Form H1010-R, Your Texas Works Benefits: Renewal Form

Instructions for Opening a Form

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Documents

Effective Date: 12/2018

Instructions

Updated: 7/2024

Purpose

To provide applicants and recipients the opportunity to register to vote and serve as a:

  • Periodic review form for the Temporary Assistance for Needy Families (TANF) program for cases processed in the Texas Integrated Eligibility Redesign System (TIERS).
  • Recertification application for Supplemental Nutrition Assistance Program (SNAP) households in TIERS.
  • Renewal or review application for Medical Programs in TIERS.
  • New application for benefits if the household submits the renewal application after their case is denied in TIERS.
  • Screening document for SNAP clients who may be entitled to expedited service.
  • Document for households to designate an authorized representative (AR).
  • Document for an AR's acknowledgement of their responsibilities as AR.
  • Screening document for staff to make necessary referrals to other agencies.

Procedure

When to Prepare

The household completes the form when reapplying for Medical Programs, SNAP and TANF.

If a person needs help completing the application packet, a volunteer or staff member must help. Anyone who helps complete the application must initial the part they helped complete or sign the form to show that they helped complete it.

SNAP

Form H1010-R is sent with Form H1830-R, Texas Works Renewal Notice, the month before the last month of certification.

TANF

Form H1010-R is sent with Form H1830-R two months before the review date.

TANF Level Families Medicaid and Children's Medicaid

Form H1010-R is generated and sent with Form H1830-R only when the household has another Texas Works program due for renewal in the fourth month of a six-month certification or the 10th month of a 12-month certification.

Number of Copies

Save a copy in the electronic case record. Upon request provide the household with a copy or a Form H1800, Receipt for Application/Medicaid Report/Verification/Report of Change (PDF).

Transmittal

TIERS pre-populates the renewal form with basic household information. The form is sent to all Texas Works households that are due for renewal, review or recertification along with Form H1830-R. The forms can only be reprinted upon request.

Households may fax the form to 877-477-2839 or mail it to:

Texas Health and Human Services Commission
P.O. Box 149025
Austin, TX 78714-9025

Detailed Instructions

The client completes the form. To evaluate specific answers, refer to policies in the Texas Works Handbook.

Voter Registration – Give Form H0025, Voter Registration Application, to clients who indicate an interest in registering to vote and who meet the voting registration requirements. ARs or representative payees may also take Form H0025 to the client to complete. Mail Form H0025 when the client does not have a face-to-face interview or the client reports a change of address by phone or by mail. Help complete Form H0025 If requested.

If the applicant or client declines to register to vote during a face-to-face interview, ask the client to sign Form H1350, Opportunity to Register to Vote. Mail Form H1350 to a client who did not have a face-to-face interview who declines the opportunity to register to vote, based on receipt of Form H0025.

Voter Registration Status – Check the appropriate box under Agency Use Only and sign.