Some forms cannot be viewed in a web browser and must be opened in Adobe Reader on your desktop system. Click here for instructions on accessing your form.

Effective Date: 




Updated: 7/2021



  • To serve as a log of issued Lone Star Cards.
  • To provide a record of issued Lone Star Cards by cardholder, Eligibility Determination Group (EDG) number and issuance staff.


When to Prepare

Enter the information on Form H1173 for each card issued in sequential order.

When a card is issued in the office, the person receiving the card must sign the log to confirm receipt. Ensure all previously recorded recipient information is covered, to ensure confidentiality.

Number of Copies

Each certification office maintains an original.


At the end of each month, staff file the log according to procedures in the Security and Accountability Handbook.


Detailed Instructions


Replacement — If using the form to log a replacement card, write "R" in the Replacement column. If a local office is replacing a card because the Lone Star Help Desk failed to replace it timely (as explained in B-235, Lone Star Card Replacement), then write “VR” to identify the vendor replacement on Form H1173, and report the total to the EBT regional coordinator or their back-up at the end of each month. The EBT regional coordinator or their back-up reports the regional total by the 15th day of the next month to the state office EBT Program Operations Section.

Issue Date — Enter the Lone Star card issue date.

If staff are logging out a card to take on a home visit, enter the date the item is issued.

Name of Primary Cardholder — Enter the name of the primary or secondary cardholder to whom the card belongs. Write "(SC)" before a secondary cardholder's name.

Note: If staff return an unused card that they previously logged out for a home visit, write "returned/wkr" in this box and return the card to inventory.

EDG Number — Enter the Temporary Assistance for Needy Families (TANF) or Supplemental Nutrition Assistance Program (SNAP) EDG number associated with the card/ being issued. If the card is linked to both programs, enter both EDG numbers.

Note: Leave this box blank when logging a returned card.

Card Number (PAN) — Enter the 19-digit personal account number (PAN) from the card when logging an issued card.

Signature of Recipient — When a person receives a card in the office, they must sign here. If the card is issued to the authorized representative (AR) or another adult household member (AHM), write “AR” or “AHM” next to their signature for identification.

Note: If staff log out a card to take on an out-of-office interview, they sign here.

Issuance Staff Initials and Emp. No. — Issuance staff initial and list their employee number when issuing a card.