Effective Date: 



Updated: 9/2003


  • To provide advisors with astandardized summary to inform applicants and recipients of their responsibilities as participants in the TANF (TP 01, 61) program.
  • To emphasize with recipients the message of individualresponsibility and self-sufficiency.


When to Prepare

Form H1073 must be signed by:

  • caretakers (SIG 8) and second parents (SIG 7) who receive TANF [including teen parents thatare caretakers] at initial interviews or at subsequent interviews if a signed form is not already on file or there has beena break in certification,
  • payees and disqualified parents if a signed form is not already or file or there has been a break certification, and
  • the advisors.


  • If the second parent is in the home, he must sign aseparate form.
  • If the caretaker, second parent, payee or disqualified adult refuses to sign FormH1073, deny the case.

Number of Copies

File the original Form H1073 under "Legal" in the case record and give a copy to the client.

Detailed Instructions

What are Your Responsibilities?

Refer to Section A-2100. Explain each responsibility and the related penalties to each client. Also explain HHSC's responsibilities to provide support service.

Information on Additional Penalties

Continue to provide clients with Form H1712 and Form H2580.

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