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: 4/2014


To provide Temporary Assistance for Needy Families (TANF) clients a written explanation of the program activities and support services that are available, their rights and responsibilities, the reasons for exemption, and the penalties for noncompliance.


When to Prepare

At the TANF application interview, complete Form H2580 for each TANF Eligibility Determination Group (EDG).

After certification, provide Form H2580 to any caretaker or second parent who:

  • is added to the TANF EDG,
  • loses exempt status, or
  • is exempt.

Number of Copies and Transmittal

Give one Form H2580 to each TANF household.

Form Retention

There are no retention requirements for Form H2580.

Detailed Instructions

TANF EDG Name – Self-explanatory.

TANF EDG Number – Self-explanatory.