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DADS Forms and Instructions

Group Misc

Number Title
AT-Report Administrative Terminal Report
FNS-135 Affidavit of Return or Exchange of Food Coupons
G-845S Document Verification Request
HHS-ECPS01 Justification for Emergency Purchase
HHS-ECPS02 Justification for Proprietary and/or Sole Source Purchase
HHS-ECPS03 Justification for Purchase of Professional Membership
HHS-ECPS04 Justification for Purchase of Non-Professional Membership
LSC Lone Star Card
LSCM Lone Star Card Mailer
LSCRS Lone Star Card Registration Sticker
LSCS Lone Star Card Sleeve
LSIS-LQER LSIS-Low Quality Enrollment Response
LSIS-MR LSIS-Match Response (Vendor Report 04B)
LSIS-SER LSIS-Successful Enrollment Response (2 Samples)
LSISReport1D Local Office Report
LSISReport8A Daily Exception Report
PIN Personal Identification Number (PIN) Packet
R-17 Nursing Home Management System Patient Status Report
RA-01 TANF Activity Report
RA-01C TANF Activity Report/Regional Summary by County
RA-04 TANF Caseload Information by Ethnicity
RA-07AB TANF Fraud/Non-Fraud Recoupment Completion Notice
RA-103 TANF Time Limits - Countable Month Precedes Notification Effective Date
RA-109 Excess TANF Benefit for Client Already at FTL Month 60
RA-110 TANF SIG 0, 2, or 9 Client at FTL Month 60
RA-18 TANF Non-Fraud Recoupment Initiation Notice
RA-24 List of Warrants on Hold
RA-58 Medicaid Report Form Case Listing
RA-60 Clients Incorrectly Dually Certified for TANF/Medical Programs and SSI
RA-66 TANF and Texas Works Cases with Unenumerated Clients
RA-79 GWS TIER Discrepancy Report
RA-80 JOBS Sanctioned Clients with Tier Level 8
RA-81 Adjustment of TANF Time Limit Months
RA-90 JOBS Sanctioned Clients with Overlapping Good Cause
RA-93 JOBS Sanctioned Clients - Notification Effective Date Change
RA-97 Voluntary Quit Penalties: Potential Food Stamp Impact
RF-01 Food Stamp Activity Report
RF-03 Food Stamp Household Size and Type by Bonus Value (Issuance)
RF-07E-1 EBT Reconciliation Exception Report
RF-14 Monthly Food Stamp Reminder
RF-158-1 Employment and Training Program Noncompliance and Sanction Reminder
RF-229 TANF Case Adjusted or Denied Due to Time Limit Policies - FS Case Not Converted
RF-30-1-3 Food Stamp Cases Whose Other Income was Insufficient to Handle TANF $30 or 1/3 Changes
RF-36 More Than One Food Stamp Benefit Authorized
RF-49 Pending Application Report
RF-50 Food Stamp Timeliness Summary Report
RF-51 Food Stamp Timeliness Detail Report
RF-54 Food Stamp Timeliness Worker Summary Report
RF-66 Food Stamp Cases with Unenumerated Clients
RG-01 NOA Report
RG-02 Probable Match Report
RG-03 Client File Referral Report
RG-07 Budgeted Job Number Realignment Card
RG-09 Bendex Information Memorandum
RG-09A Bendex Memorandum Summary
RG-101 Income and Eligibility Verification Data
RG-150-1 Employer New Hire Reporting (ENHR) Worker Report
RG-150-1-A Employer New Hire Reporting (ENHR) Worker Report
RG-150-2-A Employer New Hire Reporting (ENHR) Unit Report
RG-30 Timeliness of Application Disposition
RG-300 Lone Star Image System Reconciliation Exceptions
RG-31 Application Disposition Report
RG-311 Finger Image Exemption Code Usage
RG-83 SSN Maintenance Memorandum
RG-83B SSN Maintenance Follow-Up Tracking Report
RG-86 Income Information Request
RG-87 Unemployment Claim Data
RLSM Request for Lone Star Materials
RM-01 Medical Assistance Activity Report
RN-01 Income Assistance Medical Programs Activity Report
RN-23 Notice of Future Case Action
RN-24-2 Monthly Report of Cases on Hold Code 3 (Type Programs 43 and 48)
RN-74 TP 40 End Date Review Required
RN-75 TP 40 End Date Correction Required
RN-76 TP 40 End Date Changed
RP-24B Daily Notice of Cases/Benefits Placed On Hold
SAMPLE1 Potential Eligibility Prescreening Record
SCRF Second Cardholder Request Form
SS-5 Application for a Social Security Number Card (Original, Replacement, or Correction)
SSA-1610-U2 Public Assistance Agency Information Request
SSA-2853 Message from Social Security
SSA-3288 Social Security Administration Consent for Release of Information