Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. 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. 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.

    If still having trouble viewing or downloading a form, click here.

Effective Date: 



Updated: 1/2002


To allow a household to verbally agree to pay a food stamp claim by a one-time debit of an active Lone Star food account.


When to Prepare

OIG or ARTS staff completes Form H1021 when a household requests to have a one-time debit of an active Lone Star food account to pay a food stamp claim.

Number of Copies

Complete an original and one copy.


Original — Lone Star Technology
Copy — OIG/ARTS office file

Form Retention

The case folder file is retained for three years or until the claim is repaid, whichever is greater.

Detailed Instructions

  1. Obtain and enter information from the client to verify identity. Verify the client information on SAVERR.
  2. Enter OCIS information when the request is made prior to claim establishment. Enter ARTS information when the request is madeafter claim establishment.
  3. Enter Lone Star Technology ATA information.
  4. Enter the name, telephone number, and mail code of the OIG or ARTS employee who received the request, the date of the request, and the OIG or ARTS employee's signature.