Benefits Access Inquiry Form

In partnership with Your Texas Benefits

Navigating public benefits can be overwhelming, but you don’t have to do it alone. Our Benefits Access Navigators are here to help you apply for programs like food assistance, health coverage, and more. Complete the inquiry form below to connect with a Benefits Access Navigator. Our navigators help individuals and families identify, apply for, and maintain access to public benefits and social service programs.

Benefits types our navigators can assist in applying for: Children Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Medical Insurance, and more!

Are you a resident of Harris County?(Required)

If you are not a resident of Harris Country, please contact 211 for resources

Name(Required)

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Address(Required)

Street Address Address Line 2 City State ZIP Code

Date of Birth(Required)

Phone(Required)

Email(Required)