PURPOSE

Form H1001 will be used when a Voluntary Agency (VolAg) assists a refugee applicant and/or household apply for Texas Works benefits.

PROCEDURE

When to Prepare

Form H1001 will be the cover sheet used to fax an application (Form H1010) and supporting documents any time a VolAg assists a refugee applicant/household apply for benefits. The cover sheet will be placed in front of each application and will be used as a separator between applications. The VolAgs will complete all the information on the form.

Form Retention

The requirements are listed in the Manager's Guide for Eligibility Programs.

DETAILED INSTRUCTIONS

Date — Enter the date.

Name of Agency — Enter the name of the Voluntary Agency (VolAg) assisting the client.

Agency Representative's Name — Enter the name of the agency representative that will assist the applicant.

Representative's Area Code and Telephone No. - Enter the representative area code and telephone number.

Applicant's Name — Enter the head of household's name.

Check the programs the household is applying for — The VolAg will check all the programs the individual and/or household is applying for.

Is the application for an Unaccompanied Refugee Minor (URM) — VolAg will answer this question accordingly.

The remainder of the form notifies the VolAg of the required information and additional information that needs to be provided at the time of application if applicable.