Form H2776, Job Search Worksheet for TANF Employment Hardship Exemption

Instructions for Opening a Form

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Effective Date
H2776.pdf (56.17 KB)
H2776-S.pdf (1.06 MB)


Updated: 10/1997


To aid the client in job search activities in order to receive or continue to receive a TANF employment hardship exemption.

To serve as a record of the client's actual employer contacts made during the structured work search period.


When to Prepare

Staff initiate Form H2776 with clients who request to receive, or continue to receive, a TANF employment hardship exemption. These clients are, or will be, disqualified from TANF for five years because they have used the maximum number of months allowed in their time limit.

Form H2776-S may be used if preferred for clients who primarily speak and read Spanish.

Staff complete the top portion of the original form, providing the client with additional forms when continued monthly contacts are required. As the client makes the required job contacts, the client completes the remainder of the original form, and the additional forms when applicable.

Number of Copies

An original and one copy.

Form Retention

Retain a copy of the original Form H2776 in the client's case record as specified in the Manager's Guide for Eligibility Programs.

When the client returns the completed Forms H2776, retain the forms in the case record.


Give the original Form H2776 to the client to record job contacts and retain a copy of the Form H2776 in the case record for the documentation of the client's job search activity. Provide additional blank forms to the client who must do monthly job search activities.

Detailed Instructions

Client, case, and worker information — Complete appropriate information concerning the client indicated.

Mark whether the employer contacts are to be completed

  • before the client can receive the initial exemption, entering the date the worker explains the requirement to the client after "from" and the 31st day after "to"; or
  • each calendar month until the household's next TANF review, entering the number of contacts necessary for the partial month in which certification begins, if applicable. When there is a partial month:
    • subtract the date the form is completed from the total number of days in the month to obtain the number of days remaining in the month;
    • divide the number of days remaining in the month by 7 to obtain the whole number of full weeks remaining in the month;
    • multiply the number of full weeks remaining in the month by 10 to obtain the number of employers the client must contact during the partial month in which certification begins.


      • 30 (number of days in the month of June) minus 12 (the date the form is completed by the worker) = 18 (number of days remaining in the month);
      • 18 divided by 7 = 2 (complete weeks remaining in the month)
      • 2 times 10 = 20 (the number of contacts the client is required to make for the period from June 12 to June 30).

Company name and address — The client enters the actual company name and street address.

Position — Enter the actual position applied for or discussed.

Person Contacted — Enter the name of the person with whom an application was left or a position was discussed. Employer contacts may be made

  • in person,
  • by telephone, or
  • by other agencies on the client's behalf if the client provides documentation from the entity that the contacts were made on the client's behalf. (Example: Texas Workforce Commission, labor organization)

Telephone — Enter the phone number of the company. This phone number is used by the client to conduct job search follow-up activities.

Results — Enter a brief note about what transpired during the contact. Example: The client was instructed to call back in a week.

Date — Enter the date on which the contact was made.

Signature/Date — The client must sign and date the back of each job search worksheet when it is turned in to the HHSC worker.