Form H1817 - Food Stamp E & T Information Transmittal
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1Texas Health and Human
Form H1817
Food Stamp E & T Information Transmittal
Services Commission
April 2006
To: (HHSC)
From: (Employment Contractor)
Address
Mail Code
Address
Mail Code
Case Name
Case No.
Client Name
Client SSN
Client No.
Part I – Message from Employment Contractor to HHSC Staff
Please reconsider this client’s registration (see Comments).
Client to receive
UI each
week(s), beginning
(date)
Please provide the dates for which the client is certified to receive food stamp benefits.*
Client wishes to comply. An eligibility determination needs to be made.
Case inquiry or other request (see Comments)
Comments:
Signature – Employment Contractor
Date
Part II – Message from HHSC Staff to Employment Contractor
*This client is certified to receive food stamps from
through
(month/year)
(month/year)
Comments:
Signature – Eligibility Staff
Date
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