Form H1094, Notice of TANF-SP Time Limit

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Effective Date
02/2021
H1094.pdf (109.62 KB)
H1094-S.pdf (1.17 MB)


Instructions

Updated: 2/2021

PURPOSE

  • To use as an attachment to GWS and manual
    • Form H1009, TANF/SNAP Benefits Notice of Eligibility; or
    • Form H1017, Notice of Benefit Denial or Reduction
  • To notify a TANF-SP caretaker and/or second parent that
    • TANF-SP benefits are limited to 60 months;
    • what benefit months determine the number of state time limit months used; and
    • when they reach the end of the TANF-SP Time limit, any household member receiving benefits are ineligible for TANF-SP for life.

PROCEDURE

When to Prepare

Complete Form H1094

  • at application;
  • when adding a new caretaker or second parent; or
  • at complete review if the caretaker or second parent have not previously been informed of the TANF-SP time limit.

Number of Copies

Complete an original and one copy.