Form H1094, Notice of TANF-SP Time Limit

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Effective Date: 2/2021

Updated: 2/2021

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.

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.

Complete an original and one copy.