How to Fill Out Texas HHS Form H3034: Sections A–H and Submission

Texas HHS Form H3034, the Disability Determination Socio-Economic Report, is completed by entering case identification in Section A, letting the eligibility specialist handle Sections B and C, filling in disability and Social Security application dates in Section D, and giving detailed answers about occupation, language, education, and the disability itself in Sections E through H. Every field needs an entry — mark “Not Applicable” rather than leaving anything blank — and the completed form goes back to your HHSC eligibility specialist, not directly to the Disability Determination Unit.¹

Who Fills It Out and When

The form can be completed by the eligibility specialist, the applicant, or an authorized representative. It’s prepared for every Medicaid for the Elderly and People with Disabilities (MEPD) case that needs a disability determination to finish the eligibility process.¹

You do not need Form H3034 if your disability is already established through SSI, RSDI Title II, or Railroad Retirement benefits. In that case the eligibility specialist verifies disability through Social Security Administration records and the Disability Determination Unit (DDU) is not involved. The form is required when the applicant is under 65 without an existing federal disability finding, when anyone applies for the Medicaid Buy-In program, when someone is presumed to be a child with a disability to meet an exception to a transfer penalty, or when a person under 65 in an institutional setting would qualify for SSI except for income.²

The current version is effective January 2026 and is available as a PDF from the HHSC forms page.¹ The official instructions call for entries that are brief, accurate, and legible, with no section left blank. Unanswered sections cause processing delays.

Section A: Case Identification

This section identifies the applicant. Enter the applicant’s full name, Social Security number, date of birth, and sex (M or F). Add the spouse’s first name, or check “Not Applicable” if there is no spouse. Enter the city or town where the applicant currently lives. The case number is filled in by the eligibility specialist.¹

Sections B and C: Agency Use

Section B is for the eligibility specialist, who checks a box for the Medicaid program the applicant is expected to qualify under. Section C is also agency-filled: the earliest month the applicant could potentially qualify for Medicaid and the HHSC application date used to calculate that onset. If retroactive coverage is being requested, the specialist notes those months here as well.³ If you are completing the form yourself, leave these two sections for the specialist.

Section D: Disability and SSA Application Dates

Enter the date the applicant applied for Social Security or SSI benefits, or check “Not Applicable” if no application was filed. Then enter the date the applicant became disabled. This onset date matters because Medicaid coverage cannot begin before the first day of the month in which the disability began.⁴ Be as precise as the records allow.

Section E: Occupation

Briefly describe the work the applicant has done for most of their life, including the most common job held before the disability began. Focus on the physical and mental demands of that work, not just the job title. “Warehouse worker, lifted boxes up to 50 pounds, stood for 8-hour shifts” tells the DDU far more than “warehouse worker” on its own. The purpose is to show the gap between what the job required and what the applicant can do now.

Section F: Language Preference

List the language the applicant wants HHSC to use for any follow-up communication. One line is enough.

Section G: Education

Provide the name and location of the school the applicant attended. If this does not apply, mark “Not Applicable” rather than leaving it blank.¹

Section H: Comments About the Disability

This is the open-ended section and the one where most applicants leave value on the table. Enter anything about the disability that could affect the outcome. Medical records document diagnoses and test results, but they rarely capture how a condition plays out day to day. Describe how the condition limits specific activities: how far the applicant can walk before needing to stop, whether they can lift a bag of groceries, how long they can sit before pain forces a position change, or how a mental health condition affects their ability to follow a daily routine.

“I have back pain” gives the DDU almost nothing. A paragraph of concrete limitations gives them something to weigh against the medical file.

What to Submit With the Form

Form H3034 doesn’t travel alone. It must be accompanied by Form H3035, the Medical Information Release/Disability Determination form, along with any available medical records. When they exist, include these as well:³

Minimum Data Set information, including the physician’s signature page.
Medical treatment records, which are required for waiver applicants.
Medical records for Community Attendant Services, required for applicants seeking primary home care through CAS.

The DDU can request more complete documentation after an initial review, so sending thorough records up front reduces the chance of a follow-up request that adds weeks to the timeline.

Where to Send the Completed Form

If you or an authorized representative filled out the form, return the original to the eligibility specialist. Do not mail it to the DDU yourself. The specialist bundles it with Form H3035 and the medical records and sends the complete packet to:³

Texas Health and Human Services Commission
P.O. Box 149027
Austin, TX 78714-9971

What Happens After You Submit It

The DDU reviews the socio-economic report, the medical release, and the medical records to decide whether the applicant meets the Social Security Administration’s definition of disability or blindness, and establishes the disability onset date.³ The eligibility specialist cannot issue a final Medicaid decision until the DDU has finished.

HHSC allows up to 90 days to decide an application that requires a DDU determination, compared with 45 days when disability is already established through SSA records.⁵ That 90 days is a maximum, not a promise, and incomplete records or a DDU follow-up can push a case close to the limit. With that in mind, double-check that every field on Form H3034 has an entry before you hand it in. The instructions warn specifically that blank sections cause delays.¹

1
Texas Health and Human Services. Form H3034, Disability Determination Socio-Economic Report
2
Texas Health and Human Services. D-2200, When a Medical Determination Is Required
3
Texas Health and Human Services. D-2300, Requesting a Decision from the Disability Determination Unit
4
Texas Health and Human Services. D-2600, Disability Determination Unit Decision
5
Texas Health and Human Services. B-6400, Processing Deadlines