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Effective Date: 




Updated: 3/2008



  • To use with Form H1750, Child Support Referral, as an initial referral from the advisor to the local child support unit.
  • To use with Form H1701, Child Support, TANF Foster Care, or TANF Medicaid case Information Exchange as a subsequent referral.
  • To serve as the basic information document for TANF and Medicaid cases and the Office of Attorney General (OAG) child support cases.



When to Prepare

The client completes a separate Form H0050 for each absent parent as required in the Texas Works Handbook, A-1122, Parent Profiles for Child Support Referrals.

Number of Copies

An original only for each absent parent.


For non-GWS or TIERS cases, the advisor must attach Form H0050 to Form H1750 and send to the local child support unit within two days of receiving Form H1750. Send Form H0050 with Form H1701 when Form H0050 is needed because a child is added or a case is transferred from Medicaid Only to TANF. Cases completed on GWS or TIERS automatically transmit Form H0050 to the OAG.

Case Filing

File Form H0050 under the Child Support section of the case folder.

Form Retention

See the Texas Work's Manager's Guide for retention requirements.


Detailed Instructions

Form H0050 is self-explanatory. Advisors must explain to the client that if they cannot name the absent father, they must complete and sign the perjury statement listed under Section V, Relationship Between Mother and Father of Children. of Form H0050.