Form H1074, SNAP Force Change Request

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Effective Date: 8/2009


Updated: 8/2009


To provide advisors with a method to request that State Office Data Integrity enter or correct Supplemental Nutrition Assistance Program (SNAP) disqualification data in the System for Applications, Verifications, Eligibility Reports and Referral (SAVERR) when the advisor is unable to make the change via the Generic Worksheet (GWS) or manual Form H1000-A, Notice of Application, Form H1000-B, Record of Case Action, or Form H1000-C, Secondary Client Input.


When to Prepare

Send Form H1074 to Data Integrity to correct SAVERR information on:

  • active SNAP clients to delete the drug disqualification code; or
  • denied SNAP clients to:
    • add a "Y" (yes) or "N" (no) disqualification code,
    • delete a "Y" or "N" disqualification code,
    • change the employment and training (E&T)/voluntary quit counter, or
    • delete a finger image code.

Number of Copies

Prepare one form for each client who requires a change to a disqualification code, finger image code or the E&T/voluntary quit counter.


In order of preference by Data Integrity staff, send the original form or information by

  • mail to Mail Code Y-922;
  • fax to 512-706-7140. (Reserved for expedited cases or when requested by Data Integrity staff. If faxing a form, do not mail original.)

Form Retention

File the copy under miscellaneous correspondence. Keep it for three years after the case is denied.

Detailed Instructions

From, Address, BJN, Employee Number, Mail Code, Telephone Number — Enter the advisor's identifying information.

Date, Client Number, Client Name — Enter the date the advisor is completing the request, the client number and client name data.


The advisor requests a force change on disqualification codes for denied SNAP cases by placing a check in the appropriate box. Mark

  • "Yes" to impose a disqualification;
  • "No" to indicate the client was serving a valid disqualification, but is no longer disqualified; and
  • "Delete" to remove an invalid disqualification. Use delete only to remove an E&T/voluntary quit disqualification if the client should never have been disqualified. Checking delete in the E&T/voluntary quit clears the counter.

E&T/voluntary quit counter — If the value is incorrect on SAVERR, place a check in the appropriate box that indicates what the current value of the counter should be.

Reason for request — Explain why you are requesting changes to the disqualification code, finger image code or E&T/voluntary quit counter.

Data Integrity Response — State Office Data Integrity staff complete this section indicating the date the information was updated on SAVERR.