Downloading a Form to Your Computer

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Effective Date: 




Updated: 1/2010



To verify participation in an employment program that meets the criteria for the Supplemental Nutrition Assistance Program (SNAP) 18-50 work requirement.



When to Prepare

At application, local workforce staff complete Part I after outreach to verify participation in the Employment and Training (E&T) program for SNAP.

At recertification, Health and Human Services Commission (HHSC) staff provide the form to each non-exempt registrant in the household to verify participation with E&T or another employment program. The household must take the form to the local workforce board for verification and return the completed form to HHSC.


Give one copy to the E&T registrant. E&T staff complete and return the original if the registrant adequately participates. File one copy in the case record under Miscellaneous/Correspondence.

Form Retention

See the Texas Works Manager's Guide for the retention requirement.


Detailed Instructions

Print the case name, case number, date, name of person and Social Security number at the top of the form. Print the HHSC office information at the bottom of the form.

Part I: If a non-exempt registrant is participating in an E&T program after initial outreach by E&T staff, local workforce staff enter an "X" in Part I to verify participation.

Part II: If the form is provided to a non-exempt registrant during recertification and taken to the local workforce center, local workforce staff enter an "X" in Part II to verify current participation in an employment program listed on the form.