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- To provide a method for the advisor to manually request that Electronic Benefit Transfer (EBT) issuance staff send a primary cardholder record to the EBT system through the Administrative Terminal Application (ATA).
- To provide a method for the advisor to request that EBT issuance staff manually merge a Temporary Assistance for Needy Families (TANF) primary cardholder record and a Supplemental Nutrition Assistance Program (SNAP) primary cardholder record through the ATA, so both the cash account and food account are linked to a single cardholder record.
- To provide the advisor with a method to give EBT issuance staff the authorization/information needed to enter information into the ATA to send the EBT system new/updated primary cardholder records and benefit records.
- To provide a method for the advisor to manually request that EBT issuance staff send a SNAP benefit record to the EBT system through the ATA when the Texas Integrated Eligibility Redesign System (TIERS) is unavailable.
- To provide a method for the advisor to request an update to the primary cardholder record when it cannot be done in TIERS.
- To provide a method for the advisor to request that EBT issuance staff use the ATA to split primary cardholder records when a cardholder's food account needs to be linked to a particular cash account but is already linked to a cash account with another Eligibility Determination Group (EDG) number (or vice versa).
- To provide a method for the EBT site coordinator or designated staff to authorize the EBT clerk to use the ATA to register a cardholder's card when it cannot be done over the telephone with the Lone Star help desk.
When to Prepare
The advisor or authorized staff complete the form when it is necessary to:
- send a new primary cardholder record for a TANF or SNAP EDG using the ATA,
- split or merge primary cardholder records using the ATA,
- send SNAP priority benefit records using the ATA,
- update the primary cardholder record using the ATA, or
- register a Lone Star Card in the local office using the ATA.
Number of Copies
The advisor or authorized staff person completes the original.
The advisor gives the original to EBT issuance staff.
The signed original is retained by EBT staff in a secure environment for three years.
Records are approved for destruction through the Web-based System of Organized Automated Records (SOAR). Access the site with the following link:
For more information on the purging and destruction of records, refer to the Operational Handbook, Part J, Section 3000, Purge of Obsolete and Inactive Records, and Section 6000, Records Destruction:
Part I. Send Primary Cardholder Record for This TANF and/or SNAP EDG — Complete Part I to send a new primary cardholder record as instructed below:
- Complete the TANF box on the left side if the record is for TANF.
- Complete the SNAP box on the right side if the record is for SNAP.
- Complete both sides if a primary cardholder record must be sent on the same person for both TANF and SNAP.
Note: If you must send a primary cardholder record for both TANF and SNAP but the EDGs have different primary cardholders, you must complete separate forms for each primary cardholder.
TANF and SNAP EDG Numbers — Check the box and enter the TANF or SNAP EDG number for which the primary cardholder record is being sent.
Endorsement — (SNAP only) Based on the policy in Texas Works Handbook (TWH), B-460, Prepared Meal Services, indicate one of the following "prepared meals services" statuses if applicable:
- Code "C" — communal dining, elderly/Supplemental Security Income (SSI) recipient
- Code "H" — homeless
- Code "M" — meal delivery, housebound/has a disability
- Code "E" — every service, homeless and elderly/SSI recipient
Otherwise, make no entry.
Primary Cardholder Name — Enter the name of the primary cardholder as spelled in TIERS. Enter the last name, comma, first name, space, middle name or initial until the name is complete or the maximum of 22 characters is reached. The 22 characters include alphanumeric characters, commas and spaces.
Date of Birth and Sex — Enter the primary cardholder's date of birth (mm,dd,yyyy) and check either F (female) or M (male) to indicate the primary cardholder’s sex.
Social Security Number (SSN) — Enter the primary cardholder's SSN (if known). If the cardholder cannot provide an SSN or does not have an SSN, enter zero.
Mailing Address — Enter the address to which EBT-related materials should be delivered. This would normally be the TIERS case mailing address, unless there is an EBT representative for the EDG. If there is an EBT representative, use that individual's address on the form and ensure that the Issuance — Details and Issuance — Address pages in TIERS also reflect that there is a different issuance address than the case mailing address.
EDG Name — Check Yes or No to indicate whether the primary cardholder's name is also the EDG name.
Part II. Send SNAP Priority Benefit Record — Complete Part II when it is necessary to send a priority benefit using the ATA. Complete the line beginning with Second Month only to send a benefit record for the second month of a combined allotment.
SNAP EDG Number — Enter the SNAP EDG number.
Primary Cardholder Name — Enter the name of the primary cardholder as it is spelled in TIERS.
No. in Household — Enter the number of household members certified to receive SNAP.
Benefit Month — Enter the benefit month.
Allotment Value — Enter the dollar value of SNAP benefits the household is entitled to receive. Enter the amount ensuring there is no room to enter extra figures after the $ sign or before the amount (for example, $**75.00).
County No. — Enter the county code.
Type — Check the box to indicate if the ATA issuance is for "expedited" or to meet "timeliness" requirements. Note: For the "second month" of a combined allotment, the benefit type is always "timely."
Form H1855 signed? — Self-explanatory.
TIERS inquiry completed? — Conduct inquiry to ensure the household has not received benefits already .
Reason for Using Administrative Terminal Application (ATA) — Enter the reason for issuing benefits through manual data entry on the ATA rather than through TIERS.
Supervisor's Review — The supervisor or a person designated by the supervisor:
- reviews Form H1175 to ensure:
- it is completed only when TIERS is unavailable and is completed accurately;
- that an application for SNAP or TANF benefits is on file; and
- that Form H1901, TIERS Data Collection Worksheet, and Form H1855, Affidavit for Nonreceipt or Destroyed Food Stamp Benefits, are both completed; and
- initials Form H1175 and enters the reviewer's employee number and review date. Note: The supervisor is not allowed to approve an ATA issuance unless an application for SNAP or TANF benefits is on file.
Part III. Update Primary Cardholder Record — The worker completes Part III when the ATA must be used to update the primary cardholder record.
Cardholder Record to Be Changed — Enter the primary cardholder's name and EDG number(s) as listed in TIERS.
Update the primary cardholder record as follows: — Enter the new information only in the fields that require an update.
Part IV. Split Primary Cardholder Records — The split function on the ATA can only be done by the local office EBT site coordinator or designated staff.
The advisor completes Part IV when a cardholder's food account needs to be linked to a particular cash account but is already linked to a cash account with another EDG number (or vice versa). This situation may occur for various reasons, but it usually happens when the advisor fails to correctly reassign a denied TANF EDG number. The result is the food account is linked to a cash account with a denied EDG number and needs to be linked to the cardholder's cash account with an active TANF EDG number.
- Local offices are not to use the split process simply because a person’s TANF or SNAP EDG is denied. The split process should only be used when required to complete another merge as indicated in Part V.
- If staff become aware of a situation in which one person's primary cardholder record for a food account is erroneously linked to another person's primary cardholder record for a cash account, staff must immediately report it through supervisory channels to the regional EBT coordinator or designated staff for correction.
EDG Name — Enter the EDG name for the record that needs to be split.
TANF and SNAP EDG Numbers — Enter the cardholder's TANF and SNAP EDG numbers that need to be split in the EBT system.
Part V. Merge Primary Cardholder Records — The advisor completes Part V when a cardholder who receives both TANF and SNAP has a cash account and food account that are not linked to the same primary cardholder record on the EBT system, and the cardholder wishes to use one card to access benefits for both programs. In this situation, staff must use the ATA to manually merge the primary cardholder's two records and link both accounts to one card. The primary cardholder record data must match before this procedure can be completed.
EDG Name — Enter the EDG name for the records that need to be linked.
TANF and SNAP EDG Numbers — Enter the cardholder's TANF and SNAP EDG numbers that need to be linked in the EBT system.
Part VI. Register Card — The EBT site coordinator or person designated by the coordinator completes Part VI to authorize card registration in the local office in situations outlined in TWH B-233.5.2, Special Card Registration Procedures.
TANF and SNAP EDG Numbers — Enter the cardholder's TANF or SNAP EDG number. If the client will be accessing both a cash account and food account, enter both EDG numbers.
Primary Cardholder Name — Enter the name as spelled in TIERS.
Requestor Signature — The advisor requesting the data entry signs the form and enters an employee number and the date of the request.
Signature of Person Completing Request — The EBT issuance staff who performs data entry signs the form and enters an employee number and the date the requested action is completed.