FORM H1082
Instructions

TANF Grandparent Supplement Payment Request

11-2008

PURPOSE

To provide the Texas Works advisor with a method to request a one-time grandparent payment from State Office Data Integrity (SODI). This form can be accessed through the local area network (LAN) or generic worksheet (GWS).

PROCEDURE

When to Prepare

Complete Form H1082 after determining a household is eligible for the one-time grandparent payment.

Number of Copies

Complete an original and one copy.

Transmittal

Send the original form to SODI at Mail Code Y-922, or fax to 512-706-7140.

Form Retention

File the copy under Miscellaneous/Correspondence. Keep it for three years after the case is denied.

DETAILED INSTRUCTIONS

From, Mail Code, Telephone No., BJN, and Emp. No. — Enter the information identifying the advisor to whom database support staff will respond.

Case Number — Enter the Temporary Assistance for Needy Families (TANF) case number. If there is more than one TANF case number, use only one.

Case Name — Enter the case name that corresponds to the case number.

Benefit Effective Month — For applications, enter the grant effective date. For complete and incomplete reviews, enter the month the advisor determines the client is eligible for the supplement.

Client Address — Enter the client's address.

Client No., Name, Sex, Date of Birth, Social Security No. — Enter the information that identifies the certified group members eligible for the one-time grandparent payment. If the client has no client number, enter zero.

Comments — Enter comments for SODI as needed.

Signature — Texas Works Advisor and Date — The advisor signs and dates the form.

Signature — Supervisor and Date — The supervisor signs and dates the form.

Response from Data Integrity — Data Integrity staff respond to the advisor.

Signature — Data Integrity Staff — SODI staff signs and dates the form, prints his name and provides his area code and telephone number.