If HHSC has asked for domicile verification, Texas Form H1155 is the one-page request your caseworker sends to a nonrelative who can confirm where you live. Your job is to get that form to a qualified witness, make sure every field on the second page is filled in, and return the signed form to HHSC before the deadline printed on the front.
Why You Received This Form
HHSC verifies every applicant’s physical address at each application and redetermination for state benefit programs.{1Texas Health and Human Services. A-760, Verification Requirements} Most of the time, a utility bill, rent receipt, Texas driver license, school record, or voter registration card handles it. Form H1155 comes into play when none of those standard documents are available, or when the caseworker considers the domicile questionable. The Texas Works Handbook directs staff to use Form H1155 (or Form H1857 for landlords specifically) to request a written statement from a nonrelative for TANF and related cases.{2Texas Health and Human Services. A-940, Verification Requirements}
The caseworker fills in the front of the form with your name, case number, address, and a return-by date, then routes it to the person who will verify the information. You don’t complete the front yourself.
Who Can Sign as the Witness
Printed on the bottom of the form is a clear restriction: it must be completed by a nonrelative who does not live with you.{3Your Texas Benefits. Texas Form H1155 – Request for Domicile Verification} Parents, siblings, in-laws, cousins, and anyone sharing your address are out, including a roommate who isn’t related. The witness needs firsthand knowledge of your household, not something they heard.
The form gives checkboxes for common witness types:
- Neighbor — someone close enough to see the household day to day
- Landlord — the owner or property manager
- Employer — someone with records showing your home address
- School official — a principal, registrar, or counselor familiar with the family
- Clergyperson — a minister, pastor, or other religious leader
- Child care provider — someone who cares for your children
- Friend — anyone with personal knowledge who fits no other category
- Other — a write-in with space to explain the relationship
If the obvious choice is unreachable, a neighbor or friend who regularly sees the household is fine. Personal familiarity matters; no professional credential is required.
What the Witness Fills In on Page Two
The witness completes the second page, which has four sections.{3Your Texas Benefits. Texas Form H1155 – Request for Domicile Verification}
Household roster. The witness lists every person living in the home, including you. For each person: name, relationship to you, and employer. HHSC uses this roster to cross-check who actually lives at the address against what you reported on your application. If someone in the household isn’t working, the employer field can read “N/A,” but the name and relationship still need to be there.
Witness category. The witness checks the box that fits their connection to the household. If none of the preset categories match, they check “Other” and write a short explanation.
Length of acquaintance. The form asks how long the witness has known the family, in years, months, and weeks. A short acquaintance doesn’t disqualify anyone, but a longer one carries more weight.
Signature and contact information. The witness signs and dates the form, then prints their full name, home address, and telephone number. HHSC may call to confirm the signature and the details, so the number has to be one they actually answer. A cell number is fine.
How to Return the Form to HHSC
Once the witness has signed, you can return the form through any of the standard submission channels:{4Texas Health and Human Services. Benefits Application Next Steps}
- Online: log into YourTexasBenefits.com, scan or photograph the form, and upload it through the document submission feature. This is the fastest option.
- Local office: drop it off in person at your nearest HHSC benefits office. Find yours at YourTexasBenefits.com/Screener/FindanOffice.
- Fax: 877-447-2839.
- Mail: HHSC, P.O. Box 149027, Austin, TX 78714-9027.
Watch the return-by date printed on the front. The caseworker sets that deadline, and missing it delays your whole application. Mail adds several days of transit; fax and upload land in the system the same day. Write your case number on every page so a loose sheet doesn’t end up in a processing backlog.
What Happens After You Submit
HHSC doesn’t review domicile verification on its own. The form gets processed as part of your overall eligibility determination. For SNAP, federal law requires the state to approve or deny the application within 30 days of the filing date.{5Food and Nutrition Service. SNAP Application Processing Timeliness}
If your domicile verification arrives late, that 30-day clock keeps running and the application can be denied for incomplete documentation rather than ineligibility. After you submit, check your YourTexasBenefits.com account and confirm the document status moves to “received.” If it doesn’t show up within a few business days of faxing or uploading, call your caseworker or the HHSC general line to follow up.
Getting the Form Back on Time
The hard part isn’t the paperwork. It’s coordinating with a third party who has no personal stake in your benefits timeline. A few things that help:
Line up your witness before the caseworker sends the form. If you already know a neighbor or landlord willing to help, tell your caseworker so the form goes to the right person. A hard-to-reach witness costs you days.
Walk the form through with your witness. The household roster asks for names, relationships, and employers of everyone in the home. Your witness may not know those details from memory. Give them a written list so nothing gets guessed at, and so the caseworker doesn’t have to call back with follow-up questions.
Confirm the phone number works. HHSC may call the witness to verify what’s on the form, and an unreachable witness can stall the whole verification.
Spanish Version
HHSC publishes a Spanish-language version of Form H1155 (file name h1155-s.pdf) on its forms page.{6Texas Health and Human Services. Form H1155, Request for Domicile Verification} If your witness would rather complete the form in Spanish, ask your caseworker for that version or download it from the HHSC site directly.