FORM H1090
Instructions

FINGER IMAGING TRANSMITTAL

10-2007

PURPOSE

PART I — Reason Finger Imaging Not Completed

To provide a method of transmitting finger imaging information from the finger imaging staff to the Texas Works advisor when finger image records and results are not complete.

PART II — Match Enrollment Response Received

To provide a method of transmitting notice from the finger imaging staff to the Lone Star Image System (LSIS) Site coordinator when a match enrollment response is received.

PART III —Temporarily Unable to Travel to LSIS Site to be Imaged

To provide the Texas Works advisor with documentation of Exemption Codes C, D and E.

PART IV — Client Acknowledgment of Exemption and Agreement to be Finger Imaged

To provide client notice of future finger image requirements.

PROCEDURE

When to Prepare

Finger imaging staff complete Part I of the form and route it to the Texas Works advisor when a complete finger imaging record cannot be obtained for an applicant/recipient. The Texas Works advisor uses the entries on the form to determine the appropriate finger imaging codes to enter on the generic worksheet (GWS) or on Form H1000-C, Secondary Client Input.

Finger imaging staff complete Part II of the form and route it to the Texas Works advisor when a match enrollment response is received.

Number of Copies

The finger imaging staff complete the original. Provide the client a photocopy of the form if requested.

Transmittal

The finger imaging staff send the original to the Texas Works advisor.

Form Retention

File Form H1090 with any attachments under Legal in the case folder, and retain according to instructions in the Manager's Guide for Eligibility Programs.

DETAILED INSTRUCTIONS

Enter the following:

Person for Whom Finger Imaging Not Completed or Match Response Received —  Enter the complete name of the individual for whom finger imaging could not be completed or a match enrollment response is received.

Case Name —  Enter the name of the Temporary Assistance for Needy Families (TANF)/food stamp application or case in which the client is included. If the case name is the same as the client's name, enter "same."

SSN —  Enter the social security number of the individual for whom finger imaging could not be completed or a match enrollment response is received.

Route to (Texas Works Advisor) —  (Optional) Enter the name of the Texas Works advisor or other staff person to whom the form should be routed.

LSIS Clerk (Initials) —  Finger imaging staff initial the form when completing Part I or Part II. Leave blank when the Texas Works advisor completes Part III.

Date —  Enter the date the form is completed.

Time —  Enter the time the form is completed.

Part I — Reason Finger Imaging Not Completed —  Mark the appropriate box. For "low quality" of all available (index) finger images (Exemption Code B), attach the low quality enrollment response to Form H1090. Record any specific information about any exemption code (including a client's statement of undue burden) under comments.

Part II — Match Enrollment Response Received —  When a match enrollment response is received, mark the box and attach the match enrollment response to Form H1090.

Part III — Temporarily Unable to Travel to LSIS Site to be Imaged —  The Texas Works advisor marks the box indicating the situation and must initial the form when any household member is exempt. When exempting a client, use Exemption Codes C, D or E.

Part IV — Client Acknowledgment of Exemption and Future Finger Imaging Requirements —  Have the client sign and date the form when a temporary exemption is given due to

If the client refuses to sign the acknowledgment, the finger imaging staff will write on the signature line "client refused to sign" and initial.

For households with a member who is temporarily exempt and they are not interviewed in the office, mail a copy of the form to the client informing them that they be subject to finger imaging requirements at the next office interview.