C—111 Income Limits

Revision 23-4; Effective Oct. 1, 2023

TANF

Temporary Assistance for Needy Families (TANF) Budgetary Allowances Effective Oct. 1, 2023

	Non-Caretaker Cases			Caretaker Cases Without Second Parent			Caretaker Cases With Second Parent
Family Size	Bud Needs (100%)	Rec Needs (25%)	Max Grant	Bud Needs (100%)	Rec Needs (25%)	Max Grant	Bud Needs (100%)	Rec Needs (25%)	Max Grant
1	$256	$64	$121	$313	$78*	$147	---	---	---
2	$369	$92	$174	$650	$163	$305	$498	$125**	$216
3	$518	$130	$243	$751	$188	$353	$824	$206	$386
4	$617	$154	$290	$903	$226	$424	$925	$231	$434
5	$793	$198	$372	$1003	$251	$471	$1073	$268	$503
6	$856	$214	$402	$1153	$288	$541	$1176	$294	$552
7	$1068	$267	$501	$1252	$313	$588	$1319	$330	$619
8	$1173	$293	$551	$1425	$356	$669	$1422	$356	$667
9	$1346	$337	$632	$1528	$382	$717	$1595	$399	$748
10	$1450	$363	$681	$1701	$425	$798	$1698	$425	$796
11	$1623	$406	$762	$1804	$451	$847	$1871	$468	$877
12	$1726	$432	$810	$1977	$494	$928	$1975	$494	$926
13	$1899	$475	$891	$2080	$520	$976	$2147	$537	$1,007
14	$2003	$501	$940	$2253	$563	$1,057	$2251	$563	$1,056
15	$2174	$544	$1,020	$2356	$589	$1,105	$2423	$606	$1,136
Each additional person	$173	$43	$81	$173	$43	$81	$173	$43	$81

* Caretaker of child receiving Supplemental Security Income (SSI)
** Caretaker and second parent of child receiving SSI
"Bud Needs" is budgetary needs.
"Rec Needs" is recognizable needs.

C—112 How to Prorate TANF Grants

Revision 22-3; Effective July 1, 2022

TANF

After eligibility is determined, the TANF grant amount is prorated for the first month of eligibility using the following steps:

1. Calculate the certified group's recommended grant amount for the month based on the household size and net income. (See Step 5, line 3, page 3 of Form H1101, TANF Worksheet, or Step 5, line 3, page 2 of Form H1102, TANF Worksheet for Special Reviews and Denials.)
2. Determine the earlier of the certification date or the 30th day after the file date. Using the chart in C-112.1, Proration Multiplier Chart, determine the appropriate proration multiplier.
3. Multiply the recommended grant amount from Step 1 by the multiplier from Step 2.
4. Round the amount from Step 3 down to the next dollar. If the resulting prorated grant is less than $10, the household is not eligible for a grant in the first month. The grant effective date is the first day of the following month.

Note: One-Time TANF and One-Time TANF for Relatives payments are not prorated.

C—112.1 Proration Multiplier Chart

Revision 01-7; Effective October 1, 2001

TANF

Date Financial Eligibility Begins	Proration Multiplier
1	1
2	.97
3	.93
4	.90
5	.87
6	.83
7	.80
8	.77
9	.73
10	.70
11	.67
12	.63
13	.60
14	.57
15	.53
16	.50
17	.47
18	.43
19	.40
20	.37
21	.33
22	.30
23	.27
24	.23
25	.20
26	.17
27	.13
28	.10
29	.07
30/31	.03

C—121 Maximum Income Limits

Revision 23-4; Effective Oct. 1, 2023

SNAP

SNAP Maximum Income Limits Effective Oct. 1, 2023

Household Size	Gross (130%)	Net (100%)	165%*
1	$1,580	$1,215	$2,005
2	$2,137	$1,644	$2,712
3	$2,694	$2,072	$3,419
4	$3,250	$2,500	$4,125
5	$3,807	$2,929	$4,832
6	$4,364	$3,357	$5,539
7	$4,921	$3,785	$6,246
8	$5,478	$4,214	$6,952
9	$6,035	$4,643	$7,659
10	$6,592	$5,072	$8,366
Each additional person	$557	$429	$707

* The figures in the 165 percent column are used to determine if a person who is elderly or a person with a disability living with others may claim separate household status even though the person purchases or prepares food with the others. The figures in this column are also the income limits for categorically eligible households.

C—121.1 Deduction Amounts

Revision 23-4; Effective Oct. 1, 2023

SNAP

• Standard Deduction

If the eligible household size is ...	then the standard deduction is ...
Three or less	$198
Four	$208
Five	$244
Six or more	$279

• Standard medical expense — $170 (minus $35)
• Actual medical expense (minus $35)
• Homeless shelter standard — $179.66
• Maximum excess shelter — $672
• Standard utility allowance (SUA) — $424
• Basic utility allowance (BUA) — $391
• Telephone standard — $60

Note: A disqualified member in the household size is not used when applying the standard deduction.

Related Policy

Deductions, A-1400

C—122 How to Determine Monthly SNAP Allotments

Revision 23-4; Effective Oct. 1, 2023

SNAP

To determine the monthly allotment for a household, use the whole monthly allotments by household size chart. Calculate the monthly allotment for a household with more than 10 people by adding $219 for each additional person to the whole monthly allotment:

Determine the monthly allotment by:

• multiplying the household's net monthly income by .30;
• rounding the cents to the next higher whole dollar amount; and
• subtracting the rounded sum from the maximum monthly allotment for the household size.

Example: To determine the monthly allotment of a 12-person household with a net monthly income of $964:

• $964 X .30 = 289.2
• $289.2 is rounded to the next whole dollar amount of $290; and
• $2,627 - $290 = $2,337 whole monthly allotment. 

Related Policy

How to Prorate Benefits, C-123
Whole Monthly Allotments by Household Size, C-1431
Prorated SNAP Allotments by Application Date, C-1432

C—123 How to Prorate Benefits

Revision 22-4; Effective Oct. 1, 2022

SNAP

A prorated allotment for the month of application is determined by using the Prorated SNAP Allotments by Application Date Chart, or by:

• subtracting the date of the application from 31;
• multiplying the sum by the amount of the whole monthly allotment; and
• dividing that amount by 30. If the date of the application is the 30th or 31st, the whole allotment is divided by 30. All cents are disregarded.

Example: A household with a whole monthly allotment of $395 applies on June 17. The household's prorated allotment for June is $184. (31 - 17 = 14; $395 × 14 = $5,530; $5,530 ÷ 30 = $184.33 or $184)

Note: Some categorically eligible households can receive ongoing monthly allotments of less than $10. Do not issue allotments prorated to less than $10. A one- or two-person household that qualified for a minimum monthly allotment of $23 can receive a prorated allotment of less than $23 but not a prorated allotment of less than $10.

Do not prorate benefits if the household includes a member who meets both of the following criteria:

• is a seasonal or migrant farm worker (in or out of the workstream); and
• was certified for SNAP in Texas or another state the month before the household applied.

Related Policy

Whole Monthly Allotments by Household Size, C-1431
Prorated SNAP Allotment by Application Date, C-1432

C—131 Income Limits

Revision 13-3; Effective July 1, 2013

 

C—131.1 Federal Poverty Level (FPL)

Revision 23-2; Effective April 1, 2023

TP 33, TP 34, TP 35, TP 36, TP 43, TP 44, TP 48, TP 40, TP 42, TA 74, TA 75 and TA 76

Family Size	133% FPL (3-1-23) TP 44, 34, TA 76	144% FPL (3-1-23) TP 48, 33, TA 75	198% FPL (3-1-23) TP 40, 42, 43, 36, 35, TA 74
1	$1,616	$1,750	$2,406
2	$2,186	$2,367	$3,254
3	$2,756	$2,984	$4,102
4	$3,325	$3,600	$4,950
5	$3,895	$4,217	$5,799
6	$4,465	$4,834	$6,647
7	$5,035	$5,451	$7,495
8	$5,604	$6,068	$8,343
9	$6,174	$6,684	$9,191
10	$6,744	$7,301	$10,039
11	$7,313	$7,918	$10,887
12	$7,883	$8,535	$11,735
13	$8,453	$9,152	$12,583
14	$9,022	$9,768	$13,431
15	$9,592	$10,385	$14,280
For each additional person	$570	$617	$849

Note: See C-1114, Guidelines for Providing Retroactive Coverage for Children and Medical Programs, for the income limits.

TA 41, TA 84 (CHIP), TA 85 (CHIP-P), TA 77 and TP 70

Family Size	201% FPL (3-1-23) TA 84	202% FPL (3-1-23) TA 85	204.2% FPL (3-1-23) TA 41	400% FPL (3-1-23) TA 77	413% FPL (3-1-23) TP 70
1	$2,443	$2,455	$2,482	$4,860	$5,018
2	$3,304	$3,320	$3,356	$6,574	$6,787
3	$4,165	$4,185	$4,231	$8,287	$8,556
4	$5,025	$5,050	$5,105	$10,000	$10,325
5	$5,886	$5,916	$5,980	$11,714	$12,095
6	$6,747	$6,781	$6,855	$13,427	$13,864
7	$7,608	$7,646	$7,729	$15,140	$15,633
8	$8,469	$8,511	$8,604	$16,854	$17,402
9	$9,330	$9,377	$9,479	$18,567	$19,171
10	$10,191	$10,242	$10,353	$20,280	$20,940
11	$11,052	$11,107	$11,228	$21,994	$22,709
12	$11,913	$11,972	$12,103	$23,707	$24,478
13	$12,774	$12,838	$12,977	$25,420	$26,247
14	$13,635	$13,703	$13,852	$27,134	$28,016
15	$14,496	$14,568	$14,727	$28,847	$29,785
For each additional person	$861	$866	$875	$1,714	$1,770

C—131.2 Medically Needy and Parents and Caretaker Relatives Medicaid

Revision 15-4; Effective October 1, 2015

TA 31, TP 08, TP 32, TP 56 and TA 86

-	-	TP 08, TA 31 and TA 86
Family Size	TP 32 and TP 56	One Parent	Two Parents
1	$104	$103	N/A
2	$216	$196	$161
3	$275	$230	$251
4	$308	$277	$285
5	$357	$310	$332
6	$392	$356	$367
7	$440	$389	$412
8	$475	$441	$447
9	$532	$476	$500
10	$567	$527	$535
11	$624	$562	$587
12	$659	$613	$622
13	$716	$648	$675
14	$751	$700	$710
15	$808	$734	$762
Per each additional member	$57	$52	$52

C—131.3 Transitional Medicaid

Revision 23-2; Effective April 1, 2023

TP 07

Family Size	185% FPL (3-1-23) TP 07
1	$2,248
2	$3,041
3	$3,833
4	$4,625
5	$5,418
6	$6,210
7	$7,003
8	$7,795
9	$8,588
10	$9,380
11	$10,172
12	$10,965
13	$11,757
14	$12,550
15	$13,342
For each additional person	$793

C—131.4 Standard MAGI Income Disregard

Revision 23-2; Effective April 1, 2023

Five Percentage Points of FPL
Family Size	2023 Monthly Disregard Amount
1	$60.75
2	$82.15
3	$103.60
4	$125.00
5	$146.45
6	$167.85
7	$189.25
8	$210.70
9	$232.10
10	$253.50
11	$274.95
12	$296.35
13	$317.75
14	$339.20
15	$360.60
For each additional person	$21.45

C—131.5 IRS Monthly Income Thresholds

Revision 23-2; Effective April 1, 2023

Each year, the Internal Revenue Service (IRS) establishes income thresholds for earned and unearned income. People whose income (earned, unearned, or a combination) exceeds the federal income tax filing threshold are expected by the IRS to file a federal income tax return under federal law. The IRS monthly income thresholds are used to determine if a person’s income must be counted when calculating Modified Adjusted Gross Income (MAGI) financial eligibility, as explained in A-1341, Income Limits and Eligibility Tests, for Medical Programs, Step 3.

Determining whether a person is required to file a federal income tax return is determined by comparing the specified income types to the IRS thresholds in the following table.

Type of Income	2023 Threshold	Apply Threshold Value in Form H1042, Modified Adjusted Gross Income (MAGI) Worksheet: Medicaid and CHIP
Unearned Income	$95.83	Page 4-6, Step 3, Part 7 Page 4-6, Step 3, Part 9
Earned Income	$1,079.17	Page 4-6, Step 3, Part 8

C—211 Opening Codes

Revision 02-3; Effective April 1, 2002

TANF

Select a code for the occurrence during the six months prior to certification that is the primary reason the household needs Temporary Assistance for Needy Families (TANF). Use these codes only in Item 132 on Form H1000-A, Notice of Application.

024	Period of Lump Sum Ineligibility Shortened Use this code to open a case previously denied because of a lump sum if the household becomes eligible because its period of ineligibility is shortened.

Earnings Lost or Reduced in the Last Six Months Because ...

025	Father Incapacitated Earnings of the father in the home have terminated or decreased because of his illness, injury, or impairment. The onset of the disability may have occurred prior to the last six months. The disabled father must be in the home unless he is receiving medical treatment out of the home.
026	Mother Incapacitated Earnings of the mother in the home have terminated or decreased because of her illness, injury, or impairment.
027	Other Caretaker Incapacitated Earnings of the children's caretaker in the home, other than the father or mother, have terminated or decreased because of the caretaker's illness, injury, or impairment. Use this code if the caretaker had been supporting the children before the loss of or decrease in earnings.
028	Father Laid Off Earnings of the children's father in the home have terminated or decreased because he has been laid off or discharged from his job or discontinued his self-employment.
029	Mother Laid Off Earnings of the children's mother in the home have terminated or decreased because she has been laid off or discharged from her job, or discontinued her self-employment.
030	Other Caretaker Laid Off Earnings of the children's caretaker in the home, other than the children's mother or father, have terminated or decreased because the caretaker has been laid off or discharged from a job, or discontinued self-employment. Use only if the caretaker had been supporting the children before the loss or decrease in earnings.

Support from the Caretaker Lost or Reduced in the Last Six Months Because the Caretaker ...

031	Died Use to indicate death of the caretaker who supported the children during the six months prior to death.
032	Left Home Use if the caretaker supported the children during the six months prior to leaving and has not provided sufficient support since leaving.
033	Was Incarcerated Use if the caretaker supported the children during the six months prior to incarceration.

Support from Person in the Home Other Than Father, Mother, or Other Caretaker Was Lost or Reduced in the Last Six Months Because the Person ...

034	Died Use to indicate death of the person who supported the children during the six months prior to death.
035	Left Use if the person supported the children during the six months prior to leaving and has not provided sufficient support since leaving.
036	Is Incapacitated Use if the person is unable to continue supporting the children because of the person's disability.
037	Is Laid Off Use if the person is unable to continue supporting the children because of a change in employment status.

Support from Person Outside the Home Lost or Reduced in the Last Six Months Because ...

039	Absent Father Discontinued or Reduced the Children's Support Payments Use if the children's father has been absent for the past six months; if father left home in the past six months, use code 032.
040	Another Person Discontinued or Reduced the Children's Support Payments Use if someone outside the home other than the children's father stopped or reduced the children's support payments.

Other Income Lost or Reduced in the Last Six Months Because ...

041	TANF Father, Mother, or Other TANF Caretaker Lost or had a Reduction in Income Not Listed in Codes 025-040 Examples of income include RSDI; allowance, pension, or other payment connected with military service; unemployment benefits; workers' compensation; and rental income. Do not include the loss of any income based on need.

Depletion of the Family's Assets in the Last Six Months Because of ...

042	Medical Care Cost Medical care cost includes all items for medical or remedial care, including care in nursing facilities.
043	Other Living Costs These costs do not include medical care costs.
044	Other Material Change Examples of circumstances include loss of investments through business failure or loss of home or other buildings by fire. Do not use if the assets produced income that provided full or partial support. Use code 041, loss of or reduction in other income. Use if the household was previously certified under the real property exemption based on good faith effort to sell, and the family sold the property or it is no longer accessible.

No Change in Income or Resources During the Last Six Months. The Only Change in the Last Six Months Is ...

046	Increased Need or Other Budget Items A change in household composition or living arrangements resulted in increased needs for the TANF family.
047	No Proration of Benefits TP 01, use this code when certifying a stepchild and his parent after they have been removed from a TANF incapacity or a TANF-SP TP 61 case that is transferring to MAO, TP 07, 37, or Medical Programs for Families and Children. See B-483 for more information. an other-related child after he has been removed from an existing TANF/TANF-SP case. See B-482, Separating Household Members, for more information. SAVERR enters a six-month periodic review in Item 141. Use to administratively reopen a TP 01 or 61 case after denying a TP 01 or 61 case on hold in order to prevent the automated systems from counting a month(s) toward a individual's time limit. When used, TANF grants will not be prorated, and SAVERR will enter a six-month periodic review in Item 141.

No Change in Income or Resources During the Last Six Months. The Only Change in the Last Six Months Is ...

049	The Applicant Met the Eligibility Requirement for Residence
050	The Applicant Met the Eligibility Requirement for Citizenship
052	The Applicant Met Another Technical Eligibility Requirement
053	The Applicant Applied for Assistance
056	A Change That Cannot Be Related to Codes 045-053 Example is the departure of an unemployed caretaker who has not provided support.

Administrative Opening Codes

054	Post (Child Support) or Transitional Medicaid Reinstatement Use to reinstate a denied TP 20 household that returns to live in Texas, or TP 07 or TP 37 household that meets the requirements in A-800, Medicaid Eligibility.
055	Denied in Error Use to reopen a case or application that was denied by mistake.
057	Medicaid Administrative Opening Code Use to open a TP 07, 20, 29, or 37 case Medical Programs for Families and Children case When the TP 01 or TP 61 case on hold was denied, instead of transferred, in order to prevent the automated systems from counting a month(s) toward an individual's time limit. "Person(s) meet Medicaid eligibility requirements." "Persona(s) llena los requisitos de elegibilidad de Medicaid." For TPs 07, 29, and 37, also include the following message: "While receiving transitional Medicaid, you must report to HHSC within 10 days after you move and after anyone moves in or out of your household." "Mientras reciba Medicaid de transición, tiene que avisar a la HHSC dentro de los 10 días de su cambio de case o del cambio del número de personas de su casa."

 

C—212 Denial Codes

Revision 12-1; Effective January 1, 2012

TANF

Reasons for denying cases and applications are classified into three groups:

1. ineligibility because of death of a member;
2. need; and
3. miscellaneous reasons.

Select the code reflecting the primary reason for denial. If a reason related to need and another reason occur at the same time, use the need code. Enter in Item 132 of Form H1000-A, Notice of Application, and Form H1000-B, Record of Case Action.

Death (058-059)

058	Death of Caretaker No Notice.
059	Death of Child – A-500, Age/Relationship "You no longer have children in your home who are eligible for assistance." "Ya no hay niños en su casa que califican para asistencia."

Need (060-075)

060	Earnings of Father, Legal or Stepfather — A-1323.5, Wages, Salaries, Commission and Tips Use for applications and ongoing cases that are not eligible for post-medical coverage. "Earnings of father meet needs that can be recognized by this agency." "El padre gana suficiente para cubrir las necesidades reconocidas por esta agencia."
061	Earnings of Mother, Legal or Stepmother — A-1323.5, Wages, Salaries, Commission and Tips Use for applications and ongoing cases that are not eligible for post-medical coverage. "Earnings of mother meet needs that can be recognized by this agency." "La madre gana suficiente para cubrir las necesidades reconocidas por esta agencia."
062	Earnings of TANF Child – A-1323.1, Children's Earned Income Use for applications and ongoing cases that are not eligible for post-medical coverage. "Earnings of child meet needs that can be recognized by this agency." "Su hijo/hija gana suficiente para cubrir las necesidades reconocidas por esta agencia."
063	Earnings of Non-Parent Caretaker — A-1323.5, Wages, Salaries, Commission and Tips Use for applications and ongoing cases that are not eligible for post-medical coverage. "Earnings of other person in your home meet needs that can be recognized by this agency." "Una persona que vive en su casa gana suficiente para cubrir las necesidades reconocidas por esta agencia."
064	Support from Absent Father — A-1326.1, Cash Gifts and Contributions; A-1326.2, Child Support; A-1334, Vendor Payments (See chart in C-241, TANF and Medical Programs Chart, for appropriate reference codes.) "Income from children's father who is outside the home meets needs that can be recognized by this agency." "El padre que no vive en la misma casa manda suficiente dinero para cubrir las necesidades reconocidas por esta agencia."
065	Pursuit of Texas Works Activities — A-1527, The Texas Works Message "You have chosen to pursue employment opportunities and/or save your time-limited benefits for another time." "Usted decidió buscar empleo y/o usar sus beneficios de tiempo limitado en ortra occasión."
066	Support from Other Person Outside the Home, Including Mother — A-1326.2, Child Support; A-1334, Vendor Payments (See chart in C-241, TANF and Medical Programs Chart, for appropriate reference codes.) "Income available to you from a person outside the home meets needs that can be recognized by this agency." "El dinero que recibe de un pariente fuera de su casa es suficiente para cubrir las necesidades reconocidas por esta agencia."
067	RSDI — A-1324.15, Retirement, Survivors, and Disability Insurance(RSDI) "Income available to you from social security benefit meets needs that can be recognized by this agency." "El cheque que usted recibe ahora, o va a recibir, del seguro social es suficiente para cubrir las necesidades reconocidas por esta agencia."
068	Other Federal Benefits — A-1324.19, Veterans Benefits "Income available to you from federal benefit or pension meets needs that can be recognized by this agency." "El dinero que usted recibe ahora de beneficios o pensiones federales es suficiente para cubrir las necesidades reconocidas por esta agencia."
069	State and Local Benefits — A-1326.9, Pensions; A-1324.18, Unemployment Compensation; A-1321.4, Workers Compensation(See chart in C-241 for appropriate reference codes.) Includes workers' compensation, unemployment compensation, state and local government retirement benefits. "Income available to you from state or local benefit or pension meets needs that can be recognized by this agency." "El dinero que usted recibe de beneficios o pensiones de gobierno local o del estado es suficiente para cubrir las necesidades reconocidas por esta agencia."
070	Non-Governmental Benefits — A-1326.9, Pensions "Income available to you from pension or benefit meets needs that can be recognized by this agency." "El dinero que recibe usted de pensiones or beneficios es suficiente para cubrir las necesidades reconocidas por esta agencia."
071	Income Not Codes 060 — 070 — A-13XX (See chart in C-241, TANF and Medical Programs Chart, for appropriate reference codes.) A-800, Medicaid Eligibility, for TP 07/37 "Income available to you meets needs that can be recognized by this agency." "El dinero que gana o recibe usted es suficiente para cubrir las necesidades reconocidas por esta agencia."
072	Resources — A-12XX (See chart in C-241, TANF and Medical Programs Chart, for appropriate reference codes.) "Resources available to you from other property meets needs that can be recognized by this agency." "Los recursos que tiene usted en propiedades or dinero son suficientes para cubrir las necesidades reconocidas por esta agencia."
074	Fewer Members in Certified Group — A-1341, Income Limits and Eligibility Tests "No unmet need for the current family size." "Ahora que usted tiene menos familia, sus entradas son suficientes para cubrir las necesidades reconocidas por esta agencia."
075	Conflicting Information on Management — A-1700,Management "Information on management indicates additional income." "Según la información que tenemos acerca de su situación económica, parece ser que usted no reportó toda su entrada."
076	Refusal to Furnish Information — B-100, Processes and Processing Time Frames Use only if a Form H1010-B, Application for Assistance -Part B: Information We Need Know, is on file. Use code 091 for failure to return Form H1010-B. "You did not wish to furnish enough information for this agency to establish eligibility for assistance." "Usted no quiso darnos suficiente información para poder establecer su calificación para asistencia."
077	Refusal to Follow Agreed Plan — A-1311, Requirement to Pursue Income Use to deny ongoing cases when an individual fails to pursue potential sources of income or resources that would be made available through the individual's efforts. "You did not wish to follow agreed plan so that eligibility for assistance could be continued." "Usted ya no califica para asistencia porque no quiso utilizar, según el plan que hablamos, otros posibles recursos."
078	Earnings/Child Support Payments Terminate — A-800, Medicaid Eligibility Use to deny Medicaid coverage before the end of the four- or twelve-month period for TP 07 or TP 37 transitional Medicaid when the caretaker relative has no earnings for one month on the 7th or 10th month Medicaid Report, or TP 20 Medicaid when child support payments terminate. "Your Medicaid coverage following denial of your grant has ended as agreed." "Como fue acordado al terminar su concesión, su calificación para los beneficios de Medicaid termina ahora."
083	Federal Time Limits — A-1900, Federal Time Limits (FTLs) Use to deny an application or ongoing case because a household member has received 60 months of TANF assistance. "Your household is ineligible for TANF due to federal time limits, because the following person has received 60 months of TANF cash assistance. Your family may still be eligible for Medicaid. Contact your local office for information." "Debido alos límites de tiempo federal su unidad familiar no tiene derecho a TANF porque la siguiente persona ha recibido asistencia económica de TANF 60 meses. Es posible que sue familia todavía tenga derecho a Medicaid. Comuníquese con la oficina local para recibir información."
086	Child Admitted to Institution, Including Foster Care —A-900,Domicile "Your child has been admitted to an institution." "Su niñoha sido admitido a un hospital u otra institución."
087	No Eligible Child – A-900, Domicile, or A-800, Medicaid Eligibility, for TP 07/37 Use to deny applications or ongoing cases because the child does not meet relationship requirements or is no longer in the home. "You no longer have children in your home who are eligible for assistance." "Usted ya no tiene niños en su casa que califican para asistencia."
088	Residence Requirement Not Met — A-700, Residence Use for applications and for ongoing cases when the household moves out of state. "Residence requirements are not met." "Sus niños no califican para asistencia porque no cumplen con el requisito de residencia en el estado."
089	Citizenship or Acceptable Alien Status — A-300, Citizenship "Your children do not meet acceptable alien status or citizen requirements for assistance." "Sus niños no son elegibles para asistencia porque no cumplen con el requisito de ciudadanía ni de inmigrante elegible."
090	Prior Eligibility — A-800, Medicaid Eligibility; A-1900, Federal Time Limits (FTLs); A-2400, One Time Payments Use to authorize Medicaid or TANF warrants for denied households eligible for restored benefits. deceased individuals. individuals eligible for three months prior Medicaid only. applicants eligible for Medicaid for the application month but ineligible for TANF or Medicaid for the month following the application month. applicants eligible for TANF and Medicaid for the current month but ineligible for future months. "Assistance was granted during a prior period, but you are not eligible now for medical or financial assistance." "Usted calificó anteriormente para asistencia pero ahora ya no califica para asistencia económica ni para beneficios médicos." Use to open and close TP 37 between cutoff in the 11th and 12th months. "Your original period of transitional Medicaid has been reinstated." "Su cobertura bajo Medicaid de transición ha sido aprobada de nuevo para el periodo originalmente especificado." Use to authorize OTTANF benefits. "Your family will receive $1,000 for mm/dd/yy. Your family will be ineligible to apply for TANF, TANF-SP, or OTTANF until mm/dd/yy."
091	Failure to Furnish Information — B-100, Processes and Processing Time Frames Use this code if the applicant/individual fails to return the application form. "You failed to complete and return the necessary eligibility form." "Usted no ha entregado la forma completa que necesitamos para determinar su elegibilidad para asistencia."
092	Other Eligibility Requirements — A-132, Eligibility Factors Use to deny applications and ongoing cases for reasons other than need but not covered by codes 076-091. It cannot be entered by advisors to deny medical assistance only cases. "You do not meet eligibility requirements for assistance." "Usted no califica para asistencia." Note: SAVERR enters this code at the end of the Medicaid period for TP 07, TP 20 and TP 37. "Your Medicaid coverage has ended." "Su cobertura de Medicaid ha terminado."
093	Adult Earnings (Refugee Only) — R-700, Age/Relationship Use to deny RCA applications and ongoing cases that are not eligible for post medical coverage. Use only if the case is an adult case with no children. "You will not be eligible for Medicaid after mm/dd/yy." "La elegibilidad para Medicaid termina el mm/dd/yy."
094	Appointment Not Kept, Application/Review — B-100, Processes and Processing Time Frames "You failed to keep your appointment." "Usted no vino a la cita que le dimos."
095	Unable to Locate — A-700, Residence "You cannot be located." "No podemos localizar al solicitante."
096	Refugee Exceeds Eight-Month Limit — R-100, RCA/RMA Use to deny an RCA application or ongoing case because the household members entered the U.S. more than eight months ago. "You will not be eligible for TANF after mm/dd/yy." "La elegibilidad para Medicaid termina el mm/dd/yy."
097	Filed In Error — No Notice Use to deny a Notice of Application (NOA) that was created erroneously.
098	Voluntary Withdrawal — A-100, Application Processing Use only if an applicant requests that the application be withdrawn, or a current recipient requests that HHSC discontinue the case and the advisor cannot determine the reason. Otherwise use the applicable code. "You have advised us that you no longer want to apply for TANF." "Usted nos avisó que ya no desea solicitar TANF." "You have advised us that you no longer want to receive TANF." "Usted nos avisó que ya no desea recibir TANF."
099	Other Miscellaneous — A-1000, Deprivation Use to deny TP 01 coverage for members who must be added to a TANF-SP case. "Your needs are now included in the TANF-SP case." "Ahora el caso de TANF-SP cubre sus necesidades." Use to deny a case for other miscellaneous reasons. "You do not presently meet eligibility requirements." Usted presentemente no califica para asistencia."
134	Refusal to Assign Child Support Rights — A-1100, Child Support Use to deny an application or ongoing case because the caretaker's needs are removed for refusal to make assignment and income meets the needs of the remaining members. "You did not wish to assign support rights to the state." "No quiso usted conceder al estado el derecho de cobrar sostenimiento."
135	Provide AP's Info or Location — A-1100, Child Support Use to deny an application or an ongoing case because the caretaker's needs are removed for refusal to provide information on the absent parent or cooperate in locating the absent parent, and income meets the needs of the remaining members. "You did not supply information on the absent parent or assist support officer in locating the absent parent." "Usted no dio información sobre el padre o la madre ausente, o no ayudó al funcionario de manutención de niños a localizar a dicha persona."
136	Provide Verification of Citizenship — A-350, Verification Requirements Use to deny an application or ongoing case because all members in the certified group failed to provide verification of citizenship. "You did not provide proof of U.S. Citizenship." "Usted no presentó prueba de ciudadanía estadounidense."
137	Refusal to Help to Establish Paternity — A-1100, Child Support Use to deny a case because the caretaker's needs are removed for refusal to cooperate in establishing paternity and income meets needs of remaining members. "You chose not to help in establishing paternity." "No quiso usted ayudar a establecer la paternidad."
180	Increased Earnings from Employment Services — A-1323.5, Wages, Salaries, Commission and Tips Use to deny cases not eligible for post medical coverage if the denial results from employment or increased earnings within six months after participation in employment services. Also use to deny RCA cases because of failure to comply with employment/training requirements. "You are now ineligible due to increased earnings after employment services." "Usted no califica porque su salario aumentó después de su en el programa de servicios de empleo."
181	Refusal to Comply With Employment Services, Caretaker —A-1800, Employment Services Use to deny a case because the caretaker's needs are removed for failure to comply and income meets needs of remaining members. "You are now ineligible due to caretaker's refusal to register for employment services." "Usted no califica porque no quiso inscribirse en el programa de servicios de empleo."
196	Failed to Sign the Responsibility Agreement — A-2100, Personal Responsibility Agreement "Failure to sign the Responsibility Agreement." "Usted no firmó el Acuerdo de Responsabilidad Personal."
200	Time Limit or Hardship Ends/Household Member Disqualified – A-2500, State Time Limits "You are ineligible for TANF because _____________'s needs were removed following time limit policies." "Usted no será elegible para TANF porque _____________ dejó de ser elegible según las normas de los límites de tiempo."
201	OT Ineligibility Period – A-2400, One Time Payments "You are currently not eligible to receive TANF, OTTANF, or TANF-SP because you have received OTTANF during the past 12 months." "En este momento usted no es elegible para recibir TANF, OTTANF, ni TANF-SP porque usted ya recibió OTTANF que cubre los últimos 12 meses."
217	Income Over 185% FPIL or No Earnings During the Fourth Month Transitional Reporting Period "Your transitional Medicaid will be shortened to six months because you had no income or your gross earnings meet the needs that can be recognized by this agency." "Su Medicaid de transición se recortará a seis meses porque usted no tuvo ingresos o su salario bruto es suficiente para cubrir las necesidades que este departamento puede reconocer."
230	Transitional Medicaid Expired at the End of the 12th Month — Computer Sent

 

C—213 Reinvestigation Codes

Revision 02-8; Effective October 1, 2002

TANF

Select the code that best represents the reason for the case action. Enter it in Item 132, Form H1000-B, Record of Case Action, if taking action to raise, lower, sustain, or transfer a case to another type program.

Reasons for Raised Grants

101	"Your available income or resources are less." "Usted tiene ahora menos ingresos o recursos."
102	"Needs this agency can include in your check are more." "Ahora usted tiene más necesidades que esta agencia puede cubrir con su cheque."
103	"Your income and needs have changed." "Sus ingresos y sus necesidades cambiaron."

Reasons for Lowered Grants

104	"Your available income or resources have increased." "Usted tiene ahora másingresos o recursos."
105	"Needs this agency can include in your check are less." "Ahora usted tiene menos necesidades que esta agencia puede cubrir con su cheque."
106	"Your income and needs have changed." "Sus ingresos y sus necesidades cambiaron."

Reasons for Sustained Grants and Medical Assistance

107	"Needs included in your check remain the same." "Las necesidades cubiertas por su cheque no han cambiado."
108	"Changes in income and needs do not affect check." "Los cambios en sus ingresos y en sus necesidades no afectan su cheque."
109	"You are receiving the maximum assistance check." "Usted recibe la máxima cantidad de assistencia que se da."
110	"You remain eligible for medical coverage." "Usted sigue siendo elegible para beneficios médicos."

Reasons for Change in Assistance Status

111	Use when transferring from TP 01 or 61 to any income assistance medical program. "You are now eligible for medical coverage only." "Usted es elegible ahora sólo para beneficios médicos." Use when transferring from TP 01 or 61 to TP 40 to provide continuous coverage for a pregnant woman. "The pregnant woman on your TANF case is eligible for continuous medical coverage." "La mujer de su caso de TANF que está embarazada es elegible para cobertura médica continua."
112	Use when transferring from any income assistance medical program to TP 01 or 61. "You are eligible for financial and medical assistance." "Usted es elegible para beneficios médicos y asistencia financiera."

Reasons for Lowered Grants Because of Employment Services Program (ESP) Participation

115	"Earnings after ESP training have increased." "Las entradas aumentaron después de su entrenamiento para empleo."
116	"Adult's needs removed due to refusal to participate in employment services." "Las necesidades del adulto que se negó a participar en los servicios de empleo no pueden ser consideradas."

Transfers To and From Income Assistance Grant Programs

118	"Your family is now eligible for TANF-SP benefits only." "Ahora su familia es elegible solamente para beneficios de TANF-SP."
119	"Your family is now eligible for regular TANF benefits only." "Ahora su familia es elegible solamente para beneficios regulares de TANF."

Payee Change

120	Use when changing the payee from one designated relative to another relative when there is no break in assistance to the TANF children included in the case. "You will now receive the assistance payment." "Ahora va a recibir el cheque de asistencia a nombre de usted."

Transfers To and From Medical Programs for Families and Children

121

Use when transferring from any medical assistance program to another medical assistance program. This includes TP 07, 20, 29, 37, 40, 42, 43, 44, 45, 47, 48, and 55. "You have been transferred to another type of medical assistance." "Le cambiaron de una categoria del programa médico aotra." Use when transferring from any medical assistance program to TP 40 to allow continuous coverage for a pregnant woman. This includes TPs 07, 29, 37, 47 or an active TP 55 to TP 40. "The pregnant woman on your Medicaid case is eligible for continuous medical coverage." "La mujer de su caso de Medicaid que está embarazada es elegible para cobertura médica continua."

Reasons for Change in Transitional Medicaid Assistance Status

123	Use for TP 07 and TP 37 when shortening transitional Medicaid to end after six months, or restoring transitional Medicaid back to the original 12 months. "Your transitional Medicaid has changed because of the fourth-month Medicaid report." "Sus beneficios de transición de Medicaid han cambiado debido a su reporte para Medicaid del cuarto mes."

Reasons for Sustaining or Raising Benefits Because of Child Support

125	Removal of child's needs due to child support from absent parent, and income changes do not affect check. Use when removing a child's needs from the budget because of child support but other household income changes result in no grant change.
126	Sustained benefits. "Child support activities do not affect your TANF or Medicaid benefits." "Las actividades relacionadas con sostenimiento para niños no afectan sus beneficios de TANF ni de Medicaid."
127	Child's needs removed due to child support and your income has changed. Use when removing the needs of a child receiving child support from an absent parent, but raising the grant because other income has decreased.
128	Raised grant. "Your needs have increased and child support no longer exceeds the grant." "Sus necesidades han aumentado y el pago de sostenimiento para niños que recibe ya no sobrepasa la cantidad de la concesión."

Reasons for Lowering Benefits Because of Child Support

129	Child's needs removed due to child support received from absent parent. Use when lowering a grant because the needs of a child who is receiving child support from an absent parent are removed from the budget.
130	"You did not wish to assign support rights to the state." "No quiso usted conceder al estado el derecho de cobrar sostenimiento."
131	"You did not wish to supply information on absent parent." "No quiso usted dar informes acerca del padre/de la madre ausente."
132	"You chose not to cooperate with the child support officer." "No quiso usted colaborar con el encargado de los cobros de sostenimiento para niños."
133	"You chose not to assist in establishing paternity." "No quiso usted ayudar aaclarar la paternidad."
139	"Your grant has been reduced because a household member became eligible for SSI or SSA disability."

Reason/Message for Lowered Grant Because of Time Limits

138	Time Limit or Hardship Ends/Household Member Disqualified "Your grant was lowered because __________'s needs were removed following time-limit policies." "Se redujo su pago mensual porque _________ dejó de ser elegible según las normas de los límites de tiempo."

Reason/Message for Raised Grant Because of Time Limits

150	Time Limit or Hardship Ends/Household Member Disqualified "Your grant was raised. However, _________'s needs were removed following time-limit policies." "Se sebió su pago mensual. Sin embargo, __________ dejó de ser elegible según las normas de los límites de tiempo."

Reason/Message for Sustained Grant and Medical Assistance Because of Time Limits

160	Time Limit or Hardship Ends/Household Member Disqualified Use when sustaining TP 01 or 61. "Your grant remains the same. However, ____________'s needs were removed following time-limit policies." "Su pago mensual seguirá igual. Sin embargo, __________ dejó de ser elegible según las normas de los límites de tiempo."

Reason/Message for Change in Assistance Status Because of Time Limits

170

Time Limit or Hardship Ends/Household Member Disqualified Use when transferring from TP 01 or 61 to any income assistance medical program. "You are eligible for medical assistance only. You are ineligible for a TANF grant because__________'s needs were removed following time-limit policies." "Usted es elegible para recibir solamente ayuda médica. Dejó de ser elegible para pagos mensuales de TANF porque ____________ dejó de ser elegible según las normas de los límites de tiempo." When transferring to TP 29, also include the following message: "While receiving transitional Medicaid, you must report to HHSC within 10 days after you move and after anyone moves in or out of your household." "Mientras reciba Medicaid de transición, tiene que avisar a HHSC dentro de los 10 días de su cambio de casa o del cambio del número de personas de su casa."

C—221 Denial Codes

Revision 12-1; Effective January 1, 2012

SNAP

601	Excess Income, see C-242 for appropriate reference codes "The amount of money you get each month is over the allowed amount." "La cantidad de dinero que recibe cada mes sobrepasa la cantidad límite."
602	Excess Resources, see C-242 for appropriate reference codes "The value of the things you own (resources) goes over the allowed amount." "El valor de las cosas de las que es dueño (recursos) sobrepasan la cantidad límite."
603	Transferred Resources — A-1212 "You knowingly transferred resources to qualify for SNAP food benefits." "Transfirio sus recursos con la intención de recibir beneficios de comida del Programa SNAP."
604	Death No notice will be sent.
605	Program Violation No notice will be sent.
606	Ineligible Students — A-200 "All members of your household are ineligible students." "Todos los miembros de su casa son estudiantes inelegibles."
607	Refusal to Cooperate — C-920 "You refused to cooperate." "Usted se negó a cooperar."
608	Voluntary Withdrawal — A-100 "You have advised us that you no longer wish to receive SNAP food benefits." "Nos dijo que ya no quiere recibir beneficios de comida del Programa SNAP."
609	Failure to Provide Information — B-100 and C-900 "You did not provide enough information for this office to determine eligibility for SNAP food benefits." "No nos dio información suficiente para determinar si puede recibir beneficios de comida del Programa SNAP."
610	Work Registration — A-1800 See Form H1017, Notice of Benefit Denial or Reduction, instructions for specific individual messages.
611	Voluntary Quit — A-1800 "The household's primary wage earner voluntarily left his most recent job without good cause." "La persona que mantenia la casa dejó su empleo voluntariamente sin tener una razón aceptable."
612	Unable to Locate — A-700 "You cannot be located at the address you gave us." "En la dirección que usted nos dió, no se le puede localizar."
613	Moved from State — No notice will be sent.
614	Other, enter the appropriate reference Indicate the specific reason.
615	Missed Appointment — B-100 "You failed to keep your appointment after submitting an application for SNAP food benefits." "No se presento´ a la cita que le demos despues de presentar la solicitud de beneficios de comida del Programa SNAP."
616	No Citizens or Eligible Aliens — A-300 "No member of the household is a U.S. citizen or an alien eligible for SNAP food benefits." "Ninguno de los miembros de su familia es ciudadano de los Estados Unidos o, elegible para recibir beneficios de comida del Programa SNAP."
617	Application Filed in Error — No Notice Use to deny a Notice of Application (NOA) that was created erroneously.
621	Work Registrant Earnings — A-1323.5 "The amount of money you got from jobs (wages) goes over the allowed amount." "La cantidad de dinero que recibio de trabajos (salario) sobrepasa el limite establecido."
622	Postponed Verification Not Provided – Expedited – A-145 "Your benefits were denied because you failed to provide the proof we requested when you were certified for expedited (emergency) services." "Esta negación de beneficios se debe a que usted nunca entregó las pruebas que se le pidieron cuando le declararon elegible para los beneficios de emergencia."
625	State Office Use Only (SAVERR default code – open/close) No notice.
626	State Office Use Only (CCDMI/permanent move) No notice.
627	18-50 Denial — A-1900 "You have been disqualified for failing to meet the requirement for working 20 hours per week. To avoid the denial of benefits, you must begin working an average of 20 hours per week." "Usted ha sido descalificado por no satisfacer el requisito de trabajar 20 horas por semana. Para evitar la negación de beneficios, usted tiene que comenzar a trabajar un promedio de 20 horas por semana."
630	State Office Use Only (Certification period expired) No notice.

C—231 Opening Codes

Revision 02-6; Effective July 1, 2002

Medical Programs

Code	Detail
048	TP 40 Use when providing continuous coverage for pregnant woman on TP 40 using Form H1000-A. "The pregnant woman in your household is eligible for continuous medical coverage." "La mujer de su caso de Medicaid que está embarazada es elegible par cobertura médica continua." TP 43, TP 44, TP 47 and TP 48 Use when providing continuous coverage for a child on TP 43, 44, 47, or 48. "The following people in your household are eligible for continuous medical coverage." "Las siguientes personas de su casa son elegibles para cobertura medica continua."
052	TPs 40, 43, 44, 45, 48, and 55 without spend down "Meets eligibility requirements." "Llena los requisitos de elegibilidad."
055	TPs 40, 43, 44, 45, 48, and 55 without spend down Use to reopen a case or application that was denied by mistake. "Denied in error." "Se negó por equivocación."
057	TPs 40, 43, 44, 45, 48, and 55 without spend down Use when opening a case instead of transferring from TP 01 or 61 in order to prevent the automated systems from counting a month(s) toward a individual's time limit. "Person(s) meet Medicaid eligibility requirements." "Persona(s) llena los requisitos de elegibilidad de Medicaid."

C—232 Denial Codes

Revision 09-3; Effective July 1, 2009

Medical Programs

Code	Detail
059	Death of Child (TPs 43, 45, 44, and 48) — A-500 "You no longer have children in your home who are eligible for assistance." "Ya no hay niños en su casa que califican para asistencia."

Earnings (TPs 43, 44, 47, 48, and 55)

Code	Detail
060	Earnings of Father — A-1323.5 "Earnings of father meet needs that can be recognized by this agency." "El padre gana suficiente para cubrir las necesidades reconocidas por esta agencia."
061	Earnings of Mother — A-1323.5 "Earnings of mother meet needs that can be recognized by this agency." "La madre gana suficiente para cubrir las necesidades reconocidas por esta agencia."
062	Earnings of Child – A-1323.1 "Earnings of child meet needs that can be recognized by this agency." "Su hijo/hija gana suficiente para cubrir las necesidades reconocidas por esta agencia."
063	Earnings of Non-Parent Caretaker — A-1323.5 "Earnings of other person in your home meet needs that can be recognized by this agency." "Una persona que vive en su casa gana suficiente para cubrir las necesidades reconocidas por esta agencia."

Financial Support (TPs 43, 44, 47, 48, and 55)

Code	Detail
064	Support from Absent Father — A-1300 "Income from children's father who is outside the home meets needs that can be recognized by this agency." "El padre que no vive en la misma casa manda suficiente dinero para cubrir las necesidades reconocidas por esta agencia."
065	Support from Relative in Household "Income from relative in your household meets needs that can be recognized by this agency." "El dinero que recibe de un pariente que vive en su casa es suficiente dinero para cubrir las necesidades reconocidas por esta agencia."
066	Support from Person Outside the Home "Income available to you from a person outside the home meets needs that can be recognized by this agency." "El dinero que recibe de un pariente fuera de su casa es suficiente para cubrir las necesidades reconocidas por esta agencia."
067	RSDI (TPs 40, 43, 44, 47, and 48) — A-1324.15 "Income available to you from social security benefit meets needs that can be recognized by this agency." "El cheque que usted recibe ahora, o va a recibir, del seguro social es suficiente para cubrir las necesidades reconocidas por esta agencia."
068	Other Federal Benefits (TPs 43, 44, 47, 48, and 55) —A-1324.19 "Income available to you from Federal benefit or pension meets needs that can be recognized by this agency." "El dinero que usted recibe ahora de beneficios o pensiones Federales es suficiente para cubrir las necesidades reconocidas por esta agencia."
069	State and Local Pensions or Benefits (TPs 43, 44, 47, 48, and 55) —A-1300 "Income available to you from state or local benefit or pension meets needs that can be recognized by this agency." "El dinero que usted recibe de beneficios o pensiones del gobierno local o del estado es suficiente para cubrir las necesidades reconocidas por esta agencia."
070	Non-Governmental Pensions or Benefits (TPs 43, 44, 47, 48, and 55) —A-1326.9 "Income available to you from pension or benefit meets needs that can be recognized by this agency." "El dinero que recibe usted de pensiones o benficios es suficiente para cubrir las necesidades reconocidas por esta agencia."
071	Excess Assets Income (TPs 40, 43, 44, 47, and 48) — A-13XX (See chart in C-241 for appropriate reference codes.) "Income available to you meets needs that can be recognized by this agency." "El dinero recibe ustedes suficiente para cubrir las necesidades reconocidas por esta agencia." (TPs 55 and 30) — A-13XX (See chart in C-241 for appropriate reference codes.) "Income available to you exceeds the medically needy needs allowance and you have no medical expenses to spend down your income." "Usted dispone de ingresos que sobrepasan el limite para ser elegible para beneficios por necesidad médica y usted no tiene gastos médicos que se pudieran desontar de sus ingresos."
072	Excess Assets — Resources (TPs 43, 44, 47, 48, and 55) — A-12XX (See chart in C-241 for appropriate reference codes.) "Resources available to you from other property meets needs that can be recognized by this agency." "Los recursos que tiene usted en propiedades o dinero son suficientes para cubrir las necesidades reconocidas por esta agencia."
074	Fewer Members in Certified Group (TPs 40, 43, 44, 47, 48, and 55) —A-1341 "No unmet need for the current family size." "Ahora, que usted tiene meno familia, sus entradas son suficientes para cubrir las necesidades reconocidas por esta agencia."
075	Conflicting Information on Management (TPs 40, 43, 44, 47, 48, 55, and 30)— A-1700 "Information on management indicates additional income." "Según la información que tenemos, acerca de su situación económica, parece ser ue usted no reportó toda su entrada."
076	Refusal to Furnish Information (TPs 40, 45, 43, 44, 47, 48, 55, and 30)— B-100 "You did not wish to furnish enough information for this agency to establish eligibility for assistance." "Usted no quiso darnos suficiente información para poder establecer su calificación para asistencia."
077	Refusal to Follow Agreed Plan (TPs 40, 43, 44, 47, and 48) —A-1311 "You did not wish to follow agreed plan so that eligibility for assistance could be continued." "Usted ya no califica para asistencia porque no quiso utilizar, según el plan que hablamos, otros posibles recursos."
078	Automatic Denial (TP 40) Automatic denial because of anticipated pregnancy termination.
079	Refusal to Obtain Medical Information for Pregnancy or Disability Determinations (TPs 40, 55, and 30) — A-800 "You did not wish to obtain required medical verification." "Usted no quiso obtener la verificación médica requerida."
080	Parent Not Incapacitated (TPs 55 and 30) — A-1000 "You do not meet the agency's definition of incapacity." "Según la definición de 'incapacidad' de esta agencia, usted no califica."
082	Legal Marriage (TPs 40 and 55) "Your children are not deprived of parental support. The primary wage earner does not meet the employment or work history requirements." "A sus niños no les falta el sostenimineto paterno. El sostén principal de la casa no cumple con los requisitos con respecto a desempleo."
086	Child Admitted to Institution (TPs 40, 45, 43, 44, 47, 48, 55, and 30)— A-900 "Your child has been admitted to an institution." "Su niño ha sido admitido a un hospital u otra institución."
087	No Eligible Child (TPs 40, 45, 43, 44, 47, 48, and 55) —A-900 "You no longer have children in your home who are eligible for assistance." "Usted ya no tiene niños en su casa que califican para asistencia."
088	Residence (TPs 40, 45, 43, 44, 47, 48, 55, and 30) —A-700 "Residence requirements are not met." "Sus niños no califican para asistencia porque no complen con el requisito de residencia en el estado."
089	Citizenship or Acceptable Alien Status (TPs 40, 45, 43, 44, 47, 48, 55, and 30) — A-300 "Citizenship or acceptable alien status requirements are not met." "No cumplen con los requisitos de ciudadanía ni de inmigrante elegible."
090	Open/Close Coverage (TPs 40, 45, 43, 44, 47, 48, 55, and 30) "Assistance was granted during a prior period, but you are not eligible now for medical assistance." "Usted calificó anteriormente para asistencia pero ahora ya no califica para beneficios médicos."
091	Failure to Furnish Information (TPs 40, 45, 43, 44, 47, 48, 55, and 30)— B-100 "You failed to complete and return the necessary eligibility form." "Usted no ha entregado la form completa que necesitamos para determinar su elegibilidad."
092	Other Eligibility Requirements (TPs 40, 45, 43, 44, 47, 48, 55, and 30)— A-100 Use for denying TP 45 because the certified child becomes one year old, or the child's mother is no longer eligible for Medicaid. "You do not meet eligibility requirements for assistance." "Usted no califica para asistencia."
094	Appointment Not Kept (TPs 40, 45, 43, 44, 47, 48, 55, and 30) —B-100 "You failed to keep your appointment." "Usted no vino a la cita que le dimos."
095	Unable to Locate (TPs 40, 45, 43, 44, 47, 48, 55, and 30) —A-700 "You cannot be located." "No lo podemos localizar a usted."
096	Refugee Exceeds Eight-Month Limit (TP 55) — R-430
097	Filed In Error (TPs 40, 45, 43, 44, 47, 48, 55, and 30) — No Notice Use to deny a Notice of Application (NOA) that was created erroneously.
098	Voluntary Withdrawal (TPs 40, 45, 43, 44, 47, 48, 55, and 30) —A-100 "You have requested that your application for assistance be withdrawn." "Usted nos pidió que fuera retirada su solicitud osu concesión para asistencia."
099	Other Miscellaneous (TPs 40, 45, 43, 44, 47, 48, 55, and 30) —A-100 "You do not presently meet eligibility requirements." "Usted presentemente no califica para asistencia."
134	TP 55 without spend down  "You did not wish to assign support rights to the state." "No quiso usted conceder al estado el derecho de cobrar sostenimineto."
135	Provide AP's Info or Location — (A-1100) Use to deny an application or an ongoing case because the caretaker's needs are removed for refusal to provide information on the absent parent or cooperate in locating the absent parent, and income meets the needs of the remaining members. "You did not supply information on the absent parent or assist support officer in locating the absent parent." "Usted no dio información sobre el padre o la madre ausente, o no ayudó al funcionario de manutención de niños a localizar a dicha persona."
136	Provide Verification of Citizenship — (A-350) Use to deny an application or ongoing case because all members in the certified group failed to provide verification of citizenship. "You did not provide proof of U.S. Citizenship." "Usted no presentó prueba de ciudadanía estadounidense."
137	TP 55 without spend down "You chose not assist in establishing paternity." "No quiso usted ayudar a establecer la paternidad."
195	Monthly Income Exceeds Maximum Limits (TPs 40, 43, 44, 47, and 48) "You are ineligible because your monthly income exceeds the needs recognized by this agency." "Usted no es elegible porque sus ingresos mensuales sobrepasan las necesidades reconocidas por esta agencia."

C—233 Reinvestigation Codes

Revision 01-7; Effective October 1, 2001

Medical Programs

Code	Detail
110	(TPs 40, 45, 43, 44, 47, 48, and 55 without spend down) "You remain eligible for medical coverage." "Sigue siendo elegible para asistencia médica."
120	(TPs 45, 43, 44, 47, 48, and 55 without spend down) "You will now receive the medical coverage on behalf of the children." "Ahora usted va a recibir los beneficios médicos para sus hijos."

Use the following codes to clear Form H1708, Report of Noncooperation:

Code	Detail
126	(TPs 45, 43, 44, 47, 48, and 55 without spend down) "Child support activities do not affect your TANF or Medicaid benefits." "Las actividades con respecto a sostenimiento para niños no afectan sus beneficios de TANF y los de Medicaid."
132	(TPs 45, 43, 44, 47, 48, and 55 without spend down) "You chose not to cooperate with the child support officer." "No quiso usted colaborar con el encargado de los cobros de sostenimiento para niños."

C—241 TANF and Medical Programs Chart

Revision 02-3; Effective April 1, 2002

TANF and Medical Programs

Action Code	GWS Screen	New Reference
060 Earnings of Father	Earned Income	A-1323.5	Wages, Salaries
061 Earnings of Mother	Earned Income	A-1323.5	Wages, Salaries
062 Earnings of TANF Child	Earned Income	A-1323.1	Earnings of Child
063 Earnings of Non-parent Caretaker	Earned Income	A-1323.5	Wages, Salaries
064 Support from Absent Father	Contributions, Child Support, or Vendor Payments	A-1326.1 A-1326.2 A-1334	Gifts or Contributions Child Support Vendor Payments– Legally Obligated
066 Support from Other Person Outside the Home, Including Mother	Contributions or Vendor Payments	A-1326.1 A-1334	Gifts or Contributions Vendor Payments– Legally Obligated
067 RSDI	RSDI	A-1324.15	RSDI
068 Other Federal Benefits	VA	A-1324.19	VA Benefits
069 State and Local Pensions or Benefits	Retirements Workers' Compensation Unemployment	A-1326.9 A-1321.4 A-1324.18	Pensions Workers' Compensation Unemployment Benefits
070 Non-Governmental Benefits	Retirements	A-1326.9	Pensions
071 Income Not Codes 060 - 070 Excess Assets – Income	All Types of Countable Income	A-1324.17 A-1326.1 A-1326.2 A-1326.6 A-1322.2 A-1331 A-1326.9 A-1324.15 A-1326.9 A-1323.4 A-1324.18 A-1334 A-1324.19 A-1323.5 A-1321.4 A-1310	Non-Generic TANF Gifts or Contributions Child Support Interest – Bank Account Unearned – WIOA Lump Sum Income Pensions RSDI RR Retirement Self Employment Income Unemployment Benefits Vendor Payments – Legally Obligated VA Benefits Wages, Salaries Workers' Compensation Other types of income which do not have a designated GWS screen.
072 Resources Excess Assets – Resources	All Countable Resources	A-1210 A-1210 A-1232.2 A-1242 A-1231.4 A-1238 A-1200	Cash-on-Hand, Stocks, Bonds, Bank Accounts Land, Oil, and Mineral Rights, PASS Accounts Prepaid Burial Lump Sum Payments Retirement – Pensions Vehicles Includes all other types of resources which do not have a designated GWS Screen.

 

C—242 SNAP Chart

Revision 01-7; Effective October 1, 2001

SNAP

Action Code		GWS Screen	New Reference
601	Excess Income	Income – Earned or Unearned	A-1324.17 A-1326.1 A-1326.2 A-1322.1 A-1326.6 A-1322.2 A-1331 A-1326.9 A-1324.15 A-1324.16 A-1323.4 A-1324.18 A-1334 A-1324.19 A-1323.5 A-1321.4 A-1310	TANF Grant Gifts or Contributions Child Support Educational Assistance – Non Title IV Bank Accounts– Interest Unearned – WIOA Lump Sum Income Pensions RSDI SSI Self Employment Unemployment Benefits Vendor Payments– Legally Obligated VA Benefits Wages and Salaries Workers' Compensation Other income which does not have a designated GWS screen.
602	Excess Resources	Resources – Countable	A-1210 A-1210 A-1242 A-1236.4 A-1231.4 A-1238 A-1200	Cash-on-Hand, Stocks, Bonds, Bank Accounts Land, Oil, and Mineral Rights Lump Sum Payments Real Property Retirement Accounts Vehicles Other resources not listed in this section because they do not have a designated GWS screen.

Revision 12-3; Effective July 1, 2012

TANF

The following is a list of full and minimum service Choices counties.

Region	Full Service Counties	Minimum Service Counties
Region 1	Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum	King
Region 2	Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stephens, Stonewall, Taylor, Throckmorton, Wichita, Wilbarger, Young	Kent
Region 3	Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise	Not applicable
Region 4	Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt , Wood	Not applicable
Region 5	Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler	Not applicable
Region 6	Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton	Not applicable
Region 7	Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson	Not applicable
Region 8	Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, LaSalle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala	Not applicable
Region 9	Andrews, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler	Borden, Loving
Region 10	Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio	Not applicable
Region 11	Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata	Not applicable

C—321 Current TANF State Time Limit County Hardship List

Revision 24-1; Effective Jan. 1, 2024

TANF

Benefits Issued for January 2024 Through March 2024

Region	County	County Code
11	Starr	214

C—322 Previous TANF State Time Limit County Hardship Lists

Revision 24-1; Effective Jan. 1, 2024

TANF

Benefits Issued for October 2023 Through December 2023

Region	County	County Code
11	Starr	214

Benefits Issued for July 2023 Through September 2023

Region	County	County Code
11	Starr	214

Benefits Issued for April 2023 Through June 2023

Region	County	County Code
8	Zavala	254
11	Starr	214

 

C—331 Current SNAP ABAWD Work Requirement Waiver Counties

Revision 22-4; Effective Oct.  1, 2022

SNAP

Effective October 2022

Region	County	County Code
None	None	None

 

C—332 Previous SNAP ABAWD Work Requirement Waiver Counties

Revision 22-4; Effective Oct.  1, 2022

SNAP

Effective October 2021

Region	County	County Code
None	None	None

Revision 18-4; Effective October 1, 2018

Region	SNAP Employment and Training Counties
Region 1: High Plains	Bailey, Castro, Childress, Deaf Smith, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Moore, Ochiltree, Potter, Randall, Terry
Region 2: Northwest Texas	Archer, Baylor, Brown, Clay, Coleman, Comanche, Cottle, Eastland, Foard, Hardeman, Haskell, Jack, Mitchell, Montague, Nolan, Runnels, Scurry, Stephens, Taylor, Wichita, Wilbarger, Young
Region 3: Metroplex	Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Jones, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise
Region 4: Upper East Texas	Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood
Region 5: Southeast Texas	Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Orange, Polk, Sabine, San Jacinto, Shelby, Trinity, Tyler
Region 6: Gulf Coast	Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton
Region 7: Central Texas	Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Llano, Madison, McLennan, Milam, Robertson, San Saba, Travis, Washington, Williamson
Region 8: Upper South Texas	Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, LaSalle, Lavaca, Limestone, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala
Region 9: West Texas	Coke, Concho, Crockett, Dawson, Ector, Howard, Irion, Kimble, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Tom Green, Ward
Region 10: Upper Rio Grande	Brewster, Culberson, El Paso, Presidio
Region 11: Lower South Texas	Aransas, Bee, Brooks, Cameron, Hidalgo, Jim Hogg, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata

C—341 SNAP Non-Employment and Training Counties

Revision 22-4; Effective Oct. 1, 2022

Region	SNAP Non-Employment and Training Counties
Region 1: High Plains	Armstrong, Briscoe, Carson, Cochran, Collingsworth, Crosby, Dallam, Dickens, Donley, Floyd, Gray, Hall, Hansford, Hartley, Hemphill, King, Lipscomb, Lynn, Motley, Oldham, Parmer, Roberts, Sherman, Swisher, Wheeler, Yoakum
Region 2: Northwest Texas	Callahan, Fisher, Kent, Knox, Shackelford, Stonewall, Throckmorton
Region 4: Upper East Texas	None
Region 5: Southeast Texas	Newton, San Augustine
Region 7: Central Texas	Mills
Region 9: West Texas	Andrews, Borden, Crane, Gaines, Glasscock, Loving, Martin, Terrell, Upton, Winkler
Region 10: Upper Rio Grande	Hudspeth, Jeff Davis
Region 11: Lower South Texas	Duval, Kenedy, Live Oak, McMullen

Revision 12-2; Effective April 1, 2012

All Programs

• Alphabetical County Names, Codes and Regions

Revision 05-4; Effective August 1, 2005

General Information

All Programs

Form H1000-A, Notice of Application, Form H1000-B, Record of Case Action, and Form H1000-C, Secondary Client Input, are manual forms used in all programs to report applications, the subsequent denial or certification of eligibility, and changes and deletions to information for certified and denied cases. Use a separate Form H1000-A, Form H1000-B or Form H1000-C to report actions taken in each individual program.

Form H1000-A is a four-part form. Each part has the same control number.

• Part 1, Notice of Application (NOA) is a short form that
  • indicates that an application was filed and the date filed, and
  • gives information for an NOA report to field staff about individual information already in the computer file.
• Part 2, Input Document, is a page advisors use for handwritten entries during the decision process. Use the input document to
  • report the final disposition of an application,
  • correct Items 01 through 38 already sent on the NOA,
  • authorize the issuance of benefits, or
  • establish a central file on all individual data.
• Part 3, Case Record Copy, is a carbon copy of Part 2. It contains information on the NOA and the disposition of an application for audits.
• Part 4, Case Index Card, is a carbon copy of the NOA used to
  • make a central file of pending applications in the local office, and
  • report changes on pending applications.

Form H1000-B is a three-part form. The assigned case number and sequence number appears on all copies of the form. To request Form H1000-B, use Form H1004, Request for Form H1000-B.

• Part 1, Record of Case Action, is a computer-generated form that shows current case information.
• Use the Part 2, Input Document, to
  • update information;
  • report the disposition of a redetermination; or
  • authorize, adjust, or cancel benefits.
• Part 3, Case Record Copy, is identical to Part 2, Input Document. All items entered on the input document appear on the Case Record Copy.

Form H1000-C is a one-part form. Use this form to enter

• start and end dates for PRA penalties and good cause,
• finger image code and vun, and
• disqualifications and Supplemental Nutrition Assistance Program (SNAP) work requirement countable months.

Advisors must submit Form H1000-A or Form H1000-B with Form H1000-C.

 

C—511 Form H1000-A

Revision 05-4; Effective August 1, 2005

All Programs

Correct any errors made on Part I, Notice of Application (NOA), before submitting the form for processing.

You must process the NOA before entering the input document information. Batch and submit the NOA before, or on the same day as, the input document.

If staff damage or lose Form H1000-A, Notice of Application, substitute the same form from another set. Block out the preprinted application number and enter the application number of the original NOA.

If the number of applicants listed on Form H1010-B, Application for Assistance - Part B: Information We Need to Know, exceeds 11 people, complete an additional set of forms. Complete Item 04, Page, on the first NOA. Block out the preprinted application number on the additional NOA forms and enter the original application number of the first NOA. Make entries in

Item 04, Page;
Item 06, Budgeted Job Number;
Item 07, Mail Code;
Item 09, Case Name; and
Items 33-38. Make sure to begin with line "b" in Items 33-38.

Staple the NOAs together and batch as one.

When an applicant moves and the move requires the transfer of a pending application to another office, forward all material, including Form H1031, Case Record Transfer. The receiving office is responsible for updating the new budgeted job number, mail code, and county number.

 

C—512 Form H1000-B

Revision 02-3; Effective April 1, 2002

All Programs

The Form H1000-B, Record of Case Action, input document is identical to the Form H1000-A, Notice of Application input document. The following items appear on the record of case action, input document, and case record copy:

Item 01, Case number;
Item 02, Category;
Item 03, Sequence;
Item 09, Case name; and
Item 32, Client number.

Enter changes in the case information in red ink. To report a change or correction:

• circle the section number.
• circle the individual line indicator in the section where the change is entered. If a change is made in Section III only, circle the individual line indicator in both Sections II and III.
• enter the new information.
• enter the client number in Item 50, Client Number Validation, if changing the name and date of birth of the same client.

You may not change:

Item 08, Date Filed;
Item 32, Client Number;
Item 37, Social Security Number (SSN) validated with an asterisk;
Item 38, Social Security Claim Number validated with acode 1 or 3;
Item 48, PA – Refugee; and
Item 129, Grant Effective Date(TANF only).

Additionally for TANF Medicaid Programs you may not change

Item 02, Category; and
Item 46, Medical Effective Date (over six months old).

To delete income amounts and social security account numbers without asterisks (Item 37), enter a zero in the item. Delete all other information (including the social security claim number, Item 38) by entering a pound sign (#) in the first position of the item. Do not use a pound sign as an abbreviation for number.

To delete an individual name and individual information, enter a pound sign in Item 33, Client Name. If deleting a TANF or Medical Programs individual due to death, re-enter the original status-in-group code for the deceased individual plus status-in-group code X in Item 40, Status in Group. Enter the individual's date of death in Item 47, Death/Denial Date.

If you delete a

• TANF certified member, adjust the total needs amount in Item 66.
• Medical Programs budget group member, adjust the total needs amount in Item 66, and the number of adults/children included in the budget group in Items 125, and 126.

C—520.1 Section I, Items 01 - 31

Revision 02-3; Effective April 1, 2002

All Programs

Items 01 through 39 are listed on the Notice of Application. On the NOA, complete all items except Items 32 and 39. Items 02, 06, 07, 08, 09, 13, 15, 16, 17 and 25 cannot be deleted, but may be updated.

ITEM 01: Case Number

All Programs

If known, enter the previously assigned case number. To reassign a number, ensure that the case name is identical to the name as it appeared at the time of denial. The reassigned case number must have been active within the past year for non-public assistance (PA) Supplemental Nutrition Assistance Program (SNAP) and within the past two years for PA SNAP, TANF and Medical Programs for Families and Children.

ITEM 02: Category

TANF and Medical Programs

On the NOA, enter the code in the left-hand box that describes the type of assistance. Enter changes or corrections in the right-hand box.

2 — TANF/Medical Programs

5 — Refugee Cash Assistance (RCA)

SNAP

On the NOA, enter the code in the left-hand box that describes the type of assistance. Enter changes or corrections in the right-hand box.

6 — PA SNAP

8 — All members are refugees, other than Cuban/Haitian entrants, receiving TANF or RCA (Aid Type 5)

9 — Non-PA SNAP

ITEM 03: Sequence No. (SEQ)

All Programs

For a TANF/Medical Programs NOA, enter code Y if the case name received TANF/Medical Programs within the past two years.

The sequence is computer-printed on 1000-B turnaround. The initial Form H1000-B from the Form H1000-A input document is always sequence 02. Use only the most current sequence to update information. The sequence number cannot exceed the number 99. After 99 the sequence begins at 02 again.

ITEM 04: Page

All Programs

If more than one form is required, enter the page number in the first space and the total number of pages in the second space.

ITEM 05: Print Date

All Programs

Computer printed on 1000-B turnaround. This is the date the information from the input form is entered into SAVERR.

ITEM 06: Budgeted Job Number

All Programs

Enter the first eight alphanumeric characters of the budget job number assigned to the application.

ITEM 07: Mail Code

All Programs

Enter the mail code of the budgeted job number assigned to the application.

ITEM 08: Date Filed

All Programs

Enter the file date of application for assistance. Use month, day, year sequence.

Note: When adding a child to a new program, the file date is the date of the reported change.

SNAP

Also enter the date on the SNAP Form H1000-B, Record Of Case Action, when a new Form H1010-B, Application for Assistance - Part B: Information We Need to Know, is received.

Medical Programs

For reopened three months prior applications, enter the date the applicant requests the application be reopened. Enter the month and year of the original file date in Item 134, Three Months Prior Application Date.

ITEM 09: Case Name

All Programs

Enter on the NOA the individual's last name, comma, first name, space, middle name, or initial until the name is complete or the maximum of 22 positions is reached. The 22 positions include alphanumeric characters, commas, and spaces. If the last name includes Jr, Sr, etc., enter this after the last name(Example: SmithJr,Robert).

ITEM 10: Case Name Change

All Programs

To report a change or correction in case name, enter the complete name in the 22 positions provided in the format described in Item 9, Case Name. If the case name is on a line other than "a," Section II, of the NOA, enter

• the correct name in Item 10; and
• a pound sign (#) on line "a" of Section II, Item 33, Client Name, if you are removing the person reported on line "a."

If the person reported on line "a" remains a part of the ...	then enter the appropriate status-in-group code ...
TANF case,	for this person on line "a" of Section III, Item 40, Status-in-Group, and the appropriate entry in Item 41, ESP Code.
SNAP case,	if any, or a pound sign in Item 40, Status-in-Group to delete a code that is no longer applicable.
Medical Programs case,	for this person on line "a" of Section III, Item 40, Status-in-Group.

If the new case name is not reported on the NOA, add the person's name and information on the first available line of Section II, Item 33, Client Name. Enter the appropriate codes in Item 40 for all programs and in Item 41 for TANF and SNAP on the line where the new case name is listed.

The computer automatically realigns names to ensure the correct name is on line "a." Do not attempt to move names from line to line on Form H1000-A or Form H1000-B.

ITEM 11: Reserved

ITEM 12: Employee Number

All Programs

Enter the employee number of staff assigned the application.

ITEM 13: Mailing Address, First Line

All Programs

Enter the street number and name, rural free delivery, or post office box number using these abbreviations:

Ave — Avenue

Blvd — Boulevard

Cir — Circle

CT — Court

Dr — Drive

Gen Del — General Delivery

Hwy — Highway

Ln — Lane

PO Box — Post Office Box

Rd — Road

RFD — Rural Free Delivery

RR — Rural Route

St — Street

Do not use a pound sign (#) as a part of an address. See example in B-222.1, Mailing Addresses for Issuing Benefits, for cases with P.O. Box addresses.

TANF

When a TANF case has a guardian or protective payee, use their mailing address in Items 13-17.

ITEM 14: Mailing Address, Second Line

All Programs

Use this space if additional lines are required for the mailing address.

ITEM 15: City

All Programs

Enter the name of the city or town used in the mailing address.

ITEM 16: State

All Programs

Enter the two-letter postal abbreviation of the state used in the mailing address. Allowed abbreviations are:

TX — Texas

AR — Arkansas

LA — Louisiana

NM — New Mexico

OK — Oklahoma

ITEM 17: ZIP Code

All Programs

Enter the ZIP code of the mailing address.

ITEMS 18 - 24 ARE NOT PRINTED ON THE NOA.

TANF and Medical Programs

Use Items 18-23 to mail Form H3087, Medicaid Identification, to a temporary address. To change any of these items on a Form H1000-B, Record of Case Action, input document, re-enter all items. Use a pound sign (#) to delete items.

ITEM 18: Temporary Address, First Line

TANF and Medical Programs

Enter the temporary mailing address.

ITEM 19: Temporary Address, Second Line

TANF and Medical Programs

Use this space if additional lines are required for the temporary address.

ITEM 20: Temporary Address, City

TANF and Medical Programs

Enter the name of the city or town.

ITEM 21: State

TANF and Medical Programs

Enter the two-digit postal abbreviation of the state.

ITEM 22: ZIP Code

TANF and Medical Programs

Enter the ZIP code.

ITEM 23: Temporary Address; Months; Begin Month

TANF and Medical Programs

Months: Enter the number of months, not to exceed three, that Form H3087, Medicaid Identification, is to be sent to a temporary address.

Begin Month: Enter the month the temporary address becomes effective.

ITEM 24: Residence Address

All Programs

Enter the residence address, street, and city only if different from the mailing address. Always enter the entire address.

TANF and TP 40

Enter the telephone number, if provided, for an application from a pregnant woman.

ITEM 25: County

All Programs

Enter the three-digit code for the county associated with advisor's BJN.

Note: For TANF and Medical Programs, enter the individual's residence code in Item 164. See C-350 for the county codes.

Items 26 – 27 are not printed on the NOA.

ITEM 26: Protective Payee (TANF/Medical Programs); Authorized Representative (FS)

Enter the last name, comma, first name, space, middle name or initial until the name is complete or the maximum of 22 positions is reached. Enter the name of the institution in usual word order omitting commas, if the guardian is an institution (such as, First National Bank), or the representative payee is a licensed residential child care facility. The 22 positions include alphanumeric characters, comma, and space. If staff make an entry in this item, they must also make an entry in Item 27, Modifier.

TANF and Medical Programs

Enter the name of the legal guardian (exactly as shown on guardianship papers), protective payee, or representative payee.

SNAP

Enter the name of the authorized representative. If the authorized representative is an institution such as a halfway house, enter the name of the employee designated by the institution to act as authorized representative on its behalf.

ITEM 27: Modifier (M)

All Programs

Enter the code that identifies the person listed in Item 26.

TANF and Medical Programs

P — Protective Payee

Note: Also use P for those cases in which a representative payee is designated to receive and manage the benefits for an individual who is incompetent or incapacitated.

R — Representative Payee

SNAP

I — Authorized representative is a member of household (under the same roof).

O — Authorized representative is not a member of household (not under the same roof).

F — Authorized representative is an employee of a drug and alcohol treatment/group living arrangement facility.

ITEM 28: Indicator (I) Code

TANF

Enter on NOA. Enter only changes or corrections on Form H1000-A, Form H1000-B and Form H1000-C.

For TANF, enter code M in this item if potential eligibility is based on an incapacity determination.

For TANF-SP, make no entry. SAVERR prints U when TP 61 transfers to TP 07, 20, or 37.

SNAP

1 — Streamlined reporting (SR) household with total gross monthly income that is less than or equal to 130% FPIL.

2 — SR household with total gross monthly income that is greater than 130% FPIL.

3 — Non-SR household.

ITEM 29: Action Notice (MMDDYY)

All Programs

On Form H1000-A/B, enter the date you give the individual Form H1017, Notice of Benefit Denial or Reduction. This entry is mandatory for all denials except for Application Filed in Error, denials. For Medical Program individuals, enter the date you give the individual Form H1122, Medicaid Action Notice.

ITEM 30: Medical Delay

Medical Programs

Use for emergency medical conditions. Make an entry, using four alphanumeric characters, when more than 10 days elapse between giving/mailing a request for medical information and the date the local office receives the information. Enter code E and the number of days over 10. Example: E015.

TANF

Use when a TANF applicant applies in pay for performance and must demonstrate cooperation. A period of up to 40 days is excluded from the timeliness calculation. Enter Code E and the number of days after the interview date needed to demonstrate cooperation. Example: E030. Do not allow more than 40 days.

ITEM 31: Medical Programs Application Indicator

Medical Programs

Make an entry only on the NOA. Enter

• W to identify a TP 40 application or TANF application with a pregnant woman; or
• Y to distinguish Medical Programs applications from other Category 02 applications. Do not enter on Form H1000-B.

C—520.2 Section II, Items 32 - 39

Revision 10-4; Effective October 1, 2010

All Programs

This section contains identifying information for each person listed on the form. Always use line "a" to enter information about the head of household (case name). Items 32, 33, 34, 35, 36, and 39 cannot be deleted, but may be updated.

ITEM 32: Client Number

All Programs

When certifying a case, for each person listed in Section II, enter

• the nine-digit individual number or
• Code 2. This code tells SAVERR to check for an existing client number. If a number exists, SAVERR will reassign the client number. If a number does not exist, SAVERR will assign a number.

If Form H1000-A, Notice of Application, or Form H1000-B, Record of Case Action, will not process because of error message 307, "client is already active in same program on another case," research the case to determine if the individual is currently active in another case in the same program.

If the individual is ...	then ...
not currently active in the same program or is entitled to dual SNAP participation as a resident of a shelter for battered persons,	follow procedures in B-454.1, Duplicate Participation Procedures.
currently active in the same program and is not entitled to dual benefits,	take appropriate action to prevent duplicate participation. Process an overpayment, if applicable. The advisor who discovers duplicate participation is responsible for notifying the other offices involved.

SAVERR does not assign a client number on denied initial applications.

See C-800, Automated Support Systems, for individual merge/separate information.

To reassign a client number without an entry in Item 50, Client Number Validation, enter Code 2 in Item 32 and the person's name, birth date, social security account number, and social security claim number so that they match the information already in the computer file.

To correct biographical information enter:

• up to three corrections on the input document. Ensure that at least one item matches the information already on file.
• the client number in Item 32 and Item 50, Client Number Validation.

Using Item 50 allows the client number to be reassigned, but hierarchy may still prevent using the biographical data.

ITEM 33: Client Name

All Programs

Enter the name(s) of the people listed on Form H1010-B. Type the last name, comma, first name, space, middle name or initial until the name is complete or you reach the maximum 22 positions. The 22 positions include alphanumeric characters, comma, and spaces.

The only spaces allowed are after the first name. Do not use spaces within a last or first name. If the name includes a Jr., Sr., II, III, etc., it must follow the last name. Example: SmithJr, John Z. Enter the individual's name from line a in Item 09, Case Name, instead of Item 33.

Some eligible non-U.S. citizens traditionally use a name order that is different from the customary U.S. order (first name, middle name, last or family name). Advisors should determine name order according to U.S. custom, and enter it appropriately on Form H1000-A and Form H1000-B. Example: Vietnamese name on I-94: Nguyen(last) Thi(first) Mai(middle) Enter on Form H1000-Aand Form H1000-B: Nguyen,Thi Mai.

Medical Programs

Enter the names of all persons in the budget group. This group includes all the eligible and ineligible people whose needs, income, resources, and medical expenses are used to determine eligibility and/or spend down.

ITEM 34: Birth Date

All Programs

Enter the birth date for each person listed.

ITEM 35: Sex

All Programs

Enter the sex for each person listed.

M — Male

F — Female

ITEM 36: Race

All Programs

Enter the code that describes the race, color, national origin for each person listed:

1 — White (not Hispanic) – People whose origins derive from the original people of Europe, North Africa, or the Middle East.

2 — Black (not Hispanic) – People whose origins derive from the black racial groups of Africa.

3 — Hispanic – People of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin.

4 — American Indian or Alaskan Native – People whose origins derive from the original people of North America.

5 — Asian or Pacific Islander – People whose origins derive from the original people of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes China, Japan, Korea, the Philippine Islands, and Samoa.

6 — State Office Use Only – A code entered by the computer if the worker makes no entry or enters an inappropriate code. Staff must take action to correct.

ITEM 37: Social Security Number (SSN)

All Programs

Enter the social security number (SSN) for each person listed. Following the nine-digit entry is a space used to indicate the verification status of the SSN. A computer printed asterisk (*) indicates Social Security Administration verified the SSN. A verified SSN cannot be changed on Form H1000-B and Form H1000-C. If you determine the number is incorrect, send a memorandum with the correct SSN to State Office Data Integrity (SODI), to make a change:

SODI Section, Data Base Support Unit 
P.O. Box 14930, MC Y92-2 
Austin, TX 78714-9030

Or fax to the Data Base Support Unit at 512-706-7140.

SODI Section notifies the staff by memo when the change is made.

A blank space following the SSN indicates the SSN was entered by the advisor but is not verified.

ITEM 38: Social Security Claim Number

All Programs

Enter the benefit claim number for people enrolled in Medicare or for people who receive social security or Railroad Retirement (RR) benefits. If a person is receiving benefits under more than one number, use the number shown on the Medicare card. If there is no claim number assigned, leave blank.

Note: If entering a RR benefit claim number in Item 38, total the household's RR benefits in Item 55, not in Item 43.

Following the claim number is a code indicating whether the state is paying Medicare premiums for the individual or the individual has private medical insurance. The codes apply to all cases, but are not printed on the SNAP Form H1000-B and Form H1000-C. Reports that include biographical information have these codes. They are

0 — No insurance.

1 — Medicare premium paid by state.

2 — Private medical insurance.

3 — Private medical insurance and Medicare premium paid by state.

The presence of a code 1 or 3 indicates SSA validated the number and the number cannot be changed on Form H1000-B and Form H1000-C. If you determine a verified number is incorrect, send a memorandum with the correct number to Data Control Section, Special Programs Support Unit, State Office, Y-922, to make a change.

THIS COMPLETES THE ALLOWABLE ENTRIES ON THE NOTICE OF APPLICATION.

ITEM 39: Education/Service Code

TANF

Enter an education code for each person in the certified group who is 16 or older (including a child who will be 16 during the month of certification). Note: Do not change the code unless it was incorrect at the time the initial tier level was set or the individual has been denied for at least one complete month before reapplying.

SNAP

Enter an education code for each person with a Code 2, 3, 4, R, V, W, X, or Y in Item 41, Work Registration. Note: Education codes entered for TANF individuals will be printed on the next Form H1000-B that processes, whether registered for SNAP ESP or not.

TANF and SNAP

Enter a code in the first digit of Item 39 to indicate the highest educational level/grade each person has completed. Do not consider vocational/technical schools when determining education level.

Educational Level	Code
1st grade	1
2nd grade	2
3rd grade	3
4th grade	4
5th grade	5
6th grade	6
7th grade	7
8th grade	8
9th grade	9
10th grade	A
11th grade	B
High school graduate/completed general equivalency diploma	C
Attending college or completed some college but has not graduated from a four-year college	E
Graduate of a four-year college	F
No formal education	N

C—520.3 Section III, Items 40 - 50

Revision 11-3; Effective July 1, 2011

All Programs

Section III (a-k) is an extension of Section II (a-k). Each line in Section III relates to the corresponding line in Section II and is used to provide additional information about the people listed. Example: The status-in-group code for the case name in Section II, line a, is reported in Section III, line a. Items 40 and 46 for Temporary Assistance for Needy Families (TANF) and Medical Programs, and Item 41, for TANF and the Supplemental Nutrition Assistance Program (SNAP), cannot be deleted but may be updated.

If an active case is denied, all monetary amounts for the case are kept in the System for Applications, Verifications, Eligibility Reports and Referral (SAVERR) files until the case is purged. The amounts kept in SAVERR files are those budgeted for the latest month of eligibility.

The same is true for individual income amounts. The amount shown, however, is the latest amount of income budgeted in any program. If the individual is moved to another case, the individual income amounts can be updated. Staff can change individual income amounts if denying an active case. This action does not update the TANF case income but does update the SNAP case income.

TANF and Medical Programs

When a certified recipient becomes a payee or case name, medical effective date is automatically deleted. For TANF, the ESP code is also deleted.

ITEM 40: Status-in-Group

All Programs

Status-in-group (SIG) codes identify the people's relationship to the case. Enter all codes that describe the people listed on Form H1000-A, Notice of Application, Form H1000-B, Record of Case Action and Form H1000-C, Secondary Client Input. A maximum of six codes may be used for one person.

TANF and Medical Programs

Assign each person listed one primary code. Use secondary codes only in combination with a primary code. Use secondary codes when required or to provide additional information. Note: For TP 30 case, include only one person with an eligible primary code (SIG 8 or 4) per case.

SNAP

Always enter a code to identify the head of household. Use other codes when appropriate. Use the head of household codes with any of the other codes listed under other codes. Only one person in the case, however, may be given a code indicating head of household.

TANF

Primary Codes

2 – Disqualified/Ineligible Child or Second Parent— Identifies a child or second parent who would be a required member of the certified group but who is disqualified or ineligible for another reason, including noncompliance with the unmarried minor parent domicile requirement.

3 – Noncertified child – Identifies the only deprived child of the certified caretaker/second parent.

If the child receives ...	then enter SIG Code ...
SSI	3
Foster Care Payments	3F
Adoption Assistance payments	3A

5 – Certified Child – Identifies a child included in the certified group for TANF or refugee cash assistance (RCA) cases.

7 – Second Parent — Identifies the second parent in a TANF-SP case.

Do not use Code 7 for a Supplemental Security Income (SSI) recipient, to identify the case name, or for more than one member.

8 – Caretaker — Identifies the caretaker in TANF cases.

Do not use Code 8 for an SSI recipient or for more than one member.

9 – Payee – TANF payee only includes:

• SSI recipients (legal parents and other caretaker relatives), or
• other caretaker relatives who act as head of the TANF household and who are not eligible for TANF or do not want to be included as a caretaker (See A-222, Who is Not Included).

0 – Case Name Only — Identifies a legal parent disqualified for:

• intentional program violation;
• alien status/citizenship requirements;
• failure to comply with employment services, child support, SSN or third-party resource (TPR) requirements;
• failure to timely report the temporary absence of a certified child;
• being a fugitive;
• noncompliance with the unmarried minor parent domicile requirement; or
• a felony drug conviction (not deferred adjudication) for an offense committed on or after April 1, 2002. This disqualification is permanent. See A-222, Who is Not Included.

Secondary Codes

E – Federally Recognized Tribe or Unaccompanied Refugee Minor(URM) — Identifies individuals who are either members of a federally recognized Indian tribe or a URM. These individuals are exempt from mandatory enrollment in Medicaid managed care.

G – Reached End of State Time Limit — Identifies a person who used the maximum number of TANF months in a time limit and has a five year freeze out date on SAVERR. This code can be used with all primary SIG codes.

H – Eligible Refugee — Identifies a person identified as an eligible Amerasian, refugee, asylee, victim of severe trafficking or Cuban/Haitian entrant by the U.S. Citizenship and Immigration Services (USCIS) on Form I-94 or other USCIS document. Continue using Code H until the individual has resided in the U.S. for five years. Code H may be combined with any primary codes. Note: Entry of Code H requires an entry in Item 48.

I – Ineligible Child – Identifies a child who is ineligible for TANF for a reason other than being disqualified or being an SSI recipient. Use Code I only with Code 2.

K – Child of a Minor Child – Identifies the child of a minor parent who is also included in the TANF grant. Use Code K only with Code 5.

L – Minor Parent with a Dependent Child – Identifies a minor parent who has a dependent child on the same case. Use Code L with Codes 5, 7, 8, 9 or 0.

M – Eligible Only for Three Months Prior Medical Assistance— Identifies a person who is eligible for medical assistance during any or all of the three months before the month of application, but who is not currently eligible for medical assistance. Use Code M with Codes 5, 7 or 8.

N – Ineligible for Retroactive Medical Assistance and Current Assistance — Identifies a member of the dependent group who must be reported to certify a case for three months prior Medicaid coverage. Use this code for a member of the dependent group who is ineligible for retroactive medical assistance and current assistance. Use Code N with Codes 5, 7 or 8 to identify members of an OTTANF case. Note: If all people in a case are status-in-group N, the case must be Type Programs 11, 71 or 72.

O – Department of State Health Services (DSHS) Child with Special Health Care Needs— Identifies a child who is exempt from mandatory enrollment in Medicaid managed care.

P – Private Health Insurance — Identifies a certified person who has private health insurance other than Medicare or Medicaid benefits. Use Code P with Codes 5, 7 and 8.

Q – Proof of THSteps Screening — Identifies a child who the automated system indicates as delinquent in screening, but for whom the individual has provided proof of THSteps screening. This code does not remain on SAVERR. Use Code Q only with Code 5.

R – HHSC Employee — Identifies a person who is an HHSC employee. Use Code R with all primary codes.

S – Alien with Acceptable Alien Status — Identifies a noncitizen whose alien status allows him to receive TANF. Use Code S with all primary codes. Note: Do not use this code for refugees (SIG H).

T – Ineligible Alien — Identifies a person ineligible due to alien status. Use Code T with Codes 9, 0 and 2Y.

U – Ineligible — No U.S. Citizenship Proof— Identifies a person ineligible due to no proof of U.S. citizenship. Use Code U with Codes 0, 2I or 2Y.

V – Living in Nursing Home — Identifies a person who is temporarily in a nursing home. Use Code V with Codes 0, 3, 5, 6, 7 and 8.

W – Disqualified Child – Identifies a child disqualified for failure to comply with employment services or SSN requirements. Also identifies a minor parent certified as a child, who is disqualified for not cooperating with child support requirements. Use Code W only with Code 2.

X – Deceased – Identifies a deceased person. Use Code X with Codes 5, 6, 7 and 8. Enter the date of death in Item 47 when using Code X.

Y – Disqualified Second Parent — Identifies a legal parent who would be required to be included as a second parent but who is disqualified. Use Code Y only with Code 2.

Z – Migrant — Identifies members of a migrant household. Use Code Z with all primary codes.

SNAP

Head of Household Codes

A — The head of household is a household member.

G — The head of household is a nonmember.

GK — The head of household is disqualified for a reason other than an intentional program violation (IPV).

GT — The head of household is disqualified for an IPV.

Other Codes

B – Student — Identifies a member who is eligible to participate even though he is a student enrolled at least half time in a curriculum that requires a high school diploma or equivalent for entrance.

C – ABAWD not meeting the work requirement — Identifies an able-bodied adult without dependents (ABAWD) who is not meeting the 18-50 work requirement.

D – ABAWD meeting the work requirement — Identifies an ABAWD who is working 20 or more hours per week or is in a work program that meets the 18-50 work requirement.

F – Treatment Facility Residents — Identifies a

• participating resident of an approved drug and alcohol treatment/group living arrangement facility; or
• resident of a public institution who jointly applies for SSI and SNAP.

H – Eligible Refugee — Identifies a person identified as an eligible Amerasian, refugee, asylee, victim of severe trafficking, or Cuban/Haitian entrant by the U.S. Citizenship and Immigration Services (USCIS) on Form I-94 or other USCIS document. Continue using Code H until the individual has resided in the U.S. for five years. Note: If the Category is 8 and Aid Type is 5, all household members must be coded H.

K – Disqualified for a reason other than an IPV— Identifies a member who is disqualified for any reason other than an IPV. Even though this person is not eligible to receive SNAP, enter his biographical data.

M – Migrant, Out of Work Stream — Farm workers who travel to work in agriculture or a related industry during part of the year but who are presently residing at their permanent or home base.

R – HHSC Employee — Identifies a person who is currently an HHSC employee.

S – Eligible Alien — Identifies a noncitizen whose alien status allows him to receive SNAP. Use Code S with all primary codes. Note: Do not use this code for refugees.

T – Disqualified for Intentional Program Violation— Identifies a person who is disqualified for intentional program violation. This person is not eligible to receive SNAP; however, all biographical data, income, and expenses are entered. When using Code T, make an entry in Item 49, Disqualification Code and Date.

U – Seasonal Farm Worker — Farm workers who do not leave their permanent residence to work in agriculture or a related industry.

W – Migrant, in Work Stream — Farm workers who are presently employed away from their permanent residence or home base.

Medical Programs

Primary Codes

2 – Disqualified/Ineligible Child or Second Parent— Identifies a child or adult who is not eligible for Medicaid, but who is included in the budget group. Do not use SIG Code 2 for an ineligible person who is the case name. On GWS, the SIG labeled "Other Rel Spouse" also results in this SIG. The "Other Rel Spouse" label is used to identify the spouse of the "Caretaker/Other Rel." This individual is not eligible for Medicaid but is included in the budget group.

4 – Eligible child – Identifies a child who meets the Medicaid eligibility requirements for the current period and/or prior period or who would meet those requirements if still alive.

7 – Second Parent — Identifies either the

• eligible spouse of a dependent child's natural or adoptive parent, or stepparent; or
• second adult in an RMA case.

Do not use Code 7 for an SSI recipient, to identify the case name, for more than one member, or unless a caretaker is certified.

8 – Caretaker — Identifies the

• eligible pregnant woman;
• eligible caretaker in the home;
• independent child who applied for himself, and, if applicable, his siblings; or
• first adult or single adult in RMA cases.

Do not use Code 8 for an SSI recipient (see Code 9-Payee) or for more than one member.

On GWS, the SIG labels "Caretaker/Parent" and "Caretaker/Other Relative" result in this SIG if the individual is eligible for Medicaid on the case.

9 – Payee — Identifies the ineligible case name/payee only. Use SIG Code 9 when the person with the case name is not part of the budget group. Use this code when SSI recipients act as case names/payees.

0 – Case Name Only — Identifies the ineligible caretaker who is part of the budget group and is the case name. On GWS, the SIG labels "Caretaker/Parent" and "Caretaker/Other Rel" result in this SIG if the individual is not eligible for Medicaid on the case. Only one person per case may be coded 0.

Use SIG 0Y for legal parents who are disqualified for TPR, SSN or Child Support noncooperation. On GWS, the SIG label will remain "Caretaker/Parent."

Secondary Codes

E – Federally Recognized Tribe or Unaccompanied Refugee Minor(URM) — Identifies individuals who are either members of a federally recognized Indian tribe or a URM. These individuals are exempt from mandatory enrollment in Medicaid managed care.

H – Eligible Refugee — Identifies a person who is a refugee. Use Code H with all primary codes in Categories 1 through 5.

I – Ineligible Child – Identifies a child disqualified for Medical Program. Use Code I only with Code 2.

K – Child of a Minor Child – Identifies the child of a young mother who is also included in the budget group. Use Code K only with Code 4.

L – Minor Child with a Child of Her Own — Identifies a mother 18 years old or younger who has a child of her own in the same budget group. Use Code L with Codes 4, 7, 8 or 0.

M – Eligible Only for Three Months Prior Medical Assistance— Identifies a person who is eligible for medical assistance during any or all of the three months before the month of application, but who is not currently eligible for medical assistance. Use Code M with Codes 4, 7 or 8.

N – Ineligible for Retroactive Medical Assistance and Current Assistance — Identifies an ineligible member of the budget group who must be reported to certify a case for three months prior Medicaid coverage. Use this code for a member of the budget group who is ineligible for retroactive medical assistance and current assistance. Use Code N only with Code 2.

O – DSHS Child with Special Health Care Needs— Identifies a child who is exempt from mandatory enrollment in Medicaid managed care.

P – Private Health Insurance — Identifies a certified person who has private health insurance for hospitalization, accidental injury or sickness, other than Medicare or Medicaid benefits. Use Code P with Codes 2, 4, 7, 8 or 0.

Q – THSteps, Family Planning, or Other Service Needs— Identifies a Medicaid recipient, from birth through 18, who does not want THSteps or family planning services or who does not require assistance with other health or income-related needs. Use Code Q only on applications with Codes 4, 7 or 8.

R – HHSC Employee — Identifies a person who is an HHSC employee. Use Code R with all primary codes.

S – Alien with Acceptable Alien Status — Identifies a noncitizen whose alien status allows him to receive Medicaid. Use Code S with all primary codes. Note: Do not use this code for refugees (SIG H).

T – Ineligible Alien — Identifies a noncitizen whose alien status makes him ineligible for program benefits. Use Code T with Codes 2, 9 or 0.

U – No U.S. Citizenship Proof — Identifies a person ineligible due to no proof of U.S. Citizenship. Use Code U with Codes O, 2I or 2Y.

V – Living in Nursing Home — Identifies a person who is temporarily in a nursing home. Use Code V with Codes 4, 7 or 8.

W – Disqualified Child – Identifies a child disqualified for failure to comply with or SSN requirements, or a minor parent who is disqualified for not cooperating with child support requirements. Use Code W only with Code 2.

X – Deceased – Identifies a deceased person. If using Code X, enter the date of death in Item 47, Death/Denial Date. Use Code X with Codes 4, 7 or 8.

Y – Disqualified Caretaker or Second Parent— Identifies a legal parent who would be required to be included as a caretaker or second parent but who is disqualified for citizenship, TPR, SSN or Child Support noncooperation. Use Code Y only with Codes 2 and 0.

Z – Migrant — Identifies members of a migrant household. Use Code Z with all primary codes.

ITEM 41: (W)

TANF and SNAP

Enter an employment services code for each person listed in Item 33. The form will not process if this item is left blank.

If Form H1000-A, Form H1000-B or Form H1000-C is processed for ongoing benefits at application or complete review/recertification, SAVERR only allows a code in Item 41 that corresponds to the appropriate age, based on Item 34, Birthdate. Forms H1000-A (Form H1000-B for SNAP recertifications processed after cutoff of the last benefit month) are edited based on the date the form processes. Other Forms H1000-B are edited based on the form effective date.

For TANF, SAVERR has age edits for codes A and F.

For SNAP, SAVERR has age edits for codes 2, 3, 4, A, F, R, V and W. If Item 78, Type Review, is coded N or I, SAVERR only edits new entries in Item 41 for correctness.

TANF

Codes	Explanation
A	Child (SIG 5 or 5L).
B	A caretaker or second parent, age 18 or younger attending school.
C	Caring for an ill or disabled child in the household, even if the child is not a member of the certified group.
E	Unable to work due to a disability expected to last more than 180 days.
F	60 years of age or older.
G	Caring for a child (SIG 2, 3 or 5) under age 1. Do not use this code if another member is Code G or R.
H	Presence required in the home because of illness or incapacity of another adult member of the household and the disability is expected to last more than 180 days.
J	Not subject to participation – not a certified TANF individual. Use this code with SIG 3and 9, or with SIGs 0 or 2 who are disqualified for a reason other than ESP noncompliance.
K	Pending during appeal of denial or disqualification. Use only for currently certified TANF individuals.
L	County Hardship Exemption – Identifies an individual who has used the maximum number of TANF months allowed in the state time limit but who is certified for TANF because HHSC state office has designated the county as economically deprived.
M	Mandatory registrant.
N	Employment Hardship Exemptions – Identifies an individual who has used the maximum number of TANF months allowed in a state time limit but who is certified for TANF due to lack of employment.
P	Mandatory registrant employed or self-employed 30 or more hours per week and earning at least$700 a month. Do not use this code if the individual qualifies for exemption codes A, B, F, G, R, C, J, N, Q, W or L.
Q	Severe Personal Hardship Exemption – Identifies an individual who has used the maximum number of TANF months allowed in a state time limit but who is certified for TANF due to a disabling illness or injury of self or a close family member in the home.
R	Caring for a child under age 1 who is not listed on Form H1000-A, Form H1000-B and Form H1000-C. Do not use this code if another member is coded G or R.
T	Pregnant and unable to work.
U	A single grandparent age 50 or over caring for a child under age three.
V	An SSI recipient parent.
W	Identifies an client who noncomplies with the Choices program. There must be financial penalty of F, S or T entered on Form H1000-C.
X	A parent who has exhausted state time limits.
Y	A parent who is disqualified due to third party resource (TPR) requirements, Social Security number requirements, intentional program violation, failure to report a child’s absence, being a fugitive, having a felony drug conviction, failure to cooperate with Quality Control or noncompliance with the unmarried minor parent domicile requirement.

SNAP

Codes	Explanation
A	Child age 16 years of age, or child age 16 or 17 who attends school at least half-time, or is not the head of household.
D	Three to nine-months pregnant.
E	Physically or mentally unfit for employment.
F	60 years of age or older.
G	Caring for a child under age 6.
H	Presence in home required for care of an incapacitated person.
J	Person in drug addiction or alcoholic treatment and rehabilitation program.
N	Receiving or applying for unemployment compensation.
P	Employed or self-employed 30 hours or more a week.
Q	Individual resides in a Choices county and is mandatory or has volunteered for TANF employment services.
R	Registered again, after previously serving the E&T noncompliance penalty period.
S	Student exemption (age 18 or older)/person in a training program.
T	Disqualified household member (or nonmember head of household).
U	Primary wage earner failed to comply with SNAP employment services.
2	Registered, employed less than 30 hours a week.
3	Registered, not working.
4	Registered, job attached (temporarily laid off).
5	Registration postponed, expedited service.

TP 40, TP 43, TP 44, TP 48 and TP 55

Enter a citizenship verification code for each person in the certified group who is a U.S. citizen. The codes specify what level of citizenship verification was used to verify citizenship, if an affidavit was used, or if good cause was allowed. When using an affidavit, a fourth level verification, enter 5 instead of 4. The levels of verification sources are found in A-358.1, Citizenship.

Codes	Explanation
1	Primary level verification source used to verify citizenship
2	Level 2 verification source used to verify citizenship
3	Level 3 verification source used to verify citizenship
4	Level 4 verification source used to verify citizenship
5	Affidavit used to verify citizenship
6	Good cause allowed for citizenship verification

ITEMS 42 - 45:

All Programs

Enter income information in Items 42-45, 55 and 56 as appropriate for each individual listed in Item 33. Leave an item blank if the household does not have that type income.

TANF

Do not enter income for persons whose status-in-group is

3 – an SSI child, 
9 – a payee, or 
2I – an ineligible child.

Note: Enter the deductible amount of any diverted income in Item 58, Deductions, for any individual whose gross income is entered on Form H1000-A, Form H1000-B and Form H1000-C. No individual's deductions should exceed his income.

SNAP

For people disqualified for citizenship, 18-50 work requirement or SSN, enter the prorated amount of income attributed to the household.

Medical Programs

Enter income information for SIG Codes 2, 4, 7, 8 and 0. For TP 45 cases, make no entry in Items 42-44, 55 and 56.

ITEM 42A: Type Income

All Programs

Enter one of the following codes to indicate the type of income entered in Item 44.

A Veterans Affairs (VA) benefits 
C Unemployment Insurance benefits 
P Pension benefits (other than RSDI, SSI, VA or RR) 
M Combination of unemployment benefits with benefits from a pension, VA, or both 
W Combined income from VA and a pension

ITEM 42B: Gross Earned

All Programs

Enter the monthly amount of countable gross earned income and net self-employment income, up to seven numeric characters. Also make an entry in Item 118, and in Items 119-122, if appropriate.

ITEM 43: RSDI

All Programs

Enter the monthly amount of Social Security (RSDI) benefits for each person whose income is considered. Note: If you enter an amount in this item, you must also make an entry in Item 38.

ITEM 44: VA

All Programs

Enter the monthly amount of VA benefits, unemployment insurance benefits, pension, or any combination of these.

When entering an amount in Item 44, also make entries in Item 42A and Item 118.

ITEM 45: SSI

All Programs

SAVERR will print the active penalty codes for each individual on the Form H1000-A, Form H1000-B and Form H1000-C turnaround.

SNAP

Enter the monthly SSI benefit amount.

ITEM 46: Medical Effective Date

TANF and Medical Programs

Enter the beginning date of Medicaid coverage for each person certified for cash and/or medical coverage. Leave blank for status-in-group Codes 0, 2, or 9 and 3 for TANF.

There are many edits associated with the medical effective date. If the correct medical effective date cannot be entered, submit Form H1107, Request for Forced Change of Medical Coverage, to State Office Data Integrity (SODI) Section, SDX Eligibility Unit, State Office, Y-922.

If a recipient has previous medical coverage with HHSC, enter the nine-digit client number or Code 2 in Item 32, Client Number.

TP 55 and 30

For applications with spend down, enter the earliest possible Medicaid eligibility date (MED) for each SIG 4, 7 and 8.

TP 30

Enter the date the emergency conditions started. Use the date the practitioner entered on Form H3038, Emergency Medical Services Certification.

ITEM 47: Death/Denial Date

TANF and Medical Programs

If appropriate, enter the date of denial (always the last day of the month) or date of death(always the actual date of death) for each person.

The following situations require an entry for certified group members.

• A case is released from hold to deny benefits. If the members of the certified group are not eligible for Medicaid benefits for the hold effective month, enter the last day of the month before the hold effective month.
• A case is released from hold and an eligible individual's SIG is changed to an ineligible SIG.

If the case is active and the individual's status-in-group code is changed from eligible to ineligible, do not enter a date in Item 47.

If an active case is denied, this item shows the effective date of denial of Medicaid coverage for all individuals who have medical coverage.

TP 55 and 30

Edits for cases with spend down will not allow a date in this item that is later than the application month.

TP 30

Make an entry only for the certified member (open/close code 090).

ITEM 48: FS-Med Cost; PA-Refugee

TANF and Medical Programs

Enter the code that indicates Voluntary Resettlement Agency (VOLAG), nationality, and U.S. entry date for each refugee. The first digit is the VOLAG code, the second and third digits are the nationality code, and the fourth through seventh digits are the two-digit month and the last two digits of the year of U.S. entry.

Codes	Voluntary Resettlement Agency (VOLAG)
0	Tolstoy Foundation or American Fund for Czechoslovak Refugees
1	YMCA
2	United States Catholic Conference (USCC)
3	Church World Services (CWS)
4	Lutheran Immigration Aid Society (LIRS)
5	Hebrew Immigrant Aid Society (HIAS)
6	International Rescue Committee (IRC)
7	World Relief Services
8	American Council for Nationalities Services (ACNS)
9	Persons Granted Asylum

Codes	Nationality	Codes	Nationality
01	Cuban	17	Chinese
02	Cuban/Haitian Entrant	18	Chilean
03	Soviet Jew	19	El Salvadoran
04	Romanian	20	Brazilian
05	Hungarian	21	Colombian
06	Iranian	22	Palestinian
07	Iraqi/Kurd	23	East German
08	Afghan	24	Pakistani
09	Argentinean	25	Bulgarian
10	Nicaraguan	26	Yugoslavian
11	Ethiopian	27	Armenian
12	Somali	28	Turkish
13	Other African	29	Portuguese
14	Polish	30	Peruvian
15	Czechoslovakian	99	State office use only (do not enter)
16	Indochinese — Vietnamese, Cambodian, Laotian, Khmer, Hmong	-

Example: An Indochinese resettled by World Relief Services who entered the U.S. in June 1979 is entered 7160679.

Note: Information recorded in Item 48 cannot be changed via Form H1000-A, Form H1000-B and Form H1000-C. To change this item, send a memorandum requesting the change to State Office Data Integrity, Special Programs Support Unit, Y-922.

SNAP

Enter the total monthly amount of medical costs of each person who is eligible for the deduction. Allowable expenses of a person who is no longer a household member are entered on line "a" of this item and credited to the head of household. Do not reduce this amount by $35. If none, leave blank.

ITEM 49: Disq. Code and Date

SNAP

Only the State Office Claims Investigation Unit (SOCIU) can enter, change or authorize deletion of entries in this item. Use this item in active or denied SNAP cases if a member has been disqualified for an intentional program violation (also see Item 40). The entry must always be six full characters. Contact the SOCIU if changes must be made in this field.

The first character SOCIU enters is:

T administrative disqualifications for offenses that occurred prior to Sept. 22, 1996; 
S administrative disqualifications for offenses that occurred on or after Sept. 22, 1996, or disqualifications for convictions due to trafficking; 
C court-ordered disqualifications; or 
M disqualifications due to receipt of multiple benefits in one month.

The second digit SOCIU enters is:

• 1, 2 or 3 depending on whether this is the person's first, second, or third disqualification for intentional program violation (see B-912, IPV Disqualification Penalties, for lengths of penalties associated with each violation); or
• 4 if the disqualification is a permanent disqualification for trafficking in SNAP benefits or program access devices of $500 or more.

The remaining characters SOCIU enters are:

• the last month of the disqualification period entered in the MMYY format, or
• PERM if the disqualification is permanent.

SOCIU enters the same information whether the case is active or denied, and the penalty period is the same regardless of case status.

Example: For an offense that occurred after Sept. 22, 1996, a person is disqualified for an intentional program violation through May 1999. This is the person's second disqualification. SOCIU enters "S20599" to show that the disqualification is his second and that he is disqualified through May 1999. If the disqualification is his third, SOCIU enters "S3PERM" to show the disqualification is permanent.

ITEM 50: Client Number Validation

All Programs

Enter the client number if validation of the number entered in Item 32 is required. See instructions for Item 32. Use the validation only if reassigning a client number or changing individual biographical information.

Warning Messages

All Programs

SAVERR prints warning codes if the last input document is incomplete, questionable or invalid. If the head of household has had a name change because of hierarchy, the old name is printed after any warning messages in Item 50. The following format is used for all error messages: AAABBCCC

AAA — Form item number 001-191; client items 32-50 will be shown A32-K32, through K50. When a client item is shown without line indicator, 032-050, then the comparison of all entries within that item caused the error.

BB — One of the following two-digit qualifiers: 

EC – ERROR CODE NUMBER "CCC" 
EQ – EQUAL 
GE – GREATHER THAN OR EQUAL 
GT – GREATHER THAN 
LE – LESS THAN OR EQUAL 
LT – LESS THAN 
NA – NOT ALLOWABLE WITH THE ENTRY OR LACK OF ENTRY IN"CCC" 
NE – NOT EQUAL

CCC — Form item number 001-191; or error code number 300-999; or one of the following "KEY" words: 

ALP – ALPHABETIC 
BLK – BLANK 
CUR – CURRENT PROCESS MONTH 
DAT – VALID DATE 
FIL – VALUE ALREADY ON FILE 
N-3 – today minus 3 months 
N-6 – today minus 6 months 
N12 – today minus 12 months 
N24 – today minus 24 months 
N45 – today minus 45 days 
NAM – NAME FORMAT 
NOW – PROCESS DATE OF FORM 
NUM – NUMERIC 
NXT – NEXT PROCESS MONTH 
VAL – VALID

TANF

If at application or complete review the advisor assigns a ...	SAVERR prints the message ...
three-month periodic review,	"ERRPRONE."
12-month periodic review,	"EXTENDRV."

C—520.4 Section IV, Items 51 - 59

Revision 08-4; Effective October 1, 2004

ITEM 51: Total Earned

All Programs

This computer-printed item is the sum of the entries in Column 42B, Gross Earned.

ITEM 52: Total RSDI

All Programs

This computer-printed item is the sum of the entries in Column 43, Retirement, Survivors, and Disability Insurance (RSDI).

ITEM 53: Total VA

All Programs

This computer-printed item is the sum of the entries in Column 44, VA.

ITEM 54: Total SSI

SNAP

This computer-printed item is the sum of the entries in Column 45, SSI.

ITEM 55: Total RR

All Programs

Enter the total monthly railroad retirement benefits for people whose income is considered. Include any railroad retirement benefits received by a person disqualified because of SSN or citizenship policy and attributed to the household. If none, leave blank.

ITEM 56: Other Income

All Programs

Enter the total monthly unearned income from all sources not included in other data boxes. If none, leave blank.

TANF

This may include applied income, countable child support, or alien sponsor's income.

SNAP

This includes the portion of other income of a disqualified person, or a sponsor's income, attributed to the household.

Medical Programs

This may include the TANF grant, total gross child support, and countable income from an alien's sponsor.

ITEM 57: Total Income

All Programs

This computer-printed item is the sum of the entries in Items 51 through 56.

ITEM 58: Deductions

TANF

Enter the standard work related expense deductions for SIG 2W, 2Y, 5, 7, 8 and 0 members with earned income counted against recognized needs. The deductions cannot exceed the members' monthly earnings. Also enter any amounts diverted from the income of a:

• caretaker,
• disqualified legal parent (SIG 0), or
• disqualified second parent (SIG 2Y).

If there are no deductions, leave blank.

Note: Do not enter child care expenses or the 90% earned income deduction in this item. See instructions for Items 149-152.

SNAP

Enter the household's total monthly dependent care costs, the amount of legally obligated child support paid to or for a nonhousehold member and the remaining farm loss.

Medical Programs

Enter income deductions for everyone whose income is considered in the case, including ineligible people. Enter work-related expenses, child support disregard and any diversions for everyone. If there are no deductions, leave blank. Note: Do not include child care expenses (see instructions for Items 149-152).

ITEM 59: Adjusted Gross Income

All Programs

Enter the adjusted gross income. Enter 0 if there is no adjusted gross income.

TANF

The total case income, minus Item 58 equals Item 59, unless child care costs are entered in Item 152 or the automated 90% earned income deductions is used. For these exceptions, the total income minus Items 58, and 152 (child care and 90% earned income deduction amounts) equals Item 59.

Medical Programs

The total case income minus Items 58 and 152 (child care) must equal Item 59.

C—520.5 Section V, Items 60 - 77B

Revision 05-4; Effective August 1, 2005

ITEM 60: Shelter

SNAP

Enter the total amount of the household's monthly shelter costs. Enter zero, if there are no shelter expenses. Coordinate this item with Item 90, Utility Standard Code.

ITEM 61: Adj Gross Income

SNAP

Computer printed on Form H1000-B and Form H1000-C. Make no entry.

ITEM 62: Excess Shelter

SNAP

Computer printed on Form H1000-B and Form H1000-C. Make no entry.

ITEM 63: Net Income

SNAP

Enter the household's rounded net income. Enter zero, if there is no net income.

ITEM 64: Blank

ITEM 65: Benefits

SNAP

Computer printed on Form H1000-B and Form H1000-C. Make no entry.

ITEM 66: Total Needs

TANF

Enter the total budgetary needs figure for all members of the TANF group. Enter a new figure each time the certified group size changes.

Medical Programs

Type Program	Enter on Form H1000-A
40	185% Federal Poverty Income Limit (FPIL).
43	185% FPIL.
44	100% FPIL.
45	Leave Blank.
47	TANF budgetary needs (100%) allowance figure for all members of the budget group.
48	133% FPIL.
55	Medically Needy Income Limits for all members of the budget group.

For TP 30 cases, if Item 137 has an entry of:	Enter
40	185% FPIL
43	185% FPIL
44	100% FPIL
48	133% FPIL
55	Medically Needy Income Limits

Enter a new figure on Form H1000-B and Form H1000-C each time the household size changes. Item 66 must agree with Items 40, 125, and 126.

ITEM 67/67A: Recog/Max (Recognizable Needs/Maximum Grant)

TANF and Medical Programs

These figures are computer printed. There is no 67A entry for Medical Programs.

ITEM 68/68A: AGI (Adjusted Gross Income)

TANF and Medical Programs

These figures are computer printed. Item 68 equals the entry in Item 59. For TANF, Item 68A is the rounded down figure of Item 68. There is no Item 68A entry for Medical Programs.

ITEM 69: Unmet

TANF and Medical Programs

This figure is computer printed and is the balance of Item 68 subtracted from Item 67.

TANF

This item shows an unmet need of

• at least one cent for active TP 01, 11, and 61 cases; and
• zero cents for TP 07 and 37 cases.

Medical Programs

For ...	this item ...
TP 40, 43, 44, 47, and 48 cases,	shows an unmet need of at least one cent.
TP 55 and 30 cases that are not subject to spend down,	shows an amount greater than or equal to zero will be shown.
TP 55 and 30 cases that are subject to spend down,	shows a negative amount, which represents the monthly spend down.
TP 45	will be blank

ITEM 70: Recommended Grant Amount

TANF

This figure is computer printed and is the balance of Item 68A subtracted from Item 67A. The minimum grant of $10 is printed in Item 70 if the balance is less than $10. This item indicates benefit amount, less recoupment, if applicable. This amount is printed only for TP 01 and 61 cases.

Medical Programs

This item is computer printed. SAVERR prints a spend down amount in Item 70 if the amount in Item 69 is a negative amount. Otherwise, Item 70 will be blank.

ITEM 71 - 77-B: MAO Only

Make no entry.

 

 

C—520.6 Section VI, Items 78 - 110

Revision 10-2; Effective April 1, 2010

SNAP

Items 78, 83, 84, and 90 cannot be deleted, but may be updated. Items 86, 87, 88, 89, and 93 may be deleted with a pound sign.

ITEM 78: TR (Type Review)

SNAP

Make no entry on Form H1000-A, Notice of Case Action. SAVERR returns Form H1000-B, Record of Case Action, and Form H1000-C, Secondary Client Input, sequence 02 with Code C. Enter one of the following codes on later Form H1000-B and Form H1000-C:

C — Complete review

I — Incomplete review

N — Non-review activity (case maintenance)

State Office Review Codes

M — SNAP "end-of-month" conversion

O — SNAP conversion that occurs at September cutoff effective October (Example: SNAP allotment conversion)

1 — SNAP annual RSDI/SSI conversion

ITEM 79: App. Codes (Application Codes)

SNAP

Enter the three-digit code from the list below that describes the type of application, the referral, and the number of months since the previous application or certification period.

The first digit is the type application:

1 — Eligibility Determination – individuals who are not currently certified or individuals submitting untimely reapplications.

2 — Redetermination (Reapplication) – individuals submitting timely applications for continued benefits.

3 — Application reopened after denial using the same Form H1010-B.

The second digit is always "X."

The third digit is

0 — All initial applications, reapplications within 30 days from previous application, or later applications within 30 days after the end of the previous certification period.

1-8 — For one month, enter 1, for two months, enter 2, etc.

9 — Nine months or longer.

ITEM 80: Certification Date

SNAP

Enter the month, day, and year the certification period begins. The day is always 01, even if the whole allotment is prorated.

ITEM 81: MOS. CERT. (Months Certified)

SNAP

Enter the number of months of the certification period. This must be a two-digit number.

ITEM 82: Last ATP Date (Last Benefit Month)

SNAP

Enter the month and year that the individual receives his last benefits for the current certification period. This must correspond to Items 80 and 81.

ITEM 83: HH NO. (Household Number)

SNAP

Enter the number of certified persons in the household. This is the same as the number of eligible persons listed in Section II. Do not include status-in-group Codes G, K, or T. This must be a two-digit number.

ITEM 84: AID (Aid Type)

SNAP

Enter the code that refers to the type of SNAP case.

1 — NPA only. No members receive TANF. (Category 9)

2 — NPA mixed. Some members receive TANF or RCA and others do not. (Category 9)

3 — PA. All members receive TANF or some receive SSI and other others receive TANF. (Category 6)

5 — All members are refugees, other than Cubans or Haitians, receiving TANF or RCA. (Category 8)

ITEM 85: Test

SNAP

Enter a code to indicate the household's categorical eligibility/income test/shelter deduction..

B — Gross and net income tests and capped shelter deduction.

C — Categorically eligible household with capped shelter deduction.

E — Gross and net income test and uncapped shelter deduction. Use this code only if the member who is entitled to uncapped shelter costs is disqualified for intentional program violation.

M — Net test only, uncapped shelter deduction.

T — Categorically eligible household with uncapped shelter deduction.

SNAP-CAP

S — Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP), entered by Centralized Benefits Services.

ITEM 86: PR (Intentional Program Violation Referral)

SNAP

Make no entry. A "Y" is printed during OIG's investigation to prevent the case from being purged.

ITEM 87: NON (Non H/H Members)

SNAP

Enter the code that identifies the non-participating or non-household member(s).

A — Attendant

B — Boarders

C — Ineligible alien

D — Ineligible student

E — Any combination of two or more of A, B, C, or D

If an attendant, boarder, or roomer is an ineligible alien, code him here and in Item 88.

ITEM 88: INELIG. (Ineligible)

SNAP

Enter the total number of persons living in the SNAP household who are not eligible for participation because they are ineligible aliens.

ITEM 89: SSI

SNAP

Advisors enter an "X" if every household member receives SSI. If one or more household members do not receive SSI, leave blank.

SAVERR enters an "A" when a case transfers to Centralized Benefits Services (CBS). CBS enters an "R" when transferring a case to the field.

ITEM 90: UTIL (Utility Expense Code)

SNAP

Enter the appropriate code to describe utility and telephone costs.

Code	Description
1	Household claiming the Standard Utility Allowance.
2	Household claiming the telephone standard only.
4	Household without utility costs.
8	Households claiming the homeless shelter standard.
9	Households claiming the homeless shelter standard with one member who is disqualified for not meeting citizenship, 18-50 work and/or SSN requirements.
A	Households claiming the Basic Utility Allowance.

Do not prorate the utility and telephone standards for households with disqualified members or households sharing expenses.

ITEM 91: Action Code

SNAP

Enter the appropriate denial code. Leave blank unless the case is denied or is opened and closed on the same document. If an entry is made in Item 91, the advisor must also make an entry in Item 92. See C-221, Denial Codes, for denial codes.

ITEM 92: Action Date

SNAP

Enter the effective date of denial. If denying an application, enter the date you determine the case is ineligible. If the application is opened and closed or an active case is denied, enter the last day of the last month in which the household receives its final benefits. When making an entry in Item 92, also make an entry in Item 91.

ITEM 93: Texas Driver's License Number

SNAP

Enter the head of household's Texas driver's license number or Texas Department of Public Safety(DPS) ID number. If the head of household does not have a Texas driver's license or DPS ID, leave blank. Enter a leading zero for seven-digit license numbers.

ITEM 94: Reserved

ITEM 95: Code/Hold Date

SNAP

Enter the appropriate hold or release code under CD. Make no entry under DATE. SAVERR enters the month after cutoff as the hold effective month.

Hold Benefits

Advisor Hold Code

2 — Use to prevent SAVERR from issuing the next month's benefits. The hold is effective the first of the next SAVERR process month. Use code 2 when

• a change must be made effective the next month and the notice of adverse action expires between cutoff and the end of the month;
• an individual cannot be located; 
   
• the second or subsequent month's benefits must be held because of expedited certification pending verification; or
• a household member receives benefits pending receipt of a social security number.

Note: Entry of Code 2 does not prevent entry of information in other sections, including Section XI, to cancel benefits or issue benefits for the current processing month.

State Office Hold Codes:

A — Form H1000-B, submitted to deny a case, contains a fatal error that is not cleared by cutoff. The case remains on hold until the erroneous Form H1000-B is corrected and processed.

Z — The EBT account is dormant because the household has not accessed benefits for three consecutive months or six consecutive months when the most recent monthly issuance is less than $20.

Release Codes

O — Releases benefits effective the first of the next SAVERR process month. Release any held benefits, as necessary, by completing Section XI. Note: In case actions involving a hold Code A, enter a release code only if the case will not be denied.

ITEM 96: (Late Determination/Rescheduled Appointment Date)

SNAP

Make an entry if

• someone files an application, untimely reapplication or a timely application for a recertification, misses the first appointment, and schedules a subsequent appointment. Enter the date (mmddyy) of the latest appointment.
• expedited benefits are delayed because of a late determination caused by the applicant. Enter the date (mmddyy) that all the following have been completed:
  • Form H1010-B, Application for Assistance - Part B: Information We Need to Know, completed and signed,
  • individual or authorized representative interviewed, and
  • identification verified.

SSI/SNAP Prerelease Joint Application

If SSA does not notify HHSC of an individual's release until after the actual release date, enter the date (mmddyy) of notification.

ITEM 97: PASS Account Amount

SNAP

Enter PASS account amount.

ITEM 98A/B: Verification Requested/Received

SNAP

Make an entry in this item when:

• processing a timely recertification,
• the individual missed the first appointment,
• verification can be requested up to the 15th day of the month following the last benefit month, and
• Form H1020, Request for Information or Action, due date is after the last benefit month.

Use 98A to enter the date (mmddyyyy) the verification is requested.

Use 98B to enter the date (mmddyyyy) the verification is received. If no verification is received, do not enter a date.

The paper Form H1000-A, Notice of Application, Form H1000-B, Record of Case Action, or Form H1000-C, Secondary Client Input, does not correctly reflect the two separate items; however, advisors are able to enter both dates in Item 98.

Example: Item 98 09252000 10052000

ITEM 99: Ineligible Month/Combined Allotments

SNAP

Enter the appropriate code if the household is ineligible for the month of application or the second month.

1 — No benefit issued for month of application due to proration, but eligible for the second month as a combined allotment.

2 — Eligible for month of application but ineligible for the second month.

ITEM 100: PASS Account Code

SNAP

Enter the appropriate PASS account code.

E — Exempt from earned income

U — Exempt from unearned income

ITEM 101: (Prepared Meals Services Code)

SNAP

Enter the appropriate code to identify a household that qualifies to use SNAP benefits to purchase prepared meals from one of the following authorized meal providers:

C — SSI/elderly member authorized to purchase from communal dining facilities, meal delivery service, or contracted restaurant.

E — Homeless and either elderly or SSI recipient; authorized to purchase from every service(communal dining, meal delivery services, or homeless meal providers/contracted restaurants).

H — Authorized to purchase from homeless meal providers/contracted restaurants.

M — Household/disabled member authorized to purchase from meal delivery services.

ITEM 102: Reserved

ITEM 103: (Special Review Date)

SNAP

Enter the month and year for the special review (Example: 08-96).

ITEM 104: (Special Review Code)

SNAP

Enter the appropriate code to show the type of special review needed.

0 — State office assigned

1 — Employment Services/Work Registration

2 — School Attendance

3 — Reserved

4 — Management

5 — Income/Expense changes anticipated

6 — Living arrangement change anticipated

7 — Medical review

8 — Household change anticipated

9 — Other

To delete Items 103 and 104, enter pound (#) in 104.

ITEM 105 - 110: Reserved

C—520.7 Section VII, Items 111 - 126

Revision 02-6; Effective July 1, 2002

ITEM 111: Reserved

ITEM 112: First Case Number

All Programs

Enter the associated TANF, SNAP or Medical Programs case number.

ITEM 113: Second Case Number

All Programs

If Item 112 has an entry and there is another associated case, enter the second case number in Item 113.

ITEMS 114 - 117: Reserved

ITEMS 118 - 122

All Programs

State office uses Items 118-122 to determine discrepancies between income reported to the advisor and income reported by other agencies for the same person. Complete Items 119-122 when the earned income for a former month is not the same as the earned income entered in Item 42B for the ongoing budget. Note: Do not report unearned income that differs from entries in Item 44. If entries are made in Items 119-122 for TP 30 or 55 cases, make appropriate entries in Section XI for the Spend Down history file.

ITEM 118: Mo. Earned (Month Income Is Received)

All Programs

Make an entry in Item 118 only when making or changing an entry in Item 42-B or 44.

Enter a two-digit number to identify the earliest month of certification in which the amounts entered in Items 42B and 44 were received Example: If certification date is May 1, the ongoing budget is effective June 1, and income for May is the same as June, then enter "05."

Note: If zero is entered on Form H1000-B, Items 42B or 44, because income currently shown in these items terminates, enter the two-digit number to identify the first month the income was not received.

ITEM 119: First Budget Mo.

All Programs

Make a two-digit entry to identify the first month earned income was different than the current earned income entered in Item 42B. Make this entry even if earned income for this month totals zero.

ITEM 120: Earned Income First Month

All Programs

Enter the total amount of countable gross earnings for the household that corresponds to the month entered in Item 119. Make an entry even if the earned income for this month totals zero.

Exception: Enter the total amount of a disqualified person's earnings, even if budgeting only a prorated amount of his income.

ITEM 121: Earned Income Second Month

All Programs

Enter the total amount of countable gross earnings for all household members corresponding to the month entered in Item 122. Make an entry even if the earned income for this month totals zero.

Exception: Enter the total amount of a disqualified person's earnings, even if budgeting only a prorated amount of his income.

ITEM 122: Second Budget Mo.

All Programs

Enter the two-digit number to identify the second month in which total earned income received is different from the total of the amounts entered in Item 42-B. Make an entry even if the earned income for this month totals zero.

ITEM 123: Face-to-Face for HCO

TP 43, TP 44, TP 47 and TP 48

SAVERR enters code "N" for a caretaker required to have a Health Care Orientation (HCO). A caretaker who does not comply with the HCO requirement must have a face-to-face interview to renew Medicaid eligibility for the child. When a caretaker has a face-to-face interview to clear non-compliance, enter code "F" in Item 123.

ITEM 124: Reserved

ITEM 125: (Adults)

Medical Programs

Enter the number of adults included in the budget group. Include a minor parent who is SIG 0 on a TP 47 case. Make no entry for TP 45.

ITEM 126: (Children)

Medical Programs

Enter the number of children included in the budget group. Make no entry for TP 45. Include the unborn child in this entry for

• TP 40 cases; and
• TP 43, 44, 47, 48, 30, and 55 cases with "01" entries in Item 128 (B.P.).

Entries in Items 125 and 126 must agree with Item 66.

C—520.8 Section VIII, Items 127 - 152

Revision 10-3; Effective July 1, 2010

TANF and Medical Programs

Section VIII shows case information for TANF, foster care, Refugee Cash Assistance (RCA), and medical programs cases.

ITEM 127: T.P. (Type Program)

TANF

Enter the appropriate code to identify the type program for certifications and denials.

01 — Cash and medical assistance.

04 — Medical Assistance Only - Deceased – Medical assistance only because the applicant(s) dies after the date of application but before certification. Do not use this type program if surviving applicants are eligible to receive cash assistance.

07 — Medical Assistance Only - 12 or 18 Months – TANF or refugee cases that are denied cash assistance because of increased earnings, but are eligible for Medicaid coverage for 12 or 18 months after the last month of TANF eligibility.

11 — Medical Assistance Only - Three Months Prior, not currently eligible or a gap in coverage– TANF individuals eligible for three months prior medical assistance, but who are ineligible in the month of application and later months, or have a gap in coverage.

20 — Medical Assistance Only - Child Support – TANF cases that are denied cash assistance because of child support, but are eligible for Medicaid for four additional months.

29 — Medical Assistance Only – 12 or 18 months post Medicaid following the end of TANF state time limit.

37 — Medical Assistance Only - 12 or 18 Months – TANF cases that are denied cash assistance because of the loss of the 90% earned income deduction, but are eligible for Medicaid coverage for 12 or 18 consecutive months after the last month of TANF eligibility.

61 — TANF-SP cash and medical assistance.

71 — OTTANF – One parent household is eligible to receive OTTANF benefits.

72 — OTTANF – Two parent household is eligible to receive OTTANF benefits.

Note: To change the type program and case name, two transactions must be processed.

Category 05 is the RCA program. TP 08, 09, and 10 are foster care programs.

Medical Programs

Enter the appropriate code to identify the type medical program for certifications and denials.

40 — Pregnant woman

43 — Children under age one

44 — Children age six through 18

45 — Newborn children

47 — Dependent children ineligible for TANF because of applied income

48 — Children ages one through five

55 — Medically Needy (with or without spend down)

30 — Nonimmigrants and undocumented aliens

ITEM 128: B.P. (Base Plan)

Medical Programs except TP 40

Enter 01 to identify cases with a pregnant woman in the budget group.

ITEM 129: Grant Eff. Date

TANF

Enter the first day of the earliest month and year the individual is eligible for and is authorized to receive benefits in the same amount as shown in the ongoing budget. Use this item to authorize benefits for the current and previous months.

ITEM 130: RSDI Increase Reserved

ITEM 131: T.R. (Type Review)

TANF and Medical Programs

Enter one of the following codes on Form H1000-A, Form H1000-B and Form H1000-C.

C — Complete

I — Incomplete

N — Nonreview activity (case maintenance)

ITEM 132: Action Code

TANF and Medical Programs

Enter the code that describes the reason for the action taken on the case. See C-200 for Item 132 codes.

ITEM 133: 3 MO. I (Three Months Prior Indicator)

TANF and Medical Programs

Enter the total number of unduplicated calendar months of three months prior Medicaid eligibility. Not applicable for TP 45.

ITEM 134: 3 MOS. PRIOR APP. DATE (Three Months Prior Application Date)

TANF and Medical Programs

When providing prior coverage enter the month and year of the original file date. This date cannot be later than the medical effective date (Item 46) by more than three calendar months. Not applicable for TP 45.

TANF

Use Form H1000-B and Form H1000-C when the requested medical effective date (Item 46) is within six months of the current process month.

ITEM 135: Reserved

ITEM 136: 4 MOS. POST/End Date

TANF

Enter the last month and year for TP 07/20 Medicaid coverage.

TP 40

Enter the second month and year following the expected delivery date.

TP 45

State Office Data Control enters the last month of forced coverage.

TP 43, TP 44, TP 47 and TP 48

Make no entry. This is a computer-calculated end date. If a one or two-month Medicaid extension is needed, update the end date for two months or less in this item, and enter "I" in Item 131.

ITEM 137: SAV (Budget TP)

TP 30

Enter the Budget TP indicator used to determine income eligibility. This is a required entry when processing three months prior or simultaneous open and close situations. Do not make an entry when processing denials.

Enter	For cases that include a
40	pregnant woman who meets the 185% FPIL income criteria.
43	child under age one who meets the 185% FPIL income criteria.
48	child age one through five who meets the 133% FPIL income criteria.
44	child age six through 18 who meets the 100% FPIL income criteria.
55	caretaker/second parent who meets MNIL income criteria.

If the income exceeds the limits and the case is eligible based on TP 55 income criteria with spend down, enter 55.

ITEM 138: (Child Support Cooperation/Reason for Transfer to TP 07/20)

Enter the appropriate code to indicate child support cooperation or noncooperation.

R — Refusal without good cause to cooperate with child support for one or more absent parents.

C — Cooperation. Enter this code if Code R does not apply.

T — No proration when reinstating TANF after PRA cooperation.

Enter Code	If the case transfers to TP 07/20 because ...
E	of new or increased earned income or earnings of a returning absent parent who is added to the certified group.
S	of new or increased child support collections.
B	TANF denial results from a reason listed under Code E, and new or increased child support collections.
P	of PRA noncooperation.

ITEM 139: SPECIAL REVIEW

TANF and Medical Programs (except TP 40, TP 30 and TP 55 with Spend Down)

Enter the date of any contact planned before the date of the next periodic review, or the end of the budget period. For cases with a pregnant woman, enter the first day of the month following the month the pregnancy is anticipated to terminate.

ITEM 140: CODE

TANF and Medical Programs (except TP 40, TP 30 and TP 55 with Spend Down)

Enter the code for the type of special review needed.

1 — Employment Services/Work Registration (TANF only)

2 — School attendance

3 — (Reserved)

4 — Management

5 — Income/Expense changes anticipated

6 — Living arrangement change anticipated

7 — Medical review

8 — Household change anticipated. Note: Use to designate a review for cases with a pregnant woman

9 — Other

Q — Disability Hardship Exemption (TANF only)

To delete a special review date in Item 139, enter a pound sign in Item 140. This entry deletes the information in Items 139 and 140.

ITEM 141: PERIODIC REVIEW

TANF and TP 07, TP 20, TP 37 and TP 55 without Spend Down

Make no entry. This is a computer calculated and printed date of the next periodic review date. If incorrect, enter a new periodic review date in this item and "N" in Item 131.

TP 43, TP 44, TP 47 and TP 48

Make no entry. This is a computer-calculated date that reflects the next required periodic review. If the date is incorrect, enter a periodic review date in this item and "N" in item 131.

ITEM 142: HOLD CD: DATE

TANF and Medical Programs

Enter the appropriate hold or release code under CD. Make no entry under DATE. SAVERR enters the month after cutoff as the hold effective month.

Hold/Release Codes

Advisor

Hold Code 1

Use when the advisor cannot locate the individual and an investigation of the individual's location is pending. This code automatically denies the grant and Medicaid at cutoff of the hold month effective the first day of the hold month. Fiscal cancels any returned warrants and SODI cancels returned Form H3087, Medicaid Identification.

Release: Use Code 8 if the household does not have a new address. Use Code 9 if the household has a new address. Enter the new address on Form H1000-B.

Hold Code 2

Use when appointment of guardian is pending. SAVERR does not produce TANF benefits and Form H3087 until the advisor submits Form H1000-B releasing the hold.

Release: 9 – Enter the name of the guardian on Form H1000-B.

Hold Code 3

Use if changing the payee. SAVERR does not produce TANF benefits and Form H3087 until the advisor submits Form H1000-B releasing the hold.

Release: 0 – Enter the new payee information and complete Section XI on Form H1000-B to issue benefits for hold months.

Hold Code 4

Use when lowering benefits and the adverse action notice period expires between cutoff and the end of the month. SAVERR does not produce TANF benefits and Form H3087 until the advisor submits Form H1000-B releasing the hold.

Release: 0 – Use to release the hold after the adverse action expires. Enter the new budget and/or household composition and complete Section XI on Form H1000-Bto issue benefits for hold months.

Hold Code 5

Use when denying a case or transferring a case to TP 07 or TP 20 and Form H1000-B cannot be submitted because the adverse action period expires between cutoff and the end of the month.

When denying a case, SAVERR does not issue TANF benefits or Form H3087. SAVERR automatically denies the benefit and Medicaid at cutoff of the hold month effective the first day of that month. Fiscal cancels returned warrants and Data Control cancels returned Form H3087.

SAVERR automatically transfers a TP 01 case to TP 07 or TP 20 effective the first day of the next month. SAVERR produces Form H3087 when a case pending transfer is placed on Hold Code 5.

Release: Use Code 8 if the household does not have a new address, responds during the adverse action period, and qualifies for continued benefits. Use Code 9 if the household has a new address, responds during the adverse action period, and qualifies for continued benefits. Enter the new address on Form H1000-B.

State Office Use Only:

Computer-generated Codes

Hold Code A

Form H1000-B submitted to deny a case contains a fatal error not cleared by cutoff. The case remains on hold until the fataled Form H1000-B is corrected and processed. When the form is corrected and the case is denied, enter the correct Death/Denial Date in Item 47.

Release: Use Codes 8, 9 or 0 if the case is not denied.

Data Control Codes

Hold Code C

Form H3087 is returned with postal message: individual moved out of state. State office sends the advisor an RP-24B and sends the individual Form H1029, Notice of Case Action. Automatic denial of the grant occurs at cutoff of the hold month, effective the first day of the hold month. Automatic denial of Medicaid occurs effective the last day of the month before the hold. Apply this hold only when the message on the returned form H3087 indicates the individual has moved out of state.

Release: Use same release procedures described for Hold Code 1.

Hold Code D

Form H3087 is returned with postal message: deceased. State office sends the advisor RP-24B and holds returned warrants and Form H3087 until the advisor takes action to deny assistance or select a new payee.

Release: Use same release procedures described for advisor Hold Code 3.

Hold Code E

RESERVED

Formerly used when Form H3087 returned with postal message: unclaimed.

TANF

Advisor Codes

Hold Code 2

Use when appointment of a guardian is pending. SAVERR does not produce TANF benefits and Form H3087 until the advisor submits Form H1000-B releasing the hold.

Release: 9 – Enter the name of the guardian on Form H1000-B.

Hold Code 4

Use when lowering benefits and the adverse action notice period expires between cutoff and the end of the month. SAVERR does not produce TANF benefits and Form H3087 until the advisor submits Form H1000-Breleasing the hold.

Release: 0 – Use to release the hold after the adverse action period expires. Enter the new budget and/or household composition and complete Section XI on Form H1000-B to issue benefits for hold months.

State Office Use Only:

Computer-generated Codes

Hold Code 3

At least one refugee in a Category 05 case entered the United States more than eight months ago.

State office sends the advisor a RP-24B and holds warrants and Form H3087 until the advisor takes action to deny the case or delete the person(s) over the eight-month limit.

Release: 0 – Release benefits when deleting all people over the eight-month limit. Deny the case if all members are over the eight-month limit.

Hold Code 6

Case is automatically being denied or transferred to TP 20 because of receipt of child support.

Release: 0 – Use to release and make required entries in Section XI.

Hold Code H

Status-in-group Code 5 individual is age 19 or older. The effect is the same as Hold Code C.

Release: The release procedures are the same as Hold Code 1.

Hold Code L

Individual's state time limit is expiring and SAVERR cannot rebudget the TANF case. Advisor action to rebudget the case is required.

Release: 0 – Release hold and make required budget and Section XI entries.

Hold Code Z

The EBT account is dormant because the household has not accessed it for three consecutive months or six consecutive months when the most recent monthly issuance is less than $20.

Release: The release procedures are the same as Hold Code 1.

Fiscal Codes

Hold Code F

Warrant returned as undeliverable. The effect is the same as Hold Code C.

Release: The release procedures are the same as Hold Code 1.

Hold Code G

Warrant returned with message: deceased. The effect is the same as Hold Code D.

Release: The release procedures as the same as for advisor Hold Code 3.

Hold Code J

Warrant charged back.

Release: Hold is released only by Fiscal Division.

Data Control Codes

Code R

SDX Hold

SDX Release Codes

Code S

Mail benefits using address on SDX.

Code T

Denied

Code X

Deceased

Medical Programs

Advisor Codes

Hold Code 4

Pending assignment of protective payee.

Release: 0 – Release hold and enter protective payee information.

State Office Use Only

Computer-generated Codes

Code 3

Occurs at cutoff in the month:

• a SIG Code 4 child on a TP 44 case becomes age 19, and each following month until the advisor denies TP 44 coverage for the child;
• a SIG Code 4 child on a TP 47 or 55 case becomes age 19; or
• the corresponding case for the mother of the TP 45 child is placed on hold.

Release: Use Code 0.

TP 40

State Office Use Only

Computer-generated Codes

Code H

Occurs at cutoff in the month entered in Item 136. If the advisor does not take action, automatic denial will occur at the cutoff in the following month.

ITEM 143: F. ACT (Future Action)

TANF and Medical Programs

Enter the appropriate action code if placing the case on hold with Code 5.

Item 144 - 148: Reserved

Item 149: Code

TANF and Medical Programs

Use on earned income cases only. Enter C for a child care deduction. This entry requires an entry on the same line in Item 152.

To delete this entry, enter "C" in Item 149 and 0 in Item 152 on the appropriate line.

TANF

Enter 9 for

• a 90% earned income deduction up to $1400 per employed member. This entry requires entries on the same line in Items 151 and 152.
• 12 or 18 months additional Medicaid coverage. This entry requires an entry on the same line in Item 151.

Item 150: From Reserved

Item 151: Through

TANF

Enter the last month of the four-month period of the 90% earned income deduction on the line with Code 9. This also contains the TP 37 end date.

Item 152: Amount

TANF and Medical Programs

Enter the last month of the four-month period of the 90% earned income deduction on the line with Code 9. This also contains the TP 37 end date.

TANF

Enter the allowable amount of actual child care costs on the Code C line.

SNAP

Complete only for cases in which an individual receives or anticipates receiving a TANF child support disregard payment from the Office of the Attorney General (OAG). Enter an amount anytime you

• certify these cases for ongoing benefits, or
• make a change to Form H1000-B that will affect the budget, including disqualifications, changes in household composition, or shelter costs.

Enter six numbers indicating the amount of child support received from the OAG to be budgeted.(Example: $25 as 002500.) Enter 000000 if payments were previously reported and have now terminated.

These entries are no longer required if, for the two previous months, the OAG has not reported payments to the individual.

Always enter an amount in Item 56 if you enter an amount in this item.

C—520.9 Section IX, Items 153 - 160

Revision 02-3; Effective April 1, 2002

Item 153 - 160

All Programs

Make no entries in these items.

C—520.10 Section X, Items 161 - 178

Revision 02-3; Effective April 1, 2002

Case Classification (CC)

All Programs

The codes in Section X are not stored in the computer file. They are kept for individual transactions only and are used to complete management reports.

Item 161 - 163: Reserved

Item 164: Case County/Home Phone No.

All Programs

Enter the three-digit code for the individual's residence county, followed by a space. After the space, enter the individual's ten-digit telephone number, including the area code.

Notes:

• See C-350 for the county codes.
• Enter the county associated with the worker's BJN in Item 25.
• Enter only the individual's home telephone number. If the individual has no home telephone number, leave blank.

Item 165 - 167: Reserved

Item 168 - 170: Program Combination Code(s)

All Programs

Use program codes to indicate whether the case action associated with the Form H1000-A, Form H1000-B and Form H1000-C is worked alone or generically with other programs.

Programs	Program Code
TANF only	A
TANF-SP only	U
FS only	F
MP only	M
TANF/FS	AF
TANF-SP/FS	UF
FS/MP	FM
TANF/MP	AM
TANF-SP/MP	UM
TANF/FS/MP	AFM
TANF-SP/FS/MP	UFM

Items 171 - 178: Reserved

C—520.11 Section XI, Items 179 - 187

Revision 04-3; Effective April 1, 2004

TANF

Use this section instead of Form H1008, Authorization for Cancellation or Issuance of Public Assistance Warrants, to request benefits in situations described in the instructions for Item 180. Use Form H1008 to process all other requests for warrant actions. Use this section only for Category 2, TP 01 or 61 cases, or cases being transferred to TP 01 or 61.

Recoupment cannot be done on a benefit requested in Section XI.

SNAP

Use this section to request the issuance and cancellation of benefits.

When reporting a SAVERR or ATA issuance timely on Form H1000-A, Form H1000-B and Form H1000-C, complete Items 118-122 (if appropriate), 179, 180, 183, 184, 185, 186 (if appropriate), and 187.

When reporting an ATA issuance untimely, complete Items 118-122 (if appropriate), 179, 180, 181, 182, 183, 184, 185, 186 (if appropriate), and 187.

TP 55 and 30

Use this section on Form H1000-A with Item 46 to identify any eligible (non-spend down) or potentially eligible (spend down) prior coverage month(s). Use one line for each prior month. Use this section only for consecutive months, with or without spend down. A separate Form H1000-A will be required for any prior coverage months followed by a gap in eligibility. For this section, months with spend down are not considered gaps in eligibility.

Entries in this section for prior coverage cannot precede:

• the third month before the month in Item 08;
• the earliest month of medical coverage entered in Item 46 for any person.

Item 179: ISS/CAN (Issue/Cancel)

TANF

Enter one of the following codes to indicate the type of benefit being requested:

1 — Full month's amounts

2 — Additional benefits for a month; Form H1000-B use only

SNAP

Enter one of the following codes to indicate the method of issuance or to request a cancellation:

S — Untimely reporting EBT issuance via ATA to clear a discrepancy report RF-07E-1. This code can only be used with Code 1 or 3 in Item 180.

E — Requesting EBT issuance or timely reporting EBT benefits issued via the ATA.

N — Requesting cancellation of benefits.

5 — Historical Information: State-office entered. Used to identify a CCDMI as a certified mail issuance. No longer in use effective April 1, 2004.

C — Historical Information: State-office entered. Used to identify a CCDMI that was cancelled. No longer in use effective April 1, 2004.

TP 55 and 30

Enter the appropriate code for each prior month in which a case is eligible or potentially eligible.

N — Not eligible for Medicaid until spend down is met

E — Eligible for Medicaid without spend down

Make no entry for ineligible months. The months reported in this section must be consecutive months of eligibility, with or without spend down.

Item 180: Type ISS.

TANF

Enter the reason for authorization:

9 — Action Code 090, simultaneous open and close on Form H1000-A only. Use to request allowable warrants from Item 129, Grant Effective Date, through Item 47, Denial Date, if the amount equals Item 70, Recommended Grant.

B — Change in both household composition and money reflected in the budget

F — Additional benefits issued due penalty imposed in error

H — Change in household composition

M — Change in money reflected in the budget

Note: Use B, H, and M for certifications and reinstatements, action Codes 57 or lower, to request allowable benefits for the month(s) before the Item 129 entry. These codes identify why the prior amount is different from Item 70, Recommended Grant, amount.

Also use B, F, H, and M to issue additional amounts for months in which benefits have already been produced. These codes identify why the additional amount is requested.

Use these codes to issue a benefit for the current or previous month when releasing hold with Code 0 or 7 in Item 142.

O — Retroactive and/or current month's benefit when releasing a case from hold with release Code 0or 7 in Item 142. Use for a benefit amount equal to the grant amount to be printed in Item 70.

P — Budgeting process requires different payment month benefits. Enter Code 1 in Item 179. Use for a benefit amount different than the amount to be printed in Item 70.

R — (State office use only.) Identifies on the history file benefits produced when release Code 8or 9 is used to release a case from hold. These benefits will always be for the recommended grant amount previously on file, not a recommended grant amount changed at the time the hold is released on Form H1000-B and Form H1000-C.

T — Transfer from TP 07, 20 , 29, or 37 to TP 01 or 61 (Form H1000-B and Form H1000-C use only).Use to issue a benefit of the same amount for the previous month, if needed. The advisor must ensure that the benefit amount requested is equal to the new grant amount that is printed in Item 70. Use Form H1008 to request a benefit for a different amount or an earlier month.

SNAP

Enter one of the following codes to indicate the type of benefit requested:

Full Regular Ongoing Benefits or Replacement of These Benefits

A — Initial benefit (regular ongoing benefit).

E — Initial expedited benefit issued through

• SAVERR to meet timeliness requirements, or
• the ATA and reported timely in Section XI.

Also use for the second month on an expedited case when issuing the second month's benefits as a combined allotment and the first month's benefit cannot be issued because it prorates to less than $10.

H — Use to issue a benefit through SAVERR as a priority issuance to meet timeliness for a hearing officer decision. Do not use when timeliness can be met using another applicable code.

L — Restored full month's benefit for a past month.

1 — Use only to clear discrepancy report RF-07E-1, generated because the benefit was issued via the ATA and was not reported timely in Section XI. On inquiry, an issuance coded E by the advisor displays as a Code 1 if the benefit was issued via the ATA.

2 — Priority benefits issued through

• SAVERR to meet non-expedited application timeline requirements, or
• the ATA to meet non-expedited application timeliness requirements and reported timely in Section XI.

3 — Use only to clear discrepancy report RF-07E-1, generated because the benefit was issued via the ATA and was not reported timely in Section XI. On inquiry, an issuance coded 2 by the advisor displays as Code 3 if the benefit was issued via the ATA.

All issuances coded A, E, 2, or L in Item 180 must balance using Items 184, 185, 186 (if applicable), and 187.

Potential Item 180 code combinations for applicants receiving combined allotments are:

First Month Code	Second Month Code
E (Expedited)	2
2 (Timely)	2
No issuance*	E
A (Regular)	A
No issuance*	2
No issuance*	A
1 (Expedited-ATA; reported untimely)	3
3 (Expedited-ATA; reported untimely)	3
No issuance*	1
No issuance	3
*1st month not issued due to proration

Additional Benefits for a Month

C — Supplemental benefits. Use when providing benefits in addition to initial benefits for the current month or following month if submitting Form H1000-A, Form H1000-B and Form H1000-C after cutoff.

D — Restoration benefits. Use when restoring partial benefits for a past month.

F — Supplemental or restoration benefits. Use when providing additional benefits for a month in which the household has already received one issuance coded C and/or one coded D.

P — Restore an erroneously expunged EBT benefit.

Destroyed Food

T — Replacement of destroyed food, that was purchased with SNAP benefits.

Historical Information: State office also uses this code to replace CCDMIs that are lost/stolen within the postal system. No longer in use effective April 1, 2004.

Every month must have an uncanceled A, E, 1, 2, 3, or L before an issuance coded C, D, F, P, or Tin Item 180 can be processed. To replace a canceled issuance, always use the same code in Item 180.

Only one type issuance Code C or D is allowed per month. Codes C and D issuances are allowed for the same month. Code C cannot be used for month already having a type code L issuance. Code F cannot be used unless type code C or D has been issued for the month.

Advisor entered cancellation

G — Use to cancel EBT benefit because the household has moved out of state. Use code N in Item 179.

State Office-entered

4 — Historical Information: CCDMI mailed out of state as a result of converting EBT benefits to coupons. No longer in use effective April 1, 2004.

5 — Historical Information: Benefits placed back in an EBT account after a CCDMI was returned and cancelled. No longer in use effective April 1, 2004.

These codes do not appear on Form H1000-B. These are in the benefit history file that is available through inquiry.

Item 181: ATP/Benefit No.

TANF and SNAP

Issuance numbers issued via EBT have two leading alpha characters (Example: AA12345).

TANF

Make no entry. SAVERR assigns issuance numbers.

SNAP

Make no entry if requesting an issuance or reporting an ATA issuance timely.

SAVERR assigns an issuance number when authorizing an issuance or when the EBT system reports an issuance.

Priority Issuance Numbers:

• Issuance numbers beginning with ZX indicate priority issuances processed via the ATA that were not reported on Form H1000-A, Form H1000-B and Form H1000-C within five days.
• A code X after an issuance number indicates SAVERR sent the benefit record to the vendor system as a priority issuance. SAVERR sends benefits as priority issuances only if the advisor uses code E in Item 179 and code E, H, or 2 in Item 180.

Item 182: Issue Date

TANF

Enter only on Form H1000-B and Form H1000-C when requesting a prorated benefit resulting from the transfer of a case from TP 07, 20, 29, or 37 to TP 01 or 61.

SNAP

Enter the date benefits were issued if canceling an issuance.

Enter the issue date if reporting an ATA issuance untimely to clear an RF-07/37E-1.

In the Issue Date (ISSUE DT) column, SAVERR inquiry displays an asterisk (*) for the second month's benefit of a combined allotment if it is issued before cutoff of the application month. This information does not appear on Form H1000-B. It is in the benefit history file that is available through inquiry.

Item 183: Benefit Month

TANF and SNAP

Enter the month and year for which the benefits are requested. Use a separate line for each benefit month entered.

SNAP

Historical Information: In the EFF column, SAVERR inquiry displays the date a CCDMI was processed instead of the benefit month. This information does not appear on Form H1000-B. It is in the benefit history file that is available through inquiry. No longer in use effective April 1, 2004.

TP 55 and 30

Enter the month and year for the prior coverage month in which a case is eligible or potentially eligible.

Item 184: Net Income

TANF, SNAP, TP 55 and 30

Enter the whole dollar amount of net income that applies to the benefit month in Item 183.

Item 185: Benefit Amount

TANF

Enter the benefit amount requested.

SNAP

Enter the amount of the benefit being issued. If recouping $8 from a $10 allotment, enter $2.00

TP 55 and 30

Enter the spend down amount for that month. Enter 0 if there is no spend down.

Item 186: Other Data (Initial Month and Code)

TANF

When issuing a benefit (prorated, full, or supplemental) in Section XI that is reduced because of a financial penalty, enter the penalty amount and penalty code in Item 186. If the benefit is reduced because of multiple penalties, enter the amount and Code U (multiple penalties). Enter the adjusted benefit amount (the benefit amount minus the penalty amount) in Item 185.

If a supplement is issued because a penalty was imposed in error, enter Code F in Item 180 and code (supplemental restored benefit) in Item 179.

SNAP

Do not recoup on a Section XI issuance or a prorated initial month's benefits. Enter the appropriate initial month code in this item and record the dollar amount.

If you are not prorating the initial month's benefits, leave this item blank. Make the following entries if you are prorating benefits:

Issuance Type	Cents Field	Dollar Field
SAVERR or ATA issuance reported timely on Form H1000-A, Form H1000-B and Form H1000-C.	P	No entry.
ATA issuance reported untimely (code S entered in Item 179).	P	Enter the amount subtracted from the whole monthly benefit because of proration. Example: A $100 allotment prorates to $60. Enter $60 in Item 185, P in Item 186 cents field, and $40 in the dollar field.

For all issuances coded C, D, F, H, P, or T in Item 180, enter in the cents field the range code below that corresponds to the issuance amount in Item 185. Do not make an entry in the dollar field.

Range Code	Issuance Dollar Amount	Range Code	Issuance Dollar Amount
A	$1 - 49	H	$350 - 399
B	50 - 99	J	400 - 449
C	100 - 149	K	450 - 499
D	150 - 199	L	500 - 549
E	200 - 249	M	550 - 599
F	250 - 299	X	600 or over
G	300 - 349	-

These codes are not needed for benefits coded A, E, L, or 2 since these type of benefits must correspond to entries in Item 184, Net Income and Item 187, Household Size.

Item 187: H.H. No. (Household Number)

TANF

Enter the household composition for the benefit requested.

Digit	Number of individuals with status in group Code
1st	7 and 8. The maximum number is two. If none, enter 0.
2nd and 3rd	5. If none, enter 00. If there are less than ten members with SIG 5, enter 0 for the 2nd digit and number SIGs 5 in the 3rd digit.

Example: One adult and three children – 103.

SNAP

Enter the number of people in the SNAP household whose benefits are included in the issuance reported.

TP 55 and 30

Enter the household composition for the month.

Digit	No. of
1st	adults in the budget group.
2nd and 3rd	children in the budget group. Include the unborn child in this entry for cases with an 01 entry in Item 128, base plan.

For budget group with less than 10 children, enter 0 for the second digit.

These entries must correspond with Items 184 and 185.

C—520.12 Section XII

Revision 02-3; Effective April 1, 2002

All Programs

SAVERR completes this section to report the status of a denied application, the case status and the form effective date.

Item: (App. Code) (Action Code) (Action Date)

SNAP

SAVERR prints the denied application information in this section. This information appears only in Section XII, and not in Items 79, 91, and 92.

Item: Case Status

All Programs

This item shows the current status of the case: active, denied, or hold.

Item: Form Effective Date

All Programs

This item shows the form effective date of the previously submitted Form H1000-A, Form H1000-B and Form H1000-C.

On Form H1000-B and H1000-C with Sequence 02, the form effective date is the first of the month that the input document was entered on SAVERR.

On Form H1000-B and Form H1000-C with sequences 03 and above, the form effective date is the date the action reported on the previous Forms H1000-B and Form H1000-C becomes effective according the SAVERR cutoff cycles.

C—520.13 Section XIII

Revision 02-3; Effective April 1, 2002

TANF and SNAP

SAVERR records on the Form H1000-B turnaround the monthly benefit issuance history for the current and past 11 months.

TP 55 and 30 with Base Plan of 55

SAVERR prints the three months prior spend down on Form H1000-B turnaround.

Item: ISS/CAN/Results

TANF

This item records the authorization code from Item 180 and the benefit amount from Item 185.

SNAP

This item records the advisor entries from Items 179 and 185.

Item: Date

TANF

This item lists the month of eligibility for which the benefit was issued.

SNAP

This item records the month and year for which benefits are authorized (benefit month).

Item: Issued/No.

TANF

This item lists the number of issuances for the month of eligibility.

SNAP

This item records the number of issuances the household is issued for the month.

Item: Issued/Persons

SNAP

This item records the household size listed on the last benefit issued for the month.

Item: Issued/Amounts

TANF

This item lists the amount of benefits issued for the month.

SNAP

This item records the household's cumulative benefit allotment, including supplemental benefits and replacement issuances, less any cancelled benefits.

Item: Redeemed/No.

SNAP

This item records the cumulative number of issuances for the household.

Item: Redeemed/Persons

SNAP

This item is not used.

Item: Redeemed/Amount

SNAP

This item is a record of the amount of benefits issued monthly.

Item: CD

TANF

The code in this column indicates deductions made from recognizable needs. (R = Recoupment deduction)

SNAP

This item records the type of the last issuance processed in the month.

C—520.14 Section XIV, Items 188 - 191

Revision 02-3; Effective April 1, 2002

Item 188: Signature

All Programs

The advisor completing Form H1000-A, Form H1000-B and Form H1000-C signs and enters his unit number in this space.

Item 189: Date Signed

All Programs

Enter the date Form H1000-A, Form H1000-B or Form H1000-C is signed.

TANF

Exception: When certifying a TANF application, enter the certification date. This should be the date entered on the TANF worksheet. SAVERR prorates benefits for the first month of eligibility from this date or the 30th day after the file date, whichever is earlier.

Item 190: EMP No.

All Programs

Enter the employee number of staff signing Form H1000-A, Form H1000-B and Form H1000-C.

Item 191: TP Only

All Programs

Data Communications Unit use only. Make no entry.

Medical Programs

When the record of case action is received, the advisor or clerical reviewer edits, initials, and dates the form. If the turnaround document contains an error or warning message, the clerical reviewer must not initial and file it, but must immediately send it to the advisor.

Revision 05-4; Effective August 1, 2005

TANF and SNAP

Use Form H1000-C to enter start and end dates for PRA penalties and good cause. Form H1000-A and Form H1000-B must be submitted with Form H1000-C, but Form H1000-C is not always required when submitting Form H1000-A and Form H1000-B. SAVERR does not produce a turnaround for Form H1000-C.

C—530.1 Section I, Items 01 - 07

Revision 08-4; Effective October 1, 2008

Item 01: App. or Case No.

TANF and SNAP

Enter the application or case number.

Item 03: Seq. No.

TANF and SNAP

Enter the same sequence number from Form H1000-A and Form H1000-B.

Item 04: Pg. No.

TANF and SNAP

Enter the same page number the individual is listed on Form H1000-A and Form H1000-B.

Item 06: BJN

TANF and SNAP

Enter the employee's BJN.

Item 07: Mail Code

TANF and SNAP

Enter the office mail code.

Item 09: Case Name

TANF and SNAP

Enter the same case name from Form H1000-A and Form H1000-B.

C—530.2 Section II, Items 201 - 213

Revision 05-5; Effective October 1, 2005

Item 201: PAR. SKILLS

TANF

When an individual is referred or has completed Parenting Skills training, enter code

R — Eligibility referred the individual to parenting skills training, or

C — Eligibility verified that the individual completed parenting skills training.

SAVERR stores Code R or C on Client Screen A, Welfare Reform Data, under Parenting Skills status. In addition, the status of J appears in this SAVERR field when the Choices system verified that the individual completed parenting skills training as a Choices component.

Items 202, 205, 208, and 211: TYPE

TANF

When starting or ending a penalty or good cause, enter the following codes in these Items

Penalty Codes

Code or Action	Definition
T	Third or subsequent noncooperation with Choices
S	Second noncooperation with Choices
F	First Noncooperation with Choices
C	Child Support
V	Voluntary Quit
E	Texas Health Steps
G	Immunizations
M	School Attendance - child
P	School Attendance - minor parent
D	Alcohol or Drugs
U	Unidentifiable penalty - Use this code when making Section XI entries only and the benefit is being reduced by more than one penalty.

Good Cause Codes

Code or Action	Definition
1	Individual is on an alternate schedule for immunizations
2	Good cause for immunizations due to medical reasons
3	Good cause for immunizations due to conscientious objection
4	Grace period
6	Good cause for noncooperation with Texas Health Steps
7	Good cause for noncooperation with Parenting Skills Training

Note: Good cause Code 5 is sent through the Choices automated system.

Items 203, 206, 209, and 212: Start

TANF

Enter the month and year the penalty starts. At application, start a child support or voluntary quit penalty beginning the application month.

On incomplete and complete reviews, the start date cannot be earlier than three months before the current cutoff month or later than the next SAVERR effective month.

Items 204, 207, 210, and 213: End

TANF

Enter the month and year the penalty ends.

SAVERR does not allow entry of future end date. The end date cannot be later than the SAVERR effective month.

C—530.3 Section III, Items 214 - 215

Revision 09-4; Effective October 1, 2009

Item 214: FIC (R/E) (Finger Image Code)

TANF and SNAP

Enter finger image codes for required individuals at application and at complete review/recertification, including simultaneous open and close transactions. Finger image codes are not required on denials or Temporary Assistance for Needy Families (TANF) complete reviews with a future action code of a denial.

If the correct finger image code is not already on the System for Applications, Verifications, Eligibility Reports and Referral (SAVERR), enter a finger image code for each household member who is:

• age 18 or older as of the interview date;
• a minor parent (secondary SIG L) on a TANF case with a dependent child on the same case; or
• a minor head of household (SIG A) on a Supplemental Nutrition Assistance Program (SNAP) case.

Enter one of the following finger imaging codes:

Imaging Code	Definition
Y	All available images have been taken.
Z	One image has been taken (Note: This includes a finger image that Lone Star Image System (LSIS) determines to be temporarily unavailable because of low quality.)

Enter one of the following exemption codes:

Exemption Code	Definition
A	Appeal pending (TANF related)
B	Low quality image, physically unable to image or equipment failure
C	Certified out of office or unable to travel to the LSIS site to be imaged
D	Undue burden for disabled individual
E	Undue burden for elderly individual
F	Disqualified (SNAP only) Note: If SAVERR has no finger imaging code and Form H1000-C, Secondary Client Input, has no entry, the finger imaging code defaults to F for individuals with SIG G, or SIG K or T when the individual is over 18.

On expedited SNAP cases for required members:

• present at the interview, enter the appropriate
  • finger image code and vendor unique number (VUN); or
  • finger imaging exemption code.
• not present at the interview, allow Code C until the next recertification or reapplication.

Automated Changes

The advisor cannot change Codes I or Y on Form H1000-C. SAVERR performs this automated conversion as described in the following chart.

If the individual's status changes from ...	and SAVERR has code ...	then SAVERR ...
inactive to active	I	changes the code to Y, and sends a message to LSIS to remove the archive date.
active to inactive	Y	changes the code to I, and sends a message to LSIS to set the archive date.

SAVERR also sends a message to LSIS to set the archive date on inactive individual records with Code Z, but does not change the code.

SAVERR automatically deletes the finger Code I or Z when LSIS notifies SAVERR that it purged the finger image record. The LSIS purges the finger image record after the individual is inactive for 12 months.

Changing, Correcting or Deleting Finger Image Codes

Finger image exemption codes remain on SAVERR until it purges the individual record.

If the advisor needs to change ...	to ...	then ...
Code Z	Code Y,	enter the new code on Form H1000-C.
an exemption code	Code Y,	enter the new code and VUN, on Form H1000-C.
an exemption code	another exemption code,	enter the new code on Form H1000-C.
Codes Y or Z	an exemption code,	deletes the Y or Z through the force change process using Form H1075, Welfare Reform Force Change Request, for TANF individuals or Form H1074, SNAP Force Change Request, for food benefit individuals, and enter the new code on Form H1000-C after the forced change processes.
Code I	an exemption code	follow the procedures listed above for Codes Y and Z, or allow the vendor's automated purge process to delete the code if the LSIS record is approaching its archive date.

Item 215: Vendor's Unique Number

TANF and SNAP

If the entry in Item 214 is Y or Z, enter the nine-digit VUN.

The VUN contains a "check digit," an automated aid for validating data. If the check digit indicates the advisor did not enter the VUN correctly, Form H1000-C will not process.

SAVERR does not store the VUN, but uses it to associate the SAVERR client number with the finger image record on the vendor's system.

C—530.4 Section IV, Items 216 - 223

Revision 07-4; Effective October 1, 2007

Item 216: ADD

SNAP

Enter the code(s) to indicate that an individual is being disqualified for one or more of the following reasons, even if the disqualification results in case denial. Once entered, these codes remain on the System for Applications, Verifications, Eligibility Reports and Referral (SAVERR) until removed by an entry in Item 217.

Code or Action	Definition
B	Ineligible alien without a U.S. Citizenship and Immigration Services (USCIS) document
C	Ineligible aliens with USCIS document
D	Felony drug conviction
F	First offense failure to comply with Employment Services Program (ESP) requirements (employment and training/voluntary quit/reducing work hours to less than 30)
J	Fugitive
N	Failure to meet the Social Security number (SSN) requirement
S	Second offense failure to comply with ESP requirements
T	Third or subsequent offense failure to comply with ESP requirements
W	Failure to comply with the 18-50 work requirement

Note: Send Form H1074, SNAP Force Change Request, to correct SAVERR information on:

• active individuals to delete the drug disqualification code; or
• denied individuals to add or delete a disqualification code or change the employment and training/voluntary quit counter.

Item 217: Remove

SNAP

Enter a code below to remove a code, end a specific type of disqualification or change a Supplemental Nutrition Assistance Program (SNAP) time-limited benefit code. Enter one of the following codes to indicate the action needed.

Code or Action	Definition
1	Delete the first countable month
2	Delete the second countable month
3	Delete the third countable month
4	Delete the fourth countable month (first month of second three month period)
B	End the ineligible alien (undoc) disqualification
C	End the ineligible alien (doc) disqualification
F	End the first offense SNAP ESP disqualification
J	End the fugitive disqualification
L	Subtract one offense from the ESP offense counter (when entering code L, do not enter Code F, S or T in Item 216 on the same Form H1000-A, Notice of Application, Form H1000-B, Record of Case Action and Form H1000-C, Secondary Client Input, transaction)  N — End of the SSN disqualification
N	End of the SSN disqualification
S	End the second offense SNAP ESP disqualification
T	End the third offense SNAP ESP disqualification
W	End the 18-50 work requirement disqualification

Items 218 - 223

SNAP

Make entries in these fields to report that HHSC has authorized a SNAP benefit for accountable month of the initial or second three-month period of time-limited benefits in a 36-month period for an individual age 18-50. Make entries of Code(s) 1-4 in Items 218 and the corresponding month(s) in Item 219.

Items 220-223 can be used on the same Form H1000-A,Form H1000-B and Form H1000-C transaction when necessary to simultaneously report up to three months of countable issuances. If the advisor needs to report four months simultaneously, the fourth month (first month of second three-month period) must be reported on a subsequent Form H1000-C.

SAVERR does not automatically update the months of countable time-limited SNAP benefits received by an individual age 18-50. The advisor must update SAVERR each time when submitting Form H1000-A, Form H1000-B and Form H1000-C.

Staff do not have to enter the last month of the 36-month period. SAVERR computes it based on the months entered by the advisor as the first countable month of the initial three-month period of time-limited benefits, and displays it on inquiry.

On the same Form H1000-C, staff can delete months using Item 217 and enter corrected months in Items 218-223.

Item 218: Code (Countable Month Code)

SNAP

Enter one of the following codes and a corresponding month in Item 219:

Code or Action	Definition
1	Benefit authorized for the first month of the initial three-month period
2	Benefit authorized for the second month of the initial three-month period
3	Benefit authorized for the third month of the initial three-month period
4	Benefit authorized for the first month of the second three-month period

Item 219: Month (Countable Month MMYYYY)

SNAP

Enter the month and year corresponding to the code entered in Item 218. The month cannot be greater than the SAVERR effective month.

Item 220: Code (Countable Month Code)

SNAP

If more than one month needs to be reported on the same Form H1000-A, Form H1000-B and Form H1000-C, enter the appropriate code (2, 3 or 4) to indicate that HHSC has authorized a SNAP benefit for a second, third, or fourth (first month of second three-month period) countable month. Enter a corresponding code in Item 221.

Item 221: Month (Countable Month MMYYYY)

SNAP

Enter the month and year corresponding to the code entered in Item 220. The month cannot be greater than the SAVERR effective month.

Item 222: Code (Countable Month Code)

SNAP

If more than two months needs to be reported on the same Form H1000-A, Form H1000-B, Form H1000-C, enter the appropriate Code 3 or 4, to indicate that HHSC has authorized a SNAP benefit for a third or fourth countable month. Enter the corresponding month in Item 223.

Item 223: Month (Countable Month MMYYYY)

SNAP

Enter the month and year corresponding to the code entered in Item 222. The month cannot be greater than the SAVERR effective month. 

C—530.5 Section V

Revision 02-3; Effective April 1, 2002

Item 190: Emp. No.

TANF and SNAP

Enter employee number of staff member completing form. 

C—540 Code Summary

Revision 08-4; Effective October 1, 2008

TANF and SNAP

This section contains a Form H1000-A, Notice of Application, Form H1000-B, Record of Case Action, and Form H1000-C, Secondary Client Input, instructions code summary.

Item 02: Category

TANF

Code or Action	Definition
2	TANF
5	Refugee Cash Assistance (RCA)

SNAP

Code or Action	Definition
6	Public Assistance (PA) SNAP Case
8	Refugee, PA SNAP
9	Non-PA SNAP Case

Item 03: Sequence No. (SEQ)

TANF and SNAP

Code or Action	Definition
Y	Yes

Item 27: Modifier (M)

TANF

Code or Action	Definition
P	Protective Payee
R	Representative Payee

SNAP

Code or Action	Definition
I	Authorized representative (AR) is a member of household (under the same roof).
O	AR is not a member of household (not under the same roof).
F	AR is an employee of a drug and alcohol treatment or group living arrangement facility.

Item 28: Indicator Code

TANF

Code or Action	Definition
M	Incapacity

TANF-UP

Code or Action	Definition
U	(system entered when TP 61 transfers to TP 07, 20 or 37)

SNAP

Code or Action	Definition
1	Streamlined reporting (SR) household with total gross monthly income that is less than or equal to 130% of the Federal Poverty Income Limits (FPIL).
2	SR household with total gross monthly income that is greater than 130% FPIL.
3	Non-SR household.

Item 32: Client Number

TANF and SNAP

Code or Action	Definition
2	Check for an existing number.

Item 35: Sex

TANF and SNAP

Code or Action	Definition
M	Male
F	Female

Item 36: Race

TANF and SNAP

Code or Action	Definition
1	White
2	Black
3	Hispanic
4	American Indian or Alaskan Native
5	Asian or Pacific Islander (includes Indochinese)
6	Computer entered code indicating inappropriate or omitted code. Must be corrected.

Item 39: Education or Service Code

TANF and SNAP

Code or Action	Definition
1	First Grade
2	Second Grade
3	Third Grade
4	Fourth Grade
5	Fifth Grade
6	Sixth Grade
7	Seventh Grade
8	Eighth Grade
9	Ninth Grade
A	Tenth Grade
B	Eleventh Grade
C	High School Graduate or completed general equivalency diploma
E	Attending college or completed some college but has not graduated from a four-year college
F	Graduate of a four-year college
N	No formal education

Item 40: Status in Group

TANF

Primary Codes

Code or Action	Definition	If the child receives ...	then enter SIG Code
2	Disqualified or ineligible child or second parent
3	Noncertified child: Identifies the only deprived child of the certified caretaker or second parent	SSI Foster Care Payments Adoption Assistance payments	3 3F 3A
5	Certified Child
7	Second Parent
8	Caretaker
9	Payee
0	Case Name Only

Secondary Codes

Code or Action	Definition
G	Reached End of Time Limit
H	Eligible Refugee
I	Ineligible Child
K	Child of a Minor Child
L	Minor Parent with a Dependent Child
M	Eligible Only for Three Months Prior Medical Assistance
N	Ineligible for Retroactive Medical Assistance and Current Assistance
P	Private Health Insurance
Q	Proof of THSteps Screening
R	HHSC Employee
S	Alien with Acceptable Alien Status
T	Ineligible Alien
U	Ineligible - No Citizenship Proof
V	Living in Nursing Home
W	Disqualified Child
X	Deceased
Y	Disqualified Second Parent
Z	Migrant

SNAP

Head of Household Codes

Code or Action	Definition
A	Household head
G	Household head is nonmember
GK	Head of household disqualified for a reason other than an IPV
GT	Head of household is disqualified for intentional program violation (IPV)

Other Codes

Code or Action	Definition
A	Child (SIG 5 or 5L)
B	Caretaker or second parent, age 18 or younger attending school
C	Caring for an ill or disabled child in the household, even if the child is not a member of the certified group
E	Unable to work due to a disability expected to last more than 180 days
F	60 years of age or older
G	Caring for a child (SIG 2, 3, or 5) under age 1
H	Presence required in home due to illness or incapacity of another adult household member and the disability is expected to last more than 180 days
J	Not subject to participation – not a certified TANF individual
K	Pending during appeal of denial or disqualification
L	County Hardship Exemption
M	Mandatory registrant
N	Employment Hardship Exemptions
P	Mandatory registrant employed or self-employed 30 or more hours per week and earning at least $700 a month
Q	Severe Personal Hardship Exemption
R	Caring for child under age 1 who is not listed on Form H1000-A, Form H1000-B and Form H1000-C
T	Pregnant and unable to work
U	A single grandparent age 50 or over caring for a child under age three
V	An SSI recipient parent.
W	Identifies a individual who noncomplies with the Choices program
X	A parent who has exhausted state time limits.
Y	A parent who is disqualified due to third party resource (TPR) requirements, Social Security number requirements, intentional program violation, failure to report a child’s absence, being a fugitive, having a felony drug conviction, failure to cooperate with Quality Control or noncompliance with the unmarried minor parent domicile requirement.

B — Student

C — ABAWD not meeting 18-50 work requirement

D — ABAWD meeting 18-50 work requirement

F — Resident of drug and alcohol treatment/group living arrangement facility

H — Eligible Refugee

K — Disqualified for a reason other than IPV

M — Migrant, out of work stream

R — HHSC Employee

S — Eligible Alien (not a refugee)

T — Disqualified for Intentional Program Violation

U — Seasonal Farm Worker

W — Migrant, in work stream

Item 41: Employment Services/Work Registration

TANF

Code or Action	Definition
A	Child (SIG 5 or 5L)
B	Caretaker or second parent, age 18 or younger attending school
C	Caring for an ill or disabled child in the household, even if the child is not a member of the certified group
E	Unable to work due to a disability expected to last more than 180 days
F	60 years of age or older
G	Caring for a child (SIG 2, 3, or 5) under age 1
H	Presence required in home due to illness or incapacity of another adult household member and the disability is expected to last more than 180 days
J	Not subject to participation – not a certified TANF individual
K	Pending during appeal of denial or disqualification
L	County Hardship Exemption
M	Mandatory registrant
N	Employment Hardship Exemptions
P	Mandatory registrant employed or self-employed 30 or more hours per week and earning at least $700 a month
Q	Severe Personal Hardship Exemption
R	Caring for child under age 1 who is not listed on Form H1000-A, Form H1000-B and Form H1000-C
T	Pregnant and unable to work
U	A single grandparent age 50 or over caring for a child under age three
V	An SSI recipient parent.
W	Identifies a individual who noncomplies with the Choices program
X	A parent who has exhausted state time limits.
Y	A parent who is disqualified due to third party resource (TPR) requirements, Social Security number requirements, intentional program violation, failure to report a child’s absence, being a fugitive, having a felony drug conviction, failure to cooperate with Quality Control or noncompliance with the unmarried minor parent domicile requirement.

SNAP

Code or Action	Definition
A	Child age 16 years of age or child age 16 or 17 who attends school at least half-time, or is not the head of household
D	Three to nine-months pregnant
E	Physically or mentally unfit for employment
F	60 years of age or older
G	Caring for a child under age six
H	Presence in home required for care of an incapacitated person
J	Person in drug addiction or alcoholic treatment and rehabilitation program
N	Receiving or applying for unemployment compensation
P	Employed or self-employed 30 hours or more a week
Q	Individual resides in a Choices county and is mandatory or has volunteered for TANF employment services
R	Registered again, after previously serving the E&T noncompliance penalty period
S	Student exemption (age 18 or older/in a training program)
T	Disqualified household member or nonmember head of household
U	Primary wage earner failed to comply with SNAP employment services
2	Registered, employed less than 30 hours a week
3	Registered, not working
4	Registered, job attached (temporarily laid off)
5	Registration postponed, expedited service

Item 42A: Type Income

TANF and SNAP

Code or Action	Definition
A	Veteran's Administration (VA) benefits
C	Unemployment Insurance benefits
P	Pension benefits (other than RSDI, SSI, VA or RR)
M	Combination of unemployment benefits with benefits from a pension, VA, or both
W	Combined income from VA and a pension

Item 49: Disqualification Code (Intentional Program Violation)

SNAP

Code or Action	Definition
1st digit	T – Administrative disqualification for offense which occurred prior to September 22, 1996  S – Administrative disqualification for offense which occurred on or after September 22, 1996, or disqualification for conviction due to trafficking  C – Court-ordered disqualification  M – Disqualification due to receipt of multiple benefits in one month.
2nd digit	1 – 1st disqualification  2 – 2nd disqualification  3 – 3rd disqualification  4 – permanent disqualification for trafficking in SNAP benefits or program access devices of $500 or more.
3rd – 6th digits	MMYY – last month of disqualification  PERM – disqualification permanent

Item 50: Error Messages

TANF and SNAP

The following format is used for all error messages: AAABBCCC

Error Message	Definition
AAA	Form Item number 001-191; client Items 32-50 will be shown A32-K32, through K50. When a client Item is shown without line indicator, 032-050, then the comparison of all entries within that Item caused the error.
BB	One of the following two-digit qualifiers: EC – ERROR CODE NUMBER"CCC"  EQ – EQUAL  GE – GREATER THAN OR EQUAL  GT– GREATER THAN  LE – LESS THAN OR EQUAL  LT – LESS THAN  NA – NOT ALLOWABLE WITH THE ENTRY OR LACK OF ENTRY IN "CCC"  NE – NOT EQUAL
CCC	Form Item number 001-191; or error code number 300-999; or one of the following "KEY" words: ALP – ALPHABETIC  BLK – BLANK  CUR – CURRENT PROCESS MONTH  DAT – VALID DATE  FIL – VALUE ALREADY ON FILE  N-3 – today minus 3 months  N-6 – today minus 6months  N12 – today minus 12 months  N24 – today minus 24 months N45 – today minus 45 days  NAM – NAME FORMAT  NOW – PROCESS DATE OF FORM  NUM – NUMERIC  NXT – NEXT PROCESS MONTH  VAL – VALID

Error Codes

Code or Action	Definition
300	Either the first digit of application number is not A or the last eight digits are not numeric
301	By changing the A of the application number to zero, it was found that a case already on file has been assigned that number.
304	Application already disposed
305	BJN was incorrect
307	The case or individual indicated is already active in the same program area for the benefit period requested.
308	The client number entered cannot be reassigned due to a mismatch of client information.
309	Multiple entries for this Item contained the same value.
320	A SNAP denial cannot precede a benefit issuance month.
321	The ATA issuance exceeded the maximum allotment for household size.
400	The individual's SSI coverage was changed to Suspense
402	Hierarchy of individual information prevented the use of the client entries on the transaction.
403	The entry made in Adjusted Gross Income is zero. Determine if the correct income was entered.
404	Valid entries for case number reassignment are required.
500	The rejection of this attempted denial caused the case to be placed on hold.

Item 78: Type of Review

SNAP

Code or Action	Definition
C	Complete review
I	Incomplete review
N	Non-review activity (case maintenance)

Item 79: Application Codes

SNAP

Code or Action	Definition
First Digit – Application Type	1 – Eligibility Determination   2 – Redetermination   3 – Application reopened after denial
Second digit	Enter X
Third digit – Number of Months	0 – All initial applications, reapplications within 30 days from previous application, or later applications within 30 days after the end of the previous certification period.   1-8 – Enter the number of months, as appropriate, since the last application or certification period.   9 – Nine months or longer since the last application or certification period.

Item 84: AID

SNAP

Code or Action	Definition
1	NPA Only
2	NPA Mixed
3	TANF-PA
5	Refugee, PA

Item 85: Test (Income Test or Shelter Deduction Identifier)

SNAP

Code or Action	Definition
B	Gross and net income tests with capped shelter deduction.
C	Categorically eligible household with capped shelter deduction.
E	Gross and net income test and uncapped shelter deduction. Use this code only if the member who is entitled to uncapped shelter costs is disqualified for intentional program violation.
M	Net test only, uncapped shelter deduction.
T	Categorically eligible household with uncapped shelter deduction. Note: This code is also used in situations where a household member, disqualified for any reason, is the only elderly or disabled member.

Item 87: NON (Non H/H Members)

SNAP

Code or Action	Definition
A	Attendant
B	Boarders
C	Ineligible alien
D	Ineligible student
E	Any combination of two or more of A, B, C, or D

Item 89: SSI

SNAP

Code or Action	Definition
X	Every household member receives SSI

Item 90: Util (Utility Expense Code)

SNAP

Code or Action	Definition
1	Household claiming the Standard Utility Allowance.
2	Household claiming telephone standard only, or telephone standard plus actual utilities.
3	Household claiming actual utility costs only (even if some members are disqualified).
4	Household without utility costs.
5	Two households live together and share the standard utility allowance.
6	Households claiming the standard utility allowance with member(s) disqualified for not meeting the citizenship, 18-50 work, and or SSN requirements.
7	All other proration situations. A combination of households described in Codes 5, 6, B, and C, a prorated telephone standard, and all other situations in which the utility allowance is prorated (such as a proration involving three or more households, or more than one disqualified member).
8	Household claiming the homeless shelter standard.
9	Household claiming the homeless shelter standard with one member who is disqualified for not meeting the citizenship, 18-50 work or SSN requirements.
A	Households claiming the basic utility allowance.
B	Two households live together and share the basic utility allowance.
C	Households claiming the basic utility allowance with member(s) disqualified for not meeting the citizenship, 18-50 work or SSN requirement.

Codes 1, 2, 3, 4, 5, 7, A, and B are allowed for household containing member(s) disqualified for an intentional program violation, felony drug conviction, E&T non-compliance, and/or being a fugitive.

Codes 3, 4, 6, 7, 9, and C are allowed for households containing member(s) disqualified for not meeting the citizenship requirement, 18-50 work requirement, or SSN requirement. Also, these codes are allowed for household containing member(s) disqualified for an intentional program violation, felony drug conviction, E&T non-compliance, and/or being a fugitive and member(s) disqualified for citizenship, 18-50 work requirement, and/or SSN requirements. Note: Utility, homeless, and telephone standards, if used, are prorated for these kinds of disqualifications.

Item 91: Action Code

SNAP

See C-221, Denial Codes.

Item 95: Code or Hold Date

SNAP

Hold Codes

Code or Action	Definition
2	Hold benefits
A	Form H1000-B has fatal error not cleared by cutoff
Z	Dormant EBT account (state office use)

Release Codes

Code or Action	Definition
0	Do not hold future benefits.

Item 101: Prepared Meals Services Code

SNAP

Code or Action	Definition
C	SSI or elderly member authorized to purchase from communal dining facilities, meal delivery service, or contracted restaurant
E	Homeless and either elderly or SSI recipient; authorized to purchase from every service (communal dining, meal delivery services, or homeless meal providers and contracted restaurants)
H	Authorized to purchase from homeless meal providers/contracted restaurants
M	Household or disabled member authorized to purchase from meal delivery services

Item 104: Special Review Code

SNAP

Enter the appropriate code to show the type of special review needed.

Code or Action	Definition
0	State office assigned
1	Employment Services or Work Registration
2	School Attendance
3	Reserved
4	Management
5	Income or Expense changes anticipated
6	Living arrangement change anticipated
7	Medical review
8	Household change anticipated
9	Other

Item 127 Type Program

TANF

Code or Action	Definition
01	Cash and medical assistance
04	Medical Assistance Only – Deceased
07	12 or 18 months medical assistance only
11	Three months prior medical assistance only not currently eligible
20	Medical assistance only – Child Support
37	12 or 18 months medical assistance only
61	TANF-UP cash and medical assistance
71	OTTANF – One parent household
72	OTTANF – Two parent household

Item 131: Type Review

TANF

Code or Action	Definition
C	Complete review
I	Incomplete review
N	Non-review activity (case maintenance)

Item 132: Action Code

TANF

See C-200 for Item 132 Codes.

Item 138: (Child Support Cooperation or Reason for Transfer to TP 07/20)

TANF

Code or Action	Definition
R	Refusal without good cause to cooperate with child support for one or more APs
X	Exempt from child support requirements, or claiming good cause for all APs
C	Cooperation. Enter this code if Codes R or X do not apply
E	new or increased earned income or earnings of a returning absent parent who is added to the certified group
S	new or increased child support collections
B	TANF denial results from a reason listed under Code E and new or increased child support collections

Item 140: Code

TANF

Code or Action	Definition
1	Employment Services/Work Registration (TANF only)
2	School attendance
3	(Reserved)
4	Management
5	Income/Expense changes anticipated
6	Living arrangement change anticipated
7	Medical review
8	Household change anticipated
9	Other
Q	Disability Hardship Exemption (TANF only)

Item 142: Hold CD: Date

TANF

Advisor Hold Codes

Code or Action	Definition
1	Unable to locate
2	Guardianship pending
3	New payee pending
4	Notice of adverse action to lower benefits that expires between cutoff and the end of the month
5	Notice of adverse action expires between cutoff and end of month (case denial or transfer to TP 07 or TP 20)

State Office Hold Codes

Code or Action	Definition
A	Hold, Form H1000-B has fatal error not cleared by cutoff
C	Form H3087 returned, moved
D	Form H3087 returned, deceased
E	Form H3087 returned, unclaimed
F	Warrant Undeliverable and returned by post office
G	Warrant undeliverable because individual is deceased
H	TANF case has SIG 5 member age 19 or over
L	State time limit expiring and SAVERR cannot rebudget TANF
J	Warrant charged back
R	SDX hold
Z	Dormant EBT account
3	RCA case has a member who entered the United States eight months ago
6	TANF case pending denial or transfer to TP 20

Advisor Release Codes

Code or Action	Definition
8	Release benefits as originally authorized
9	Release benefits as originally authorized using the new address on this Form H1000-B
0	Release future benefits. Use Form H1008 to release any returned benefits. Use Section XI to issue benefits for months on hold.

Item 149: Code

TANF

Code or Action	Definition
C	Dependent care deduction
9	A 90% earned income deduction up to $1400 per employed member or 12 or 18 months additional Medicaid coverage. This entry requires an entry on the same line in Item 151.

Item 179 - Type of Warrant Requested

TANF

Code or Action	Definition
1	Full months amount
2	Additional amount for a month; Form H1000-B use only

SNAP

Code or Action	Definition
S	Reporting ATA issuance untimely
E	Requesting issuance or timely reporting benefits issued via the ATA
N	Requesting cancellation of benefits

Item 180: Type Issuance

TANF

Reason for authorization of benefits

Code or Action	Definition
9	Action Code 090, simultaneous open and close on Form H1000-A only
B	Change in both household composition and money reflected in the budget
H	Change in household composition
M	Change in money reflected in the budget
O	Retroactive or current month's benefit when releasing a case from hold with release Code 0 or 7 in Item 142
P	Budgeting process requires different payment month benefits. Enter Code 1 in Item 179
R	(State office use only) Identifies on the history file benefits produced when release Code 8 or 9is used to release a case from hold
T	Transfer from TP 07, 20, 29, or 37 to TP 01/61 (Form H1000-B and Form H1000-C use only)

SNAP

Full Regular Ongoing Benefits or Their Replacements

Code or Action	Definition
A	Initial benefit (regular ongoing benefit)
E	Initial expedited benefit issued*
H	Priority benefits issued to meet hearing officer decision timeliness
L	Restoring benefits for a past month
1	Initial expedited benefits issued through ATA*
2	Priority benefits issued through SAVERR or ATA to meet timeliness
3	Initial priority benefits issued through ATA*
4	Historical Information: CCDMI mailed out of state as a result of converting EBT benefits to coupons (state office use only). No longer in use effective April 1, 2004.
5	Historical Information: Benefits replaced in EBT account when CCDMI was returned (state office use only). No longer in use effective April 1, 2004.

*See details in C-500, Item 180 instructions.

Additional Benefits for a Month

Code or Action	Definition
C	Supplemental benefits. Use when providing benefits in addition to initial benefits for the current month, or following month if submitting Form H1000-A, Form H1000-B and Form H1000-C after cutoff.
D	Restoration benefits. Use when restoring partial benefits for a past month.
F	Supplemental or restoration benefits. Use when providing additional benefits for a month in which the household has already received one issuance coded C or D.
P	Restore an erroneously expunged EBT benefit.

Destroyed Food

Code or Action	Definition
T	Replacement of destroyed food, which was purchased with SNAP benefits

Advisor enter cancellation

Code or Action	Definition
G	Use to cancel EBT benefit because the household has moved out of state

Item 186: Other Data (Range Code)

SNAP

Code or Action	Definition
P	Initial month benefit prorated

Benefit Range Code for all issuances coded C, D, F, H, P, or T in Item 180.

Range Code	Issuance Dollar Amount	Range Code	Issuance Dollar Amount
A	1 - 49	H	350 - 399
B	50 - 99	J	400 - 449
C	100 - 149	K	450 - 499
D	150 - 199	L	500 - 549
E	200 - 249	M	550 - 599
F	250 - 299	X	600 or over
G	300 - 349	-	-

Item 187: Household Composition for Benefit Requested

TANF

• 1st digit - Number of individuals with status-in-group (SIG) code 7 and 8 (maximum of two). If none, enter 0.
• 2nd and 3rd digits - Number of individuals with status-in-group Code 5 (maximum of nine). Always enter as two-digit number. If none, enter 00. If there are more than nine Code 5s, use Form H1008.

Note: See C-500 for additional codes and instructions to Form H1000-C. A Form H1000-C cannot be submitted without Form H1000-A or Form H1000-B.

Item 214: FIC (R/E) (Finger Image Code)

TANF and SNAP

Enter individual's finger image enrollment or exemption code.

Code or Action	Definition
Y	If all available images have been taken
Z	If one image has been taken
A	Appeal pending (TANF related)
B	Low quality image, physically unable to image or equipment failure
C	Certified out of office or unable to come to office
D	Undue burden for disabled individual
E	Undue burden for elderly individual
F	Disqualified (FS only)

D — Undue burden for disabled individual

E — Undue burden for elderly individual

F — Disqualified (FS only)

Item 215: LSIS Vendor's Unique Number (VUN)

TANF and SNAP

If the entry in Item 214 is Y or Z, enter the nine-digit VUN.

Item 216: Disqualification Type

SNAP

Enter the code(s) to indicate that an individual is being disqualified for one or more the following reasons.

Code or Action	Definition
B	ineligible alien without BCIS document
C	ineligible aliens with BCIS document
D	felony drug conviction
F	first offense failure to comply with ESP requirements (E&T, voluntary quit or reducing work hours to less than 30)
J	fugitive
N	failure to meet SSN requirement
S	second offense failure to comply with ESP requirements
T	third or subsequent offense failure to comply with ESP requirements
W	failure to comply with the 18-50 work requirement

Item 217: Remove

SNAP

Enter a code below to end a disqualification or change a time-limited benefit code.

Code or Action	Definition
1	delete the first countable month
2	delete the second countable month
3	delete the third countable month
4	delete the fourth countable month (first month of second three month period)
B	end the ineligible alien (undoc) disqualification
C	end the ineligible alien (doc) disqualification
F	end the first offense SNAP ESP disqualification
J	end the fugitive disqualification
L	subtract one offense from the ESP offense counter (when entering Code L, do not enter Code F, S, or T in Item 216 on the same Form H1000-A, Form H1000-B and Form H1000-C transaction)
N	end of the SSN disqualification
S	end the second offense SNAP ESP disqualification
T	end the third offense SNAP ESP disqualification
W	end the 18 - 50 work requirement disqualification

Items 218-223

SNAP

Make entries in these fields to report that HHSC has authorized a SNAP benefit for a countable month of the initial or second three-month period of time-limited benefits in a 36 month period for an individual age 18-50. Make entries of Code(s) 1-4 in Items 218 and the corresponding month(s) in Item 219.

Items 218, 220, and 222 – Countable Month Code

SNAP

Enter one of the following codes and a corresponding month in Item 219, 221, and 223:

Code or Action	Definition
1	benefit authorized for the first month of the initial three-month period
2	benefit authorized for the second month of the initial three-month period
3	benefit authorized for the third month of the initial three-month period
4	benefit authorized for the first month of the second three-month period

Additional Codes

TANF

Benefit History Codes

Code or Action	Definition
A	Mailed warrant or EBT benefit issued
C	Warrant held
D	Warrant or EBT issuance cancelled
E	Warrant charged back
P	Warrant paid by state treasure
R	Warrant returned
S	Warrant stop payment in effect
L	Warrant stop payment lifted
Y	Duplicate EBT benefit or warrant issued
Z	Duplicate warrant returned

Read benefit history codes on inquiry from right to left. The most recent code or action appears on the far left.