Effective Date: 



Updated: 10/2001


To allow a household to pay a food stamp claim by monthly debit of an active Lone Star food account.


When to Prepare

OIG or ARTS staff complete Form H1023 when a household agrees to pay a food stamp claim by debit of an active Lone Star food account and requests monthly installment payments.

Number of Copies

Complete an original and two copies.


Original — Case Name
Copy — Lone Star Technology
Copy — OIG or ARTS office file


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

Detailed Instructions

  1. Enter the case name and mailing address.
  2. Enter the date, case number, case name, office's name, and address and telephone number of staff completing the letter.
  3. Enter the amount of the overpayment.
  4. The client must enter the monthly amount of the debit and sign and date the agreement and return it to HHSC.

Having trouble viewing or downloading a form?

Get Help