Form H0901, HHSC Enhanced Data Gathering Worksheet

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Effective Date: 6/2019

Updated: 6/2019



  • For use by Community-Based Organizations (CBOs), that contract with the state to serve Supplemental Nutrition Assistance Program (SNAP) households, to conduct eligibility interviews on behalf of the Health and Human Services Commission (HHSC).
  • To record the documentation and types of verifications collected for each case by the CBO interviewer.
  • To record other relevant information collected by the CBO interviewer during the interview related to the applicant/recipient household.
  • To provide a worksheet for data entry into HHSC's eligibility systems for final disposition by a Texas Works advisor.
  • To record the identifying information of the CBO interviewer and the time and date of the interview.
  • To determine if any special policy considerations are applicable to the household, for example Is the household eligible for expedited services? or Does the household need a Lone Star Card?


CBO interviewers complete Form H0901 for each client eligibility interview they conduct and include the form on top of the application and supporting information with the application package that is submitted to HHSC. The data collection worksheet guides the CBO interviewer through the eligibility points necessary for HHSC's data entry advisor to make an eligibility determination.

Form Retention

The form retention requirements are the same for the form as for the entire SNAP case record. The form must be included with the case record, whether an electronic or physical case record. Retention information is discussed more fully in the Texas Works Manager's Guide.

Detailed Instructions

More detailed information is provided to CBO interviewers through specially-created training.