Form H1086, School Attendance Verification

Instructions for Opening a Form

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Effective Date: 10/1997


Updated: 10/2000


To assist the TANF client in obtaining verification of school attendance.


When to Prepare

Use Form H1086 when a client does not have other sources of verification of school attendance.

Note: See Item A-1640 for other sources of verification for school attendance which may already be accessible to the client before using Form H1086.

Document in the household's case record the date the form is given to the client.

Number of Copies

Give or send the client one copy of Form H1086 with an addressed, stamped envelope.


File the completed form in the case record directly under the applicable worksheet.

Form Retention

Keep Form H1086 for three years from the month the form is signed by the school official.


Enter the name, date of birth, grade, case name, case number and address of the child. The school official enters the remaining information in the gray shaded area. All are self explanatory.

Enter the date the information is needed.

Enter the name of the advisor and office information. The advisor preparing the form must sign and date the form.

Enter the caretaker's name in the space giving his permission for release of requested information. He signs and dates the form in the spaces provided.