Form H1021, Payment Agreement - Verbal Authorization for One-Time Debit of an Active Lone Star Food Account

Texas Health and Human Services

This government document is issued by Texas Health and Human Services for use in Texas

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File Details: PDF (31.4 KB)
Downloads: 4
Source
https://www.hhs.texas.gov/regulations/forms/1000-1999/form-h1021-payment-agreement-verbal-authorization-one-time-debit-active-lone-star-food-account

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