Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
If still having trouble viewing or downloading a form, click here.
To provide staff responsible for maintaining a supply of Lone Star cards and PIN packets a means of accounting for them.
When to Prepare
Staff designated in the local office security chart as responsible for maintaining a supply of Lone Star cards and PIN packets must complete this form at the end of each month. The only person with this responsibility is the local office EBT site coordinator or back-up.
Number of Copies and Transmittal
- An original is maintained in each certification office.
- A copy is sent to the regional security officer (RSO) or designee.
Note: Use one Form H1174 for Lone Star cards and a separate form for PIN packets.
All copies of the form are retained as specified in the Manager's Guide for Eligibility Programs.
In the boxes at the top of the form, enter the region and unit numbers, mail code, and date completed, and check the appropriate box for the item being inventoried.
Sections I through IV require the inclusive complete serial numbers of EBT cards/PIN packets on hand, received, and used. Report serial numbers in proper sequence. Do not report broken sequence numbers as though they were continuous: for example, 9200001 through 9220009 and 9228815 through 9228845 would not be 9200001 through 9228845. Make as many entries as needed to account for the serial numbers of each card/PIN packet.
Note: To determine the sequence number on
- Lone Star cards, ignore the first and third number of the three-digit group on the end of the PAN.
- PIN envelopes, ignore the last number of the PIN control number.
Section I — Enter the month being reported. Enter the total number of Lone Star cards/PIN packets on hand at the beginning of the reporting month being reported and the inclusive serial numbers.
Section II — Number of Lone Star cards/PIN packets received from vendor.
Section III — Enter the total number of Lone Star cards/PIN packets used during the month and their inclusive serial numbers.
Section IV — Enter the total number of Lone Star cards/PIN packets on hand at the end of the month being reported and the inclusive serial numbers.
Note: The total number of Lone Star cards/PIN packets on hand at the beginning of the month should be same amount reported in Section IV at the end of the preceding month.
Type the name, title, date received and city of the staff member responsible for completing Form H1174. The responsible staff must sign this form.
Note: Signing validates that a physical count was made and the numbers reported on the form are consistent with the results of the physical count.