Form H1899, Unauthorized Use Replacement Benefit Eligibility Notice

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Documents

Effective Date: 5/2023

Instructions

Updated: 5/2023

Purpose

  • To notify Supplemental Nutrition Assistance Program (SNAP) households if they are approved or denied for unauthorized use replacement benefits and the amount of benefits eligible for replacement.
  • To notify SNAP households if they need to provide more verification to receive an unauthorized use replacement benefit.
  • To give SNAP households information about how to request an appeal of their replacement benefit determination.

Procedure

When to Prepare

Complete Form H1899 when a Form H1854 requesting replacement benefits was submitted to a HHSC local office by a SNAP household.

Number of Copies

Prepare an original.

Transmittal

Save a copy in the electronic case record and mail the form to the SNAP household. 

Detailed Instructions

Date — Enter the date the notice is mailed to the SNAP household.

Case No. — Enter the household’s case number.

Case Name — Enter the name of the head of household’s (HOH’s) name as listed in the case record. The HOH should also be the primary cardholder on the EBT account.

Part I

Transactions Eligible for Replacement — If the household has transactions eligible for replacement, check the box and list the transaction dates and amounts eligible for replacement.

The total amount of benefits eligible for replacement — Enter the total amount of the replacement benefits. 

Part II

Transactions Not Eligible for Replacement — If the household has transactions not eligible for replacement, check the box and list the transaction dates and amounts not eligible for replacement.

These transactions are not eligible for replacement because: — Check the box that applies to the reason transactions listed are not eligible for replacement.

Part III

Transactions Requiring More Information — If the household has transactions that require additional verification before replacement, check the first box and list the transaction dates and amounts that require additional information. Check the second box to request the household provide the additional information and write a date 10 calendar days from the date of the notice. The date of the notice is day zero.

Part IV

Help with Your Case or Lone Star Card — Provides details on how a household can manage their benefit case or access their Lone Star Card account details.

Part V

Keeping Your Lone Star Card and PIN Safe — Provides helpful hints that households can use to protect their benefits from unauthorized use.

Part VI

Fair Hearings and Appeals — Provides the household with information on their right to appeal and instructions on how to request a fair hearing and appeal.