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Effective Date: 



Updated: 12/2010


  • To provide clients a form that lists their reporting requirements for the Former Foster Care in Higher Education program.
  • To provide clients a form to report changes in their circumstances.
  • To provide HHSC office staff a form to record information reported by clients about changes in their circumstances.
  • To advise the client that the advisor can explain what type of proof is required for a reported change.
  • To provide clients with a receipt of the change(s) they reported.


When to Prepare

Clients complete this form when they want to report a change in their circumstances. HHSC office staff also complete the form when the client reports a change in person or by telephone.

Number of Copies

The client or HHSC office staff complete an original and one copy of the form. Provide the client with the copy if he requests a receipt of the change.


HHSC office staff give this form and a prepaid return envelope to all clients at the initial certification and each recertification, if needed. Staff must issue a new form and envelope to the client each time a change is reported.

Form Retention

See retention requirements in the Texas Works Manager's Guide.

Detailed Instructions

Provide Spanish-speaking households with Form H1019-FS (Spanish version).

Page 2 — Enter the case name, case number(s) and advisor name in the top section.

Changes — The client or staff enter an explanation of the changes with the effective date and the duration of each change.

Signature — The person reporting the change signs the form and enters the date of the report in the appropriate spaces. If the change is reported by telephone, the person receiving the information signs the form and completes it in as much detail as possible.

Enter the local office address and telephone number at the bottom of page 2 (rubber stamp is preferred).

Voter Registration — Give Form H0025, Voter Registration Application, to clients who indicate an interest in registering to vote and who meet the voting registration requirements. Authorized representatives or representative payees may also take Form H0025 to the client to complete. Mail Form H0025 when the client does not have a face-to-face interview or the client reports a change of address by telephone or by mail. If requested, assist in the completion of Form H0025.

If the applicant or client declines to register to vote during a face-to-face interview, ask the client to sign Form H1350, Opportunity to Register to Vote. Mail Form H1350 to a client who did not have a face-to-face interview who declines the opportunity to register to vote, based on receipt of Form H0025.

Voter Registration Status — Check the appropriate box under Agency Use Only and sign.