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Effective Date: 



Updated: 8/2005


  • To collect data to:
    • assist in developing plans to address quality control (QC) errors; and
    • focus on regionally-selected eligibility points.
  • To provide information for:
    • developing staff;
    • assessing Texas Works advisor (TWA) and program performance; and
    • identifying needed improvements in client services and accuracy.


Form H1161 has specific eligibility questions dealing with the completion of a case. Household composition, resources, earned income, unearned income and deductions are divided into specific areas.

When to Prepare

Use this form for both positive and negative (denied) case actions that occur at applications, changes, reviews, or recertifications. Complete a separate form for each case reviewed.


Complete Form H1161 based on Texas Works Handbook (TWH) policies and procedures and verification/documentation standards.

Number of Copies

Complete an original and two copies for each case reviewed.


The case reader retains the original for data entry and regional files, sends one copy to the advisor, and sends one copy to the advisor's supervisor.

Form Retention

If errors are ... Then the supervisor files the form in ...
not identified the advisor's conference notebook for use in ongoing staff development and retains until the advisor's next evaluation.
identified a pending file until all errors have been corrected. After correction, the form is filed in the advisor's conference notebook and retained until the next evaluation.

Forms sent to the regional office for data entry purposes may be purged at the end of 60 days since they are not part of a permanent case record.


Month/Year (MM/YYYY) — For core cases, MAPPER identifies the sample month/year. For post cert cases, the sample month is the process month. For example, if cutoff is on 4/20 and the case was processed on 4/25, then the sample month is 05/2005. For pre-cert cases, the sample month is the month the case is read based on cutoff. For example, if cutoff is 4/20 and the case was read on 4/25, then the sample month is 05/2005.

Region — Enter the region number.

PM Code — Enter the two-digit numeric code for the program manager responsible for the unit in which the case work was completed. This number is available by contacting the regional case reading coordinator.

Unit — Enter the unit number.

Mail Code — Enter the advisor's mail code.

Reader Emp. No. — Enter the case reader's four-digit employee number.

Case Name — Enter as shown on the sample list or case record being read.

Case No. — Enter the case number of the case being read.

Sample No. — Enter the two-digit sample number as shown on the MAPPER sample list. If MAPPER is not used, leave blank.

Category — Enter the code for the category or type program being read.

01– TANF
04 – Medical Assistance for deceased individuals
05 – Refugee Cash Assistance
06 – PA food stamps
07 – 12-18 month transitional Medicaid
08 – PA food stamps (refugees)
09 – Non-PA food stamps
11 – Three Month's Prior not currently eligible
20 – Child support post Medicaid
29 – 12-18 month transitional Medicaid
30 – Undocumented aliens
37 – 12-18 month transitional Medicaid
40 – Pregnant women with income below 185% of Federal Poverty Income Limit (FPIL)
42 – Presumptive eligibility for pregnant women
43 – Children under age one with income below 185% FPIL in two-parent families, or who meet the TANF definition of deprivation, or are independent children
44 – Children age six born on or after 10/1/83 with income below 100% FPIL in two-parent families, or who meet the TANF definition of deprivation, or are independent children
45 – Newborn children of Medicaid-eligible mothers

47 – Deprived children ineligible for TANF due to the applied income of:

  • their stepparent when they live with their legal parent and stepparent, or
  • grandparent(s) when they live with their minor legal parent and their minor legal parent's parent(s)

48 – Children ages 1-5 with income below 133% of FPIL in two-parent families, or who meet the TANF definition of deprivation, or are independent
55 – Medically needy
61 – TANF-SP
71 – OTTANF – one-parent household
72 – OTTANF – two-parent household
81 – OTTANF – Grandparent as Payee
82 – OTTANF – Grandparent as Caretaker

Employee No. — Enter the advisor's employee number.

Employee Name — Enter the name of the advisor who completed the action being reviewed.

Action Date — Enter the date the advisor completed the worksheet.

Type Sample — Check the appropriate box.

1 – Pre-cert
2 – Slant
3 – Core
4 – Validation
5 – Regional Use
6 – Regional Use
7 – Regional Use
8 – Regional Use
9 – Regional Use

Pre-cert — A full case reading of a case prior to certification where all eligibility points are scored.

Slant — Targeted case reading of certain elements and/or spot-checking. Case reading may include a case action prior to certification or after certification where targeted eligibility points are scored.

Core — Case reading of all elements or eligibility points after certification. Core cases will consist of cases from the MAPPER sample only.

Validation — A case reading completed after the case reader to ensure case reading of Form H1161 was scored accurately.

Regional Use — Type of case action determined by the regions. Regions using No. 5 through No. 9 must advise state office of how these codes are being used and when there are any changes.

Reader Activity — Check the appropriate box.

Action Type — Enter one of the following action codes to indicate the type of action reviewed:

1 – Certification, complete review, or recertification
2 – Incomplete review or reinstatement
3 – Denial

Denial Code — Enter the denial code used to deny the case.


"CORRECT Yes, No, N/A" column

Yes: Check a "Yes" in the space provided after the numbered eligibility point if no payment, policy, verification, documentation, or case clue errors are found in the element.

No: Check the "No" in the space provided after the numbered eligibility point if an error is found. If "No" is checked, also check one or more boxes under "Error" identifying the type error (Policy, Verification, Documentation, Case Clue) based on the following criteria:

  • Policy Error: When TWH policy is applied incorrectly, forms required by policy are not completed or are incorrectly completed, or mandatory special reviews are not set.
  • Verification Error: When mandatory verification required by TWH is not obtained, or unnecessary verification is requested, or if handbook forms used for verification are not in the case record.
  • Documentation Error: When mandatory documentation required by TWH is not present on the worksheet or in the case record.
  • Case Clue: When reported, available, discrepant, or incomplete information is not addressed, investigated, or fully explained.

N/A: Check "N/A" if the advisor was not required to complete the eligibility point (as in the case of incomplete reviews, or when the eligibility point applies to a program different from the one being read).

"PAYMENT ERROR" column — Check the box in this column for the numbered eligibility point found in error. When information on the worksheet, in the case record, from collateral contacts, or from computer data proves that an actual benefit or eligibility error exists or will occur in the ongoing budget.

"Check Here if Case Has Payment Error" box — Check this box if a payment error is discovered in the case, even if the eligibility point containing the payment error was not scored. Entries in this box will not be used for "Dollars in Error" calculations. This box is for a quick reference only. In order for amounts to be entered in the "Dollars in Error" box, the eligibility point must be read and a payment error scored.

Comments — Briefly explain all errors to inform the advisor and others why the error was scored. Reference the question number and related handbook sections. Attach Form H1161, page 2 for additional comments as needed.

Case reader — Self-explanatory.

Date — Enter the date the case was read.

Dollars Issued — Enter the total amount of food stamp or TANF benefits authorized, including recouped amounts, according to SAVERR/GWS for the action read. Enter this amount on every case read.

Dollars in Error — Enter the amount of benefits (+ or –) issued in error. Overissuances are (+) amounts and underissuances are (–) amounts. Note: A scored eligibility point must contain a payment error for an amount to be entered here.

Example: Readeris reading food stamp case complete review. Benefit amount according to SAVERR = $100. This amount is entered in "Dollars Issued." A payment error is scored due to incorrect budgeting. The correct amount of benefits is $90. The amount entered in "Dollars in Error" is +$10.

Clear by — Enter the date by which the advisor must correct any identified errors.

Date cleared — Staff who are monitoring the correction of identified errors enter the date the error is cleared in this space.

The scoring process:

  1. If the case reader does not find an error, the "Yes" box under the "Correct" column for the numbered eligibility point is checked. Additional scoring is not required.
  2. If the case reader discovers an error, the "No" box under the "Correct" column next to the numbered eligibility point is checked.
  3. If the case reader discovers an error, check the box under "Error" that applies. Note: There may be more than one error type scored per eligibility point.
  4. If a payment error is found, the case reader checks the box for the numbered eligibility point in the "Payment Error" column and enters the amount of the payment error in "Dollars in Error."
  5. If no payment error is found, no entry is made in the "Payment Error" column.

Determining Dollars Issued/Dollars in Error — When there is no payment error in the case, the "Dollars Issued" amount will be the amount of benefits issued in the month the action affects.

Example: When an application is being read, the amount issued in the sample month will be entered. When a review, recertification, or change is being read, the amount issued in the month affected by the action will be entered.

When there is a payment error in the case, the "Dollars Issued/Dollars in Error" amounts will be based on the amount of benefits issued the first month the payment error occurs.

Example: When an application is being read and the first month's benefits are correct but the second month's benefits are incorrect, the amount of benefitsand the amount of the error for the second month will be entered.