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Effective Date: 
4/2002

Documents

Instructions

Updated: 4/2002

Purpose

To provide a record of an applicant's statement of understanding of the TANF, TANF-SP, and OTTANF ineligibility period.

Procedure

When to Prepare

Complete Form H1072 before authorizing OTTANF payments.

Number of Copies

Prepare three originals.

Transmittal

Original – Give to applicant.

Original – File in an office or unit master file.

Original – File in the case record under Form H1010-B.

Retention

See Texas Works Manager's Guide.

Detailed Instructions

Staff complete applicant identifying information and data.

Staff review each statement of Form H1072 with the applicant at each application in which the applicant opts to receive an OTTANF payment rather than TANF or TANF-SP.

The applicant or second parent must sign and date Form H1072 (in ink) in the presence of the advisor.

The certifying worker must sign and date Form H1072 (in ink) and enter his BJN and employee number.