Form 1019, Opportunity to Register to Vote/Declination

Instructions

Updated: 12/2026                                                                            

Purpose

To record the decision of an applicant or recipient after given the opportunity to register to vote.

Procedure

The caseworker will record the response from an applicant or recipient when given the opportunity to register to vote. If they decline to register, the caseworker will ask them to sign and print their name and date the form acknowledging the declination. The caseworker will also record if the person is already registered, refuses to sign, is unable to sign or will mail the voter registration application, Form VR30, themselves.

Form Retention

The caseworker will keep a copy of Form 1019 in the person’s case record for 22 months.

Detailed Instructions

The caseworker will:

• record the applicant’s or recipient’s decision after they are given the opportunity to register to vote.
• ask them to sign, print their name and date the form acknowledging the declination.
• record in the For HHSC Use Only box if they are already registered, refuse to sign, are unable to sign or will mail the voter registration application, Form VR30, themselves.
• file the form in the person’s case record.