Form H2583, Choices Information Transmittal

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Effective Date: 4/2006


Updated: 4/2006


To provide a two-way communication form between Choices staff and Texas Works staff to:

  • notify Texas Works staff of Choices client's employment status or need for a change in exemption status, including a request from TANF-UP parents to switch the participation requirement from one parent to the other; and
  • request or provide other relevant information about a Choices client.


When to Prepare

Choices staff complete Form H2583 to:

  • send medical information about a client's employability to Texas Works staff;
  • inform Texas Works staff of a request from TANF-UP parents to switch the Choices participation requirement; and
  • provide or request other relevant information to Texas Works staff.

Texas Works staff complete Form H2583 in response as appropriate.

Number of Copies

Prepare an original and two copies.


Choices staff send the original and first copy to Texas Works staff and retain the second copy in the case record.

Texas Works staff make a response, return the original to Choices staff and retain the first copy (Texas Works staff may instead originate a new Form H2583, if desired.)

Texas Works staff file the first copy under work registration.

Form Retention

Choices staff — Keep Form H2583 in the case record for three years after the case is closed.

Texas Works staff — See Texas Works Manager's Guide.

Detailed Instructions

To — Self-explanatory.

From — Self-explanatory.

Choices staff enter the following:

Client Name — Enter the client's complete name.

Social Security No. — Self-explanatory.

Client No. — Enter the individual's client number.

Case Name — Enter the name of the TANF case in which the client is included. If the case name is the same as the client name, enter "same."

Case No. — Enter the TANF case number from Form H1000-B or Choices system.

Client Address — Enter the client's complete address.

Exemption Status — Check the box to indicate that the client is nonexempt or exempt.

Part I — Message from Choices Staff to Texas Works Staff:

Reconsider Nonexempt Status — Check the box if information has been received indicating that the client is eligible for exemption status.

Client Employed — Check this box if information is received indicating that the client is employed. Send a copy of the contractor's information transmittal document to Texas Works staff, if appropriate. Complete the employer's name, address and telephone number. Also complete all other employment-related information, including whether it was obtained from the employer or the client (only when the employer refuses to cooperate).

Medical information attached — Check this box if sending medical information to Texas Works staff. Indicate whether the client was found to be exempt or nonexempt.

Inquiry or other request — Check this box when requesting information from Texas Works staff about a Choices client.

Comments — Enter comments, if any.

Signature — Choices staff sign, date and enter mail code.

Part II — Response from Texas Works Staff to Choices Staff:

Comments — Enter comments, if any.

Signature — Texas Works staff sign, date and enter mail code.