Effective Date: 



Updated: 6/2015


  • To serve as a log of issued Lone Star Cards and personal identification number (PIN) packets.
  • To provide a record of issued Lone Star Cards and PIN packets by cardholder, by Eligibility Determination Group (EDG) number and by issuance staff.



When to Prepare

Issue the first card listed on Form H1173 from the last card issued the previous workday.

As staff issue cards/PIN packets, staff enter the information on Form H1173.

If staff issue a card/PIN packet to someone in the office, the person receiving it must sign the log to verify receipt. While obtaining a recipient's signature, staff must shield all previously listed recipient names/information to ensure confidentiality.

Number of Copies

Each certification office maintains an original.


At the end of each month, staff file the log according to procedures in the Security and Accountability Handbook.

Form Retention

Retain Form H1173 for the period of time specified in the Manager's Guide to Eligibility Programs.


Replacement — If using the form to log a replacement card or PIN packet, write "R" in the Replacement column. If a local office is replacing a card or PIN because the Lone Star help desk failed to replace it timely (as explained in Texas Works Handbook, Section B-235), highlight the replacement on Form H1173 and report the total to the regional director or designee at the end of each month. The regional director/designee reports the regional total by the 15th of the next month to the state office EBT Program Operations Section.

Issue Date — Enter the Lone Star Card or PIN packet issue date.

If an advisor is logging out a card or PIN packet to take on a home visit or to an itinerant office, enter the date the items are issued to the advisor.

Name of Primary Cardholder — Enter the name of the primary or secondary cardholder to whom the card or PIN packet belongs. Write "(SC)" before a secondary cardholder's name.

Note: If an advisor returns an unused card or PIN packet that staff previously logged out to the advisor for a home visit, write "returned/wkr" in this box and return the card or PIN packet to inventory.

EDG Number — Enter the Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) EDG number associated with the card/PIN packet being issued. If the card is linked to both programs, enter both numbers.

Note: Leave thisbox blank when logging a returnedcard.

Issuance Type: PAN — Enter the 19-digit personal account number (PAN) from the card when logging an issued card. Do not enter the two-digit card control number.

Issuance Type: PIN

Self-Select — Enter:

  • Y — if the cardholder chooses to self-select a PIN.
  • N — if the cardholder chooses to receive a PIN packet. Log the PIN Control Number on the separate log.
  • N/A — if the cardholder requests a card replacement without a PIN replacement.

Control No. — Enter the eight-digit control number on the outside of the PIN envelope when issuing a PIN packet.

Signature of Recipient — When someone receives a card or PIN packet in the office, the person must sign here.

Note: If anadvisor logs out a card or PIN packet to take on an out-of-officeinterview, the advisor signs here.

Issuance Staff Initials and Emp. No. — The issuance staff who issues the card/PIN packet enters their initials and employee number (legacy number or last six digits of employee identification number).

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