Form H1008-A, Warrant Inquiry/EBT Benefit Conversion and Affidavit for Non-receipt of Warrant

 

Instructions

Updated: 1/2012

Purpose

• To notify Fiscal Management Services that a client reported he did not receive a warrant or that he received one, but it was subsequently lost, stolen, or destroyed.
• To obtain a payee's written statement that he has not endorsed or otherwise received payment for a particular warrant and that he understands he is to contact HHSC if he finds or receives that warrant.
• To provide a record of a payee's statement for prosecution if HHSC discovers perjury or intentional program violation.
• To notify Fiscal Management Services that a client requested conversion of an entire month's benefit in an EBT account to a warrant after moving out of state, while remaining eligible to receive the benefit.
• To notify Fiscal Management Services that a benefit in an EBT account needs to be cancelled because
  • the client is not eligible for it, and
  • HHSC is not required to make it available.

Procedure

When to Prepare

Prepare Form H1008-A to make inquiries about warrants or to request EBT benefit conversion or cancellation. Complete one Form H1008-A (Page 1 and 2) for each benefit for which an inquiry or a conversion is needed.

Number of Copies

For warrant inquiries, print or type an original and one copy of Page 1 and an original and two copies of Page 2. For EBT benefit conversion/cancellation, complete only an original and one copy of Page 1.

Transmittal

OTTANF, TANF, TANF-SP, RCA or ADOPTION SUBSIDY

• Submit original of Page 1 and 2 to Fiscal Management Services, State Office, Mail Code 3500 or fax to 512-487-3400.

  Note: If a TANF household moves out of state, complete Form H1008-A to cancel and reissue the next month's benefit if the case is denied after cut-off and the benefit has not been accessed. Write EBT across the top of Form H1008-A and fax it to Fiscal Management Services (fax number 512-487-3400).

• File copy of Page 1 and 2 under Issuance in the case record.
• Give second copy of Page 2 to the client.

Electronic Transmittal

OTTANF, TANF, TANF-SP

HHSC staff may mail Page 1 of this form electronically to Fiscal Management Services through Outlook. Outlook users send the form to: WarrantIssuance@hhsc.state.tx.us. Forms sent electronically are delivered to an Outlook mailbox.

Note: If a TANF household moves out of state, complete Page 1 of Form H1008-A to cancel and reissue the next month's benefits if the case is denied after cut-off and the benefit has not been accessed. Type "EBT" in the Section V — Worker Information, Comments.

File a copy of Page 1 under Issuance in the case record.

Form Retention

Keep the case record copy for three years after the recipient's denial or death.

Note: For Texas Works, see the requirements listed in the Manager's Guide for Eligibility Programs.

DETAILED INSTRUCTIONS, EBT Benefit Conversion

To cancel or cancel and reissue a month's benefit issued via EBT, complete Sections I, II, IV, and V. In Section IV, check the applicable box to authorize a cancellation or cancellation and reissuance of a month's TANF benefit issued via EBT.

Cancel and Reissue a benefit — Check the first box to cancel the TANF benefit issued via EBT specified in Section II of the form and reissue it via warrant to the address listed in Section I of the form.

Cancel a benefit — Check the second box to cancel the EBT-issued TANF benefit listed in Section II of the form for which the client is not eligible.

DETAILED INSTRUCTIONS Page 1, Warrant Inquiry

STEP	ACTION
1	Determine whether Form H1008-A is needed.
-	a.	Check SAVERR or call DCU to obtain warrant status.
-	b.	Refer to the attached table (Interpretation of Warrant Status Codes) to determine the next action.
-	c.	Proceed to Step 2 if Form H1008-A is needed.
2	Complete Section I — Client Information.
-	Note:	Client information should be based on information currently on SAVERR. If this information has changed since the warrant was issued, note the change(s) under Comments.
3	Complete Section II — Warrant Information.
-	Complete Section II-A.
-	Item		Information Required
-	Benefit Month		Enter the benefit month and year for which the warrant was intended.
-	Issue Date		Enter the month/day/year the warrant was actually issued.
-	Warrant Number		Enter the warrant number for warrant in question. This must be one alpha followed by six numeric characters.
-	Warrant Status		Enter warrant status code A, ARA or ACA obtained from SAVERR inquiry or DCU. If warrant status is a different code, do not complete Form H1008-A. Refer to attached table (Interpretation of Warrant Status Codes) for correct action.
-	Amount		Enter the amount of warrant in question.
4	Check the appropriate box in Section III, indicating the purpose of the inquiry.
5	Complete Section V — Worker Information.
6	Sign and date Page 1 of Form H1008-A.
7	Complete Page 2 — Affidavit for Non-Receipt of Warrant, following detailed instructions below:
-	Enter the case name, case number and warrant information. Check the certification statement that applies to the missing warrant. Ensure the payee reads and understands that he is certifying that he did not cash or receive any benefit from the described warrant. should he find or receive the missing warrant, he must contact the appropriate HHSC representative to find out if he can cash that warrant. the replacement warrant will have a different warrant number and issue date, and will have the word "REPLACEMENT" in the upper left corner. this affidavit may be used at HHSC's discretion for purposes of investigation and criminal prosecution.
-	The payee's signature must be signed in ink in the presence of the witnessing worker. witnessed by two persons if the payee signs with a mark "X."
-	The worker's signature signifies that he verified the payee's identity. witnessed the payee's signature on this affidavit. explained the affidavit to the payee and answered all questions. explained the warrant replacement procedures to the payee.
-	Note: If the affidavit is not completed properly, it will be returned to the worker, which will delay the processing of the replacement warrant.

 

INTERPRETATION OF WARRANT STATUS CODES

Warrant Status	Meaning	Worker Action Required to Dispose Warrant
A	warrant was mailed	If it has ...	then ...
-	-	been at least 10 days since issue date,	complete Form H1008-A.
-	-	not been at least 10 days since issue date,	wait until at least 10 days after issue date, and contact client to see if warrant has been received.
-	-	-	If ...	then ...
-	-	-	warrant received	no further action.
-	-	-	warrant not received	complete Form H1008-A.

continued

Warrant Status	Meaning	Worker Action Required to Dispose Warrant
CA	warrant was mailed but was returned to state office	If Form H1000-B ...	then ...
-	warrant is on hold and case is on hold	can be used,	submit Form H1000-B to either deny or release case from hold.
-	-	cannot be used,	If ...	then ...
-	-	-	client is eligible for warrant,	call Fiscal Division (512-487-3435) to release warrant.
-	-	-	client is ineligible for warrant,	complete Form H1008 Section II to cancel warrant.
-	-	-	warrant needs to be reissued in a different amount or to different payee,	complete Form H1008 Sections II and III-B to cancel and reissue warrant.
RA	warrant was mailed	If ...	then ...
-	warrant was returned to state office for special handling	warrant needs to be rewritten and remailed to the client,	call Fiscal Division at 512-487-3435 to request that warrant be rewritten and remailed.
-	-	warrant needs to be cancelled and reissued to different payee or in different amount,	complete Form H1008 Sections II and III-B to cancel and reissue warrant.

 

 continued

Warrant Status	Meaning	Worker Action Required to Dispose Warrant
ARA or ACA	warrant was mailed	Call Fiscal Division at 512-487-3435 to find out the date warrant was remailed and address to which it was remailed.
-	warrant was returned to state office	If it has ...	then ...
-	warrant was remailed	been at least 10 days since remail date,	complete Form H1008-A.
-	-	not been at least 10 days since remail date,	wait until at least 10 days after remail date, and contact client to see if warrant has been received.
-	-	-	If ...	then ...
-	-	-	warrant received	no further action.
-	-	-	warrant not received	complete Form H1008-A.
PA or EPA	warrant was mailed state office has taken action based upon the original inquiry (Form H1008-A)	do not submit another Form H1008-A. if further information is required, call Fiscal Division 512-487-3435.

continued

Warrant Status	Meaning	Worker Action Required to Dispose Warrant
DCA	warrant was mailed	If client was ...	then ...
-	warrant was mailed	eligible for warrant,	check case folder to see if Form H1008 has been submitted to replace the warrant.
-	warrant was returned to state office	-	If Form H1008 ...	then ...
-	warrant was placed on hold	-	was not submitted,	submit Form H1008.
-	warrant was cancelled	-	was submitted and signature date is at least two weeks old,	submit a second Form H1008, and write in comments "second request."
DA or DEPA	warrant was mailed forged warrant was sent back to paying bank (EPA) lost or stolen warrant was cancelled	call Fiscal Division (512-487-3435) for further information if a replacement warrant has not been issued for the month in question. Replacement warrants are identified by code 3 under the "TYPE" column on SAVERR inquiry PA case screen 8 (PC inquiry warrant status screen).
If no warrant was issued for month in question		handle same as for status DCA above.