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 serve as a transmittal and receipt memorandum accompanying supplies of Lone Star cards or other controlled EBT documents.
- To provide a security and accounting mechanism for controlled EBT documents.
Regional and local offices use Form H1177 as a receipt for controlled EBT documents. Only persons who are authorized to maintain a supply of controlled documents and who are named in the local office security chart may sign this form.
Number of Copies
Complete an original and two copies.
The person sending the controlled documents sends the original and first copy of Form H1177 with the documents. The sender keeps the second copy as a control document until the receiver signs and returns the original.
The person who receives the controlled documents signs the original and first copy, returns the original to the sender, and retains the first copy for the office's inventory file.
Retention requirements are found in the Manager's Guide for Eligibility Programs.
To— Enter the name and address of the person designated to receive the controlled documents.
From— Enter the name and address of the person sending the controlled documents.
Check the appropriate box to indicate the type of document. Enter the total number and inclusive serial numbers of documents being sent. The person sending the controlled documents signs and dates Form H1177. The person receiving the controlled documents signs and dates Form H1177 and marks through any blanks not used.