Downloading a Form to Your Computer

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  2. Select the folder you want to save the file in and then click "Save."
  3. 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.

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Effective Date: 


Note: This form is automatically sent to Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP) recipients to renew benefits. SNAP-CAP applications are available only from Centralized Benefit Services staff. Call 2-1-1 or 1-877-541-7905 (after choosing a language, press 2 ) to request an application to apply for or renew benefits.



Updated: 4/2015


  • To serve as a renewal form for the Supplemental Nutrition Assistance Program Combined Application Project (SNAP-CAP).
  • To establish a SNAP-CAP renewal application file date.
  • To serve as a document for recipients to designate an authorized representative (AR).


When to Prepare

Supplemental Security Income (SSI) recipients who currently receive SNAP-CAP benefits will be required to complete one copy of the form in order to determine continued SNAP-CAP eligibility.

The recipient or a designated AR may complete and sign the form. Recipients may use page 2 of the form to designate an AR.

Texas Health and Human Services Commission (HHSC) staff must help the recipient with completing the form if the person requests help. The HHSC staff member must initial any entries the staff member makes on the form.

Number of Copies

Original only.


State office automatically mails a renewal application to individuals who remain potentially eligible for SNAP-CAP.

A SNAP-CAP renewal application returned to a local eligibility determination office must be faxed to the non-expedited fax line at 1-877-447-2839 the same day it is received for task creation for the Centralized Benefit Services (CBS) unit.

Note: Form H1842 is used to reapply for SNAP-CAP only.

Form Retention

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


Application for Assistance

Pages 1 and 2 are the actual renewal application for assistance.

Voter Registration — Give Form H0025, Voter Registration Application, to individuals who indicate an interest in registering to vote and who meet the voting registration requirements. Authorized representatives or representative payees also may take Form H0025 to the individual to complete. Mail Form H0025 when the individual does not have a face-to-face interview or the individual reports a change of address by telephone or by mail. If requested, assist in the completion of Form H0025.

If the individual declines to register to vote during a face-to-face interview, ask the person to sign Form H1350, Opportunity to Register to Vote. Mail Form H1350 to an individual who did not have a face-to-face interview who declines the opportunity to register to vote, based on receipt of Form H0025.

Voter Registration Status — Check the appropriate box under Agency Use Only and sign.

Page 3 lists an overview of SNAP-CAP, information regarding who is eligible, benefit amounts, appeal information, and a number to call for more information or help.

Page 4 includes a Privacy Act statement and penalty information.