Effective Date: 
1/2019

Documents

Instructions

Updated: 1/1993

PURPOSE

  • To inform clients of their rights and responsibilities.
  • To notify TANF and food stamp clients that they may request a receipt for any reported change(s).
  • To provide information about the Women, Infants, and Children (WIC) Program.

PROCEDURE

When to Prepare

Certification office staff use Form H1009-A with the computer-printed Form H1009, TANF/SNAP Notice of Eligibility, to inform clients of their rights and responsibilities.

Number of Copies and Transmittal

Certification office staff attach one copy of Form H1009-A to the computer-printed Form H1009 and give or mail both forms to the client. It is not necessary to attach a copy of Form H1009-A to the case record copy of Form H1009.

Form Retention

There is no retention requirement.

DETAILED INSTRUCTIONS

The form is self-explanatory.

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