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Effective Date: 




Updated: 1/2011


TANF, SNAP and Medical Programs:

  • To explain to clients their responsibilities for completing and submitting the application/review form.
  • To schedule interview appointments.
  • To tell clients to bring items needed for the interview, and inform them of their rights and responsibilities, in addition to the responsibilities of the Health and Human Services Commission.


  • To notify clients of the expiration of the certification period (and the reason why) to help them file timely applications for continued certification.
  • To advise clients who receive Supplemental Security Income (SSI) that they
    • may apply for recertification at the local eligibility determination office or at a Social Security office.
    • are entitled to a home or telephone interview if they are unable to appoint an authorized representative.
  • To notify the applicant that the application has been screened for expedited services and that the applicant needs to contact the office as soon as possible.

TANF and Medical Programs:

  • To schedule appointments for prior Medicaid applications.


When to Prepare


Staff prepare Form H1830 to send to

  • System for Application, Verification, Eligibility, Referrals, and Reports (SAVERR) Public Assistance (PA) or Non-Public Assistance (NPA) applicants, and
  • SAVERR NPA clients when their certification is expiring.

Note: Staff schedule a joint TANF/SNAP appointment for PA SNAP cases unless the SNAP recertification cannot be completed timely.

TANF and Medical Programs:

Staff prepare Form H1830 to send with

  • application packets to SAVERR applicants,
  • review forms to SAVERR clients for periodic reviews, and
  • review forms to SAVERR clients for complete reviews because of changes in their circumstances.

TANF, SNAP and Medical Programs:

Staff schedule appointments on a second Form H1830 after the application is returned.

Number of Copies

Staff complete an original and two copies.


Staff give or mail the original to clients with Form H1010-B. Include a return stamped envelope.

Staff file one copy under miscellaneous in the case folder. The third copy can be used for monitoring and tracking.

Form Retention

Staff must keep the copy

  • three years from the month of origin for SNAP cases,
  • until the next review for TANF and medical cases.

Exception: Staff may destroy the copy after 30 days if it was for an initial application (first-time applicant) that was not returned.

Detailed Instructions

Enter the client's name and address. Also enter the case or application number at the top of the form if desired. Enter the name of the advisor, local office address, and telephone number.

  1. Check box 1 to indicate that an application form is being given to the applicant.
  2. Check box 2 when sending a review form for TANF or one of the medical programs.
  3. Check box 3 if notice of expiration is given to a SNAP client, and enter the dates. Example: A client's certification expires the last day of October 2010. Notice is sent in mid-September. Enter "October 2010" in the first blank, "November" in the second blank and "October 15, 2010" in the last blank.
  4. Check box 4 when scheduling appointments for applications and reviews/recertifications. Enter the appointment date, time and place. When scheduling a telephone interview, enter the client's telephone number and the approximate time using one-hour increments. Example: Phone interview will be conducted between 1:00 p.m. and 2:00 p.m. Note: Local offices may choose to establish a shorter time increment.
  5. Check box 5 when the applicant may be eligible for expedited services.