- 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.