Downloading a Form to Your Computer
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC application. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
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- 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.
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.
There is no retention requirement.
The form is self-explanatory.