How to Fill Out Texas Form H1836-B: Provider, Signature, and Submission

Texas Form H1836-B is the Medical Release or Physician’s Statement that the Health and Human Services Commission (HHSC) uses to confirm you need to stay home caring for a disabled family member and therefore cannot meet standard TANF or SNAP work requirements. Your Texas Works advisor starts the form and hands it to you; you take it to a qualifying medical provider who has examined your family member, sign the release yourself, and return it to HHSC before your verification deadline.1Texas Health and Human Services. Form H1836-B, Medical Release or Physician’s Statement

When HHSC Uses Form H1836-B

The form applies in three situations, all tied to a family member’s disability rather than your own:1Texas Health and Human Services. Form H1836-B, Medical Release or Physician’s Statement

  • You receive TANF or SNAP and claim you cannot work or participate in employment activities because you are needed at home to care for an incapacitated family member.
  • You are a TANF recipient applying for a hardship exemption during the state time-limit freeze-out period, based on a family member’s disabling illness or injury.
  • You are applying for an extended TANF hardship exemption during or after your 60th month of assistance because you are caring for a disabled family member.

If the medical issue is your own, you need Form H1836-A instead, which covers the individual’s personal medical limitations.2Texas Health and Human Services. Form H1836-A, Medical Release and Physician’s Statement Confirm with your advisor that you have the B version before you book an appointment.

Who Starts the Form and Who Can Sign It

You do not download or fill out H1836-B yourself. Your Texas Works advisor completes Section 1 with the disabled family member’s name, date of birth, and Social Security number, plus your case name and case number as the caregiver.3Texas Health and Human Services Commission. Form H1836-B Medical Release or Physician’s Statement Your job is to take that partially filled form to a provider who has examined your family member.

Only certain providers can complete the medical portion:1Texas Health and Human Services. Form H1836-B, Medical Release or Physician’s Statement

  • Physician (M.D.)
  • Licensed osteopath (D.O.)
  • Physician’s assistant working under a physician’s orders
  • Advanced practice nurse
  • Certified psychologist

Some offices charge for completing state paperwork. Ask about that fee when you schedule, and book early enough to beat your deadline.

What the Provider Fills In

Section 2 has two parts. In Part A, the provider evaluates how much you can work or participate in work-preparation activities given your family member’s condition, and checks one of three options:3Texas Health and Human Services Commission. Form H1836-B Medical Release or Physician’s Statement

  • You can work or participate full time, either inside or outside the home.
  • You can work part time, with the provider specifying how many hours per week you can work outside the home and, separately, inside the home.
  • You cannot work or participate at all. If the provider selects this, they must also indicate whether the disability is permanent, expected to last more than six months, or expected to last six months or less.

Part B is for the primary disabling diagnosis, a secondary diagnosis if there is one, and any additional clinical comments. The provider then prints their name, signs and dates the form, and lists their office address, phone number, and license number.3Texas Health and Human Services Commission. Form H1836-B Medical Release or Physician’s Statement

Before you leave the office, look at Part A. If the provider marked part-time hours without filling in the number of hours, or marked “unable to work” without checking a duration, HHSC will send the form back. Incomplete answers here are the most common reason exemptions get delayed.

Your Signature on the Release

Section 3 is your authorization. Signing it lets HHSC and the Texas Workforce Commission receive and use the medical information on the form, and the authorization expires when your benefits do.1Texas Health and Human Services. Form H1836-B, Medical Release or Physician’s Statement Without your signature, the agency cannot act on the physician’s findings, so sign before you submit even if the medical section is already complete.

How to Submit the Form

The instructions direct you to return the completed form to your local eligibility office, but HHSC accepts documents through several channels:4Texas Health and Human Services. Benefits Application Next Steps

  • Online upload through your account at YourTexasBenefits.com (a scan or a clear photo works).
  • In person at your local HHSC benefits office; the office locator at YourTexasBenefits.com lists addresses.5Texas Health and Human Services. HHS Locations
  • Fax to 877-447-2839.
  • Mail to HHSC, P.O. Box 149027, Austin, TX 78714-9027.

Keep a copy of whatever you send. Save the fax confirmation page, use tracking if you mail it, and screenshot the upload receipt if you submit online. Online uploads are generally fastest because there is no postal transit.

What Happens If the Form Is Late or Incomplete

If HHSC does not get a usable form before your deadline, your caseworker may not be able to process the exemption, and a work-requirement sanction can follow. SNAP sanctions escalate with each occurrence:6Texas Health and Human Services. A-1840, Noncooperation with ESP

  • First failure: a one-month minimum penalty or until you cooperate, whichever is longer.
  • Second failure: a three-month minimum penalty or until you cooperate.
  • Third or later failure: a six-month minimum penalty or until you cooperate.

For TANF, failing to cooperate with Choices work-program requirements triggers a full-family sanction for at least one month or until you begin cooperating.6Texas Health and Human Services. A-1840, Noncooperation with ESP

Appealing a Denial or Sanction

If HHSC denies your caregiving exemption or imposes a sanction, you can request a fair hearing. You have 90 calendar days from the effective date of the action or the date of the notice, whichever is later, and you can request the hearing in writing or orally. For SNAP, you can also challenge your current benefit level at any point during your certification period, regardless of the 90-day window.7Texas Health and Human Services. 1400, Submitting a Fair Hearing Request Summary

HHSC staff cannot refuse to accept an appeal because they think it was filed too late; the hearings officer decides whether to accept a late filing for good cause.7Texas Health and Human Services. 1400, Submitting a Fair Hearing Request Summary To start, contact your local HHSC office or call 2-1-1.