Effective Date: 



Updated: 6/2002


  • To use as an attachment to GWS and manual
    • Form H1009, TANF/Food Stamp Notice of Eligibility, or
    • Form H1017, Notice of Benefit denial or Reduction
  • To notify a TANF-SP caretaker and/or second parent that
    • TANF-SP benefits are limited to 60 months,
    • what benefit months determine the number of state time limit months used, and
    • when they reach the end of the TANF-SP Time limit, any household member receiving benefits are ineligible for TANF-SP for life.


When to Prepare

Complete Form H1094

  • at application,
  • when adding a new caretaker or second parent, or
  • at complete review if the caretaker/second parent have not previously been informed of the TANF-SP time limit.

Number of Copies

Complete an original and one copy.

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