Form H1853, Documentation of Findings for Form H1852

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Effective Date: 11/2002


Updated: 7/2014


  • To document the comparative findings of Form H1852, List of Resident Participants in the Supplemental Nutrition Assistance Program (SNAP), returned monthly by a drug and alcohol treatment/group living arrangement facility authorized representative (AR).
  • To report violations after conducting a site visit.


When to Prepare

Complete Form H1853:

  • monthly, to document any reportable findings after evaluating the information on Form H1852, received monthly from a facility AR; and
  • to report violations after conducting a site visit.

If no findings, document "no findings."

Number of Copies

Complete an original and one copy.


Mail the copy to the program manager in charge of the case record. The program manager sends a copy to Eligibility Services Field Operations, Health and Human Services Commission, 909 West 45th Street, Mail Code: 992-6, Austin, TX 78751.

Form Retention

File the original in the facility's case file. Retain in the case file for five years.

Detailed Instructions

  • Enter the review month, date, advisor name and facility name.
  • Check either Yes or No based on the outcome of the evaluation of Form H1852.
  • If negative findings are discovered, enter the date a report was made to Eligibility Services Field Operations in state office.
  • Use the Summary of Findings section to document detailed findings reportable to Eligibility Services Field Operations in state office.