or baptismal certificate. Citizenship – U.S. passport, Certificate of Citizenship – U.S. passport, Certificate ofNaturalization, U.S. birth certificate (copies of theNaturalization, U.S. birth certificate (copies of thefront and back), hospital record of birth, orfront and back), hospital record of birth, orMedicare card. If you were born in Texas, we mightMedicare card. If you were born in Texas, we mightbe able to look up your birth record.be able to look up your birth record. Child’s vaccines – Vaccine records for each child. Child’s vaccines – Vaccine records for each child. Proofa childA signedstatementProofa childlivesliveswithwithyouyou– neighborfrom your landlord or a non-relative neighbor thatthatincludeshisheror hername,address,phonenumber.includeshis orname,address,andandphonenumber. Childsupportanyonepays–CourtpapersthatshowChild support anyone pays – Court papers that cewhat you must pay for child support. For example: ree, court order, or district clerk record. Childsupportanyone– Districtclerkrecord.Childsupportanyonegetsgets– Districtclerkrecord.Or letter from the parent who pays showing how much,Or letter from the parent who pays showing how much,how often and the date it is usually paid. The letter musthow often and the date it is usually paid. The letter musthave the name, address, phone num

speak English? Call 1-800-441-7323 (1-800-441-READ). Women, Infants and Children program (WIC) Are you pregnant or a new mother? You can get help: Getting food for you and your children. Getting vaccines. Call 1-800-942-3678. Alcohol and Drug Abuse Prevention Program Do you or someone you know want to stop using alcohol or drugs?

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