food stamps and snap and tanf report change form texas
Submitted by Unregistered User on Thu, 12/26/2019 - 18:25

food stamps and tanf programs in texas texas health and human services
Form H1019
April 2018-E
Report of Change
You must report changes to your case within 10 days of the change.
1. Families who get TANF must report changes in:
• Address.
• Source of household earned and unearned income.
• Amount of unearned income.
• The number of people in your household.
• Receipt of a car or other licensed vehicle purchased by your household or received as a gift.
• Wage rate or status (full-time to part-time or vice versa as defined by the employer).
• The total amount of your resources, such as money in bank or savings accounts, stocks, bonds, or cash, when the total goes over
$1,000 for TANF and $2,000 for Adult Medicaid households.
• Termination of pregnancy.
• Receipt of or change in a resource that may provide payment for medical services. This includes getting or changing health
insurance coverage, or getting a settlement payment from an insurance or accident claim.
• Address, job, or other information related to the absent parent.
2. Everyone who gets Medicaid or CHIP benefits must report changes if:
• Their address changes.
• They no longer live in Texas or are planning to leave Texas.
• Anyone moved in or out of their home.
• They get more money.
• They get money from a different person or job.
• The amount of hours they work changes.
• Their pregnancy ended — either by birth or miscarriage.
• There's a change in getting health insurance.
• (The following is needed only if the person gets Medicaid and: (1) is age 65 or older, or (2) has a disability.) They buy, get as a gift,
or sell things such as: car, truck, boat, motorcycle, home, property, insurance policy, stocks, or bank accounts.
• (The following is needed only if the person gets Medicaid or CHIP and: (1) is age 64 or younger, or (2) doesn't have a disability.)
There's a change in the people they will claim or plan to claim as tax dependents on their next tax return.
3. SNAP Streamlined Reporting (SR) households must report changes in:
• The amount of money everyone on your case gets each month before taxes are taken out, if it becomes $ or more.
Right now, we show the amount everyone on your case gets each month before taxes are taken out is $ .
• Address.
• Housing costs at a new address (rent, home payment, home tax and insurance, water, sewer, electricity, gas, phone, other). Tell us
as soon as you know there will be changes to these costs. Don't wait to get your new bills to tell us.
Able Bodied Adult without Dependents (ABAWD). Work or participation hours fall below an average of 20 hours per week. This
includes all employment and self-employment income and any hours that count toward the work requirement.
4. SNAP Non-Streamlined Reporting households must report changes in:
• Address.
• Housing costs at a new address (rent, home payment, home tax and insurance, water, sewer, electricity, gas, phone, other). Tell us
as soon as you know there will be changes to these costs. Don't wait to get your new bills to tell us.
• Source of household earned and unearned income.
• The legal obligation to pay child support.
• The number of people in your household.
• Receipt of a car or other licensed vehicle purchased by your household or received as a gift.
• Wage rate or status (full-time to part-time or vice versa as defined by the employer).
• Any unearned income greater than $50 per month.
• The total amount of your resources, such as money in bank or savings accounts, stocks, bonds, or cash, when the total goes
over $5,000.
Page 2 / 04-2018-E
Form H1019
When you report a change, you might need to give us proof of the change. To give us proof, you can: (1) upload your files showing proof on
www.YourTexasBenefits.com, or (2) give us copies of items showing proof when you give us this form.
Another person can report changes for you. You can ask for a receipt for your change report.
Your advisor can explain what type of proof of the change is required.
Reporting these changes is a way to make sure your household receives all the benefits it is entitled to. If you withhold any information or give
false information about changes you are required to report, you will owe us the value of any extra benefits you received as a result, and you
may also lose some deductions. You also may be barred from receiving SNAP food benefits for one year to permanently, and be fined
$250,000, imprisoned for 20 years, or both. A member of your household will never be able to get SNAP food benefits again if they are found
guilty in a court of law of:
• buying or selling firearms, ammunition, or explosives in exchange for SNAP food benefits, or
• illegally buying, selling, trading, or redeeming $500 or more in SNAP food benefits.
Name Case No. Advisor Date
Your household is responsible for reporting changes to this office within 10 days. You are required to report changes based on your reporting
requirements listed on Page 1.
Give the date of each change and an explanation of the change. Attach proof of the change(s).
How long do you expect the change to last?
Signature – Person Reporting Change Date Telephone No. of Person Reporting Change
You can report changes one of the following ways:
• Go to: www.YourTexasBenefits.com.
• Call toll-free: 2-1-1 or 1-877-541-7905.
After you pick a language, press 2.
• Fax this form to: 1-877-447-2839.
• Mail this form to:
Texas Health and Human Services Commission
PO Box 149024
Austin, TX 78714-9024
Signature – Representative Receiving Report of Change Date
Signing up to vote:
Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency.
If you are not registered to vote where you live now, would you like to apply to register to vote here today? Yes No
IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS TIME. If
you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours.
You may fill out the application form in private. If you believe that someone has interfered with your right to register or to decline to register to
vote, or your right to choose your own political party or other political preference, you may file a complaint with the Elections Division, Secretary
of State, P.O. Box 12060, Austin, TX 78711. Phone: 1-800-252-8683.
Page 3 / 04-2018-E
Form H1019
With a few exceptions, you have the right to request and be informed about the information the Texas Health and Human Services Commission
(HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct
information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and
your right to request correction, please contact your local eligibility determination office.
The information provided on this form will be subject to verification of federal, state, and local officials. If any is found inaccurate, you may be
denied SNAP food benefits and/or be subject to criminal prosecution for knowingly providing false information.
Anyone buying or selling controlled substances (illegal drugs or certain drugs for which a doctor's prescription is required) in exchange for
SNAP food benefits will not be able to get SNAP food benefits for two years for the first offense and permanently for the second offense.
Anyone who gives false information in order to receive SNAP food benefits more than once in a month may be barred from the SNAP food
benefits for 10 years.
Agency Use Only: Voter Registration Status
Already registered Client declined Agency transmitted Client to mail Mailed to client Other
Agency staff signature
date put here dec 2019
Form H1019-F
Submitted by Unregistered User on Thu, 12/26/2019 - 20:32
Form H1019-F December 2012-E Reporting Changes to Your Case You must report changes to your case within 10 days of the change. You can go to www.YourTexasBenefits.com to report changes, or use Page 2 of this form. You must report the following types of changes: Address and phone: Where you live, where you get your mail or your phone numbers. Facts about you: Pregnancy, school, citizenship, felonies, health insurance policy or military status. Things you are paying for or own: If you have more than $10,000 in cash, bank accounts, loans, vehicles, stocks, bonds, CDs, IRAs or trusts. Money from a job: Amount of money you make, how often you are paid, hours you work, if you are on strike or the reason you left a job. Money from working for yourself: Type of job, amount of money you make, how often you are paid, number of months you will work, costs you pay for the job, or if a job ended. Other money you get: Child support, alimony, insurance payment, dividends, interest, foster care, gifts, pensions, SSI or retirement. Housing costs: Rent, house payment, utilities, taxes, insurance or homeowners association fees. Day care costs: Care for a child or adult so you can work, find work, or go to school or training. To report these changes or any other changes you have, you can: • • • • Tips: • • • • • you will owe us the value of any extra benefits you were not supposed to get. Form H1019-F Page 2 / 12-2012-E Change Report Name Case No. Advisor Date You must report changes to your case within 10 days of the change. You must report changes outlined on Page 1 of this form. Give the date of each change and the reason for the change. You must show proof of the changes you list. To show proof, send copies of forms showing the change you are reporting. For example, if the amount of money you make at your job changes, send a copy of your pay stub. Date of Change Reason For Change How long do you expect the change to last? Signature — Person reporting change Date Telephone No. of Person Reporting the Change If you have questions or want to report changes, contact: Address Field City State ZIP Code Call 2-1-1 or 1-877-541-7905 (toll-free). After you pick a language, press 2. Signing up to vote: Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. If you are not registered to vote where you live now, would you like to apply to register to vote here today? Y N If you do not check either box, you will be considered to have decided not to register to vote at this time. If you would like help filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private. If you believe that someone has interfered with your right to register or to decline to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with the Elections Division, Secretary of State, P.O. Box 12060, Austin, TX 78711. Phone: 1-800-252-8683. With a few exceptions, you have the right to request and be informed about the information the Texas Health and Human Services Commission (HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please contact your local eligibility determination office. The information provided on this form will be subject to verification of federal, state and local officials. If any is found inaccurate, you may be denied SNAP food benefits and/or be subject to criminal prosecution for knowingly providing false information. Anyone buying or selling controlled substances (illegal drugs or certain drugs for which a doctor’s prescription is required) in exchange for SNAP food benefits will not be able to get SNAP food benefits for two years for the first offense and permanently for the second offense. Anyone who gives false information in order to receive SNAP food benefits more than once in a month may be barred from the SNAP food benefits for 10 years. Form H1019-F Page 3 / 12-2012-E Agency Use Only Signature — Person reporting change Date Voter Registration Status Already registered Client declined Agency Transmitted Client to mail Mailed to client Other Agency Staff Signature To report these changes or any other changes you have you can Fill out page 2 of this form and then mail it to the address listed on page 2 Write a letter and then mail it to the address listed on page 2 Call the office phone number listed on page 2 Contact your local eligibility determination office Tips If you are unable to report a change someone who knows about the change can report it for you Whenever a change is made you can ask for a receipt from the office Your advisor can tell you the type of proof you need to give when you report a change Reporting changes is a way to make sure people in your home get the right amount of benefits You must not hide any facts about a change you must tell the truth about changes if you hide facts or don’t tell the truth You will owe us the value of any extra benefits you were not supposed to get
reply
Form H1019-F
Submitted by Unregistered User on Thu, 12/26/2019 - 21:49
Form H1019-F December 2012-E Reporting Changes to Your Case You must report changes to your case within 10 days of the change. You can go to www.YourTexasBenefits.com to report changes, or use Page 2 of this form. You must report the following types of changes: Address and phone: Where you live, where you get your mail or your phone numbers. Facts about you: Pregnancy, school, citizenship, felonies, health insurance policy or military status. Things you are paying for or own: If you have more than $10,000 in cash, bank accounts, loans, vehicles, stocks, bonds, CDs, IRAs or trusts. Money from a job: Amount of money you make, how often you are paid, hours you work, if you are on strike or the reason you left a job. Money from working for yourself: Type of job, amount of money you make, how often you are paid, number of months you will work, costs you pay for the job, or if a job ended. Other money you get: Child support, alimony, insurance payment, dividends, interest, foster care, gifts, pensions, SSI or retirement. Housing costs: Rent, house payment, utilities, taxes, insurance or homeowners association fees. Day care costs: Care for a child or adult so you can work, find work, or go to school or training. To report these changes or any other changes you have, you can: • • • • Tips: • • • • • you will owe us the value of any extra benefits you were not supposed to get. Form H1019-F Page 2 / 12-2012-E Change Report Name Case No. Advisor Date You must report changes to your case within 10 days of the change. You must report changes outlined on Page 1 of this form. Give the date of each change and the reason for the change. You must show proof of the changes you list. To show proof, send copies of forms showing the change you are reporting. For example, if the amount of money you make at your job changes, send a copy of your pay stub. Date of Change Reason For Change How long do you expect the change to last? Signature — Person reporting change Date Telephone No. of Person Reporting the Change If you have questions or want to report changes, contact: Address Field City State ZIP Code Call 2-1-1 or 1-877-541-7905 (toll-free). After you pick a language, press 2. Signing up to vote: Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. If you are not registered to vote where you live now, would you like to apply to register to vote here today? Y N If you do not check either box, you will be considered to have decided not to register to vote at this time. If you would like help filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private. If you believe that someone has interfered with your right to register or to decline to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with the Elections Division, Secretary of State, P.O. Box 12060, Austin, TX 78711. Phone: 1-800-252-8683. With a few exceptions, you have the right to request and be informed about the information the Texas Health and Human Services Commission (HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please contact your local eligibility determination office. The information provided on this form will be subject to verification of federal, state and local officials. If any is found inaccurate, you may be denied SNAP food benefits and/or be subject to criminal prosecution for knowingly providing false information. Anyone buying or selling controlled substances (illegal drugs or certain drugs for which a doctor’s prescription is required) in exchange for SNAP food benefits will not be able to get SNAP food benefits for two years for the first offense and permanently for the second offense. Anyone who gives false information in order to receive SNAP food benefits more than once in a month may be barred from the SNAP food benefits for 10 years. Form H1019-F Page 3 / 12-2012-E Agency Use Only Signature — Person reporting change Date Voter Registration Status Already registered Client declined Agency Transmitted Client to mail Mailed to client Other Agency Staff Signature To report these changes or any other changes you have you can Fill out pages 2 of this form and then mail it to the address listed on page 2 Write a letter and then mail it to the address listed on page 2 Call the office phone number listed on page 2 Contact your local eligibility determination office tips if you are unable to report a change someone who knows about the change can report it for you whenever a change is made you can ask for a receipt from the office your advisor can tell you the type of proof you need to give when you report a change reporting changes is a way to make sure people in your home get the right amount of benefits you must not hide any facts about a change you must tell the truth about changes if you hide facts or don’t tell the truth you will owe us the value of any extra benefits you were not supposed to get
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texas health and human
Submitted by Unregistered User on Thu, 12/26/2019 - 21:59
texas health and human services commission Report of Change h1019 July 2015-E You must report changes to your case within 10 days of the change. 1. Families who get TANF must report changes in: ● Address. ● Source of household earned and unearned income. ● Amount of unearned income. ● The number of people in your household. ● Receipt of a car or other licensed vehicle purchased by your household or received as a gift. ● Wage rate or status (full-time to part-time or vice versa as defined by the employer). ● The total amount of your resources, such as money in bank or savings accounts, stocks, bonds, or cash, when the total goes over $1,000 for TANF and $2,000 for Adult Medicaid households. ● Termination of pregnancy. ● Receipt of or change in a resource that may provide payment for medical services. This includes getting or changing health insurance coverage, or getting a settlement payment from an insurance or accident claim. ● Address, job, or other information related to the absent parent. 2. Everyone who gets Medicaid or CHIP benefits must report changes if: ● Their address changes. ● They no longer live in Texas or are planning to leave Texas. ● Anyone moved in or out of their home. ● They get more money. ● They get money from a different person or job. ● The amount of hours they work changes. ● Their pregnancy ended — either by birth or miscarriage. ● There's a change in getting health insurance. ● (The following is needed only if the person gets Medicaid and: (1) is age 65 or older, or (2) has a disability.) They buy, get as a gift, or sell things such as: car, truck, boat, motorcycle, home, property, insurance policy, stocks, or bank accounts. ● (The following is needed only if the person gets Medicaid or CHIP and: (1) is age 64 or younger, or (2) doesn't have a disability.) There's a change in the people they will claim or plan to claim as tax dependents on their next tax return. 3. SNAP Streamlined Reporting (SR) households must report changes in: ● The amount of money everyone on your case gets each month before taxes are taken out, if it becomes $ or more. Right now, we show the amount everyone on your case gets each month before taxes are taken out is $ . ● Address. ● Housing costs at a new address (rent, home payment, home tax and insurance, water, sewer, electricity, gas, phone, other). Tell us as soon as you know there will be changes to these costs. Don't wait to get your new bills to tell us. 4. SNAP Non-Streamlined Reporting households must report changes in: ● Address. ● Housing costs at a new address (rent, home payment, home tax and insurance, water, sewer, electricity, gas, phone, other). Tell us as soon as you know there will be changes to these costs. Don't wait to get your new bills to tell us. ● Source of household earned and unearned income. ● The legal obligation to pay child support. ● The number of people in your household. ● Receipt of a car or other licensed vehicle purchased by your household or received as a gift. ● Wage rate or status (full-time to part-time or vice versa as defined by the employer). ● Any unearned income greater than $50 per month. ● The total amount of your resources, such as money in bank or savings accounts, stocks, bonds, or cash, when the total goes over $5,000. When you report a change, you might need to give us proof of the change. To give us proof, you can: (1) upload your files showing proof on www.YourTexasBenefits.com, or (2) give us copies of items showing proof when you give us this form. Another person can report changes for you. You can ask for a receipt for your change report. Your advisor can explain what type of proof of the change is required. Reporting these changes is a way to make sure your household receives all the benefits it is entitled to. If you withhold any information or give false information about changes you are required to report, you will owe us the value of any extra benefits you received as a result, and you may also lose some deductions. You also may be barred from receiving SNAP food benefits for one year to permanently, and be fined $250,000, imprisoned for 20 years, or both. A member of your household will never be able to get SNAP food benefits again if they are found guilty in a court of law of: ● buying or selling firearms, ammunition, or explosives in exchange for SNAP food benefits, or ● illegally buying, selling, trading, or redeeming $500 or more in SNAP food benefits. Report of Change Page 2 / 07-2015-E Name Case No. Advisor Date Your household is responsible for reporting changes to this office within 10 days. You are required to report changes based on your reporting requirements listed on Page 1. Give the date of each change and an explanation of the change. Attach proof of the change(s). How long do you expect the change to last? You can report changes one of the following ways: Signature – Person Reporting Change Date Signature – Representative Receiving Report of Change Date Signing up to vote: Applying to register or declining to register to vote will not affect the amount of assistance that you will be provided by this agency. If you are not registered to vote where you live now, would you like to apply to register to vote here today? Yes No IF YOU DO NOT CHECK EITHER BOX, YOU WILL BE CONSIDERED TO HAVE DECIDED NOT TO REGISTER TO VOTE AT THIS TIME. If you would like help in filling out the voter registration application form, we will help you. The decision whether to seek or accept help is yours. You may fill out the application form in private. If you believe that someone has interfered with your right to register or to decline to register to vote, or your right to choose your own political party or other political preference, you may file a complaint with the Elections Division, Secretary of State, P.O. Box 12060, Austin, TX 78711. Phone: 1-800-252-8683. With a few exceptions, you have the right to request and be informed about the information the Texas Health and Human Services Commission (HHSC) obtains about you. You are entitled to receive and review the information upon request. You also have the right to ask HHSC to correct information that is determined to be incorrect (Government Code, Sections 552.021, 552.023, 559.004). To find out about your information and your right to request correction, please contact your local eligibility determination office. The information provided on this form will be subject to verification of federal, state, and local officials. If any is found inaccurate, you may be denied SNAP food benefits and/or be subject to criminal prosecution for knowingly providing false information. Anyone buying or selling controlled substances (illegal drugs or certain drugs for which a doctor's prescription is required) in exchange for SNAP food benefits will not be able to get SNAP food benefits for two years for the first offense and permanently for the second offense. Anyone who gives false information in order to receive SNAP food benefits more than once in a month may be barred from the SNAP food benefits for 10 years. Agency Use Only: Voter Registration Status Already registered Client declined Agency transmitted Client to mail Mailed to client Other Agency staff signature
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