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.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- 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.
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- To use as an attachment to manual
- Form H1009, TANF/Food Stamp Notice of Eligibility;or
- Form H1017, Notice of Benefit Denial orReduction.
- To notify an TANF household of ongoing TANF time limit information.
When to Prepare
Complete Form H1076-B for all TP 01 and 61 households at complete review, incomplete review, and reapplication, when providing
- manual Form H1009 or Form H1017, and
- information about
- the number of months used in the client's state time limit,
- a change in the client's state time limit at reapplication, or
- a correction in the client's state time limit because incorrect information was previously used.
Number of Copies
Complete an original and two copies.
The advisor gives an original and one copy to the client.
Note: The GWS prints the household's time limit information on Form H1009 and Form H1017.
File one copy under Miscellaneous/Correspondence. Keep it for three years after the case is denied.
Enter the name(s) of the caretaker and/or second parent.
Check the box that indicates whether the client has a time limit of 12, 24, or 36 months, and when available, enter the number of months counted toward the time limit (See Client Screen A2 — Welfare Reform Data, "TL Months Used.")
When applicable, check the box that indicates
- a change in the client's time limit,
- a correction to the client's time limit, or
- the client is penalized for non-compliance with the Choices program.