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Effective Date: 
8/2015

Documents

 

Instructions

Updated: 7/2010

Purpose

To record the decision of an applicant after given the opportunity to register to vote.

Procedure

The case manager will record the response from an applicant when given the opportunity to register to vote. If the applicant declines to register, the case manager will ask the applicant to sign and print his name, and date the form acknowledging the declination. The case manager will also record if the applicant is already registered, refuses to sign, is unable to sign or will mail the voter registration application (Form 0030) themselves.

Form Retention

The case manager will keep a copy of Form 1019 in the individual case record for 22 months.

Detailed Instructions

The case manager will:

  • record the decision of an applicant after given the opportunity to register to vote in section one;
  • ask the applicant to sign, print his name, and date the form acknowledging the declination;
  • record in the "For HHSC Use Only" box if the applicant is already registered, refuses to sign, is unable to sign or will mail the voter registration application (Form 0030) themselves; and
  • file the form in the individual case record.