Effective Date: 
10/2018

Documents

Instructions

Updated: 7/2015

Purpose

This form is an optional form for clerks to use as a desk aid or, at regional direction, the form may be used to screen every Supplemental Nutrition Assistance Program (SNAP) application to determine eligibility for expedited services.

Note: If the region decides to use this form for every application screened, then this form must be considered part of the case record.

Procedure

When to Prepare

Not applicable if used as a desk aid.

The clerk completes Form H1105 when screening a SNAP application for expedited benefits.

Number of Copies

Not applicable if used as a desk aid.

Follow regional direction if Form H1105 is used to screen every SNAP application.

Transmittal

Not applicable if used as a desk aid.

Follow regional direction if Form H1105 is used to screen every SNAP application.

Form Retention

Not applicable if used as a desk aid.

When used to screen a System for Applications, Verifications, Eligibility Reports and Referrals (SAVERR) SNAP application, file the form in the case record and follow normal retention requirements.

When used to screen a Texas Integrated Eligibility Redesign System (TIERS) SNAP application, this form becomes part of the permanent case record. Forward the form to the Document Processing Center (DPC), along with other case documents, for imaging.

Detailed Instructions

Self-explanatory.

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