Form H1019, Report of Change

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Effective Date

8/2026

Instructions

Updated: 10/2026

Purpose

  • To list client reporting requirements.
  • To report changes in client circumstances.
  • To provide Texas Health and Human Services Commission (HHSC) office staff a form to record information clients report about changes in their circumstances.
  • To advise the client that HHSC staff can explain what type of proof is required for a reported change.
  • To provide clients with a receipt of the change(s) they reported.

Procedure

When to Prepare

Clients complete this form when they want to report a change in their circumstances. HHSC office staff also complete the form when the client reports a change in-person or by phone.

Number of Copies

The client or HHSC office staff complete an original and one copy of the form. Provide the copy to the person if they request a receipt of the change.

Transmittal

HHSC sends this form and a prepaid return envelope to all clients at the initial certification and each recertification, if needed. 

Detailed Instructions

Changes Required to Report — Enter an X in the appropriate box next to each category. HHSC office staff must enter an X in only one box using the following guidelines:

  1. Enter an X in the TANF category if the household receives ongoing Temporary Assistance for Needy Families (TANF), regardless of if they receive Supplemental Nutrition Assistance Program (SNAP) food benefits. This includes households receiving ongoing TANF and Medicaid or CHIP. Do not enter an X under the SNAP category.
  2. Enter an X in the Medicaid or CHIP category if the household receives ongoing Medicaid or CHIP, regardless of if they receive SNAP food benefits. Do not enter an X under the SNAP category.
  3. Enter an X in the Transitional Medicaid category if the household receives Transitional Medicaid.
  4. Enter an X in the HTW category if the household receives Healthy Texas Women (HTW),.
  5. Enter an X in the SR category if the household receives SNAP-Streamlined Reporting (SR) only. Enter the appropriate amounts of income.
  6. Enter an X in the Non-Streamlined Reporting category if the household receives SNAP and does not meet Streamline Reporting Criteria.
  7. Enter an X in the SNAP-CAP category if the household receives SNAP-CAP.

Note: Enter an X in the SR category if certifying a SNAPSR household and pending their application for TANF or Medicaid. Send the household a new Form H1019 with an X in the appropriate category to inform them of their new reporting requirement If later certifying the TANF or Medicaid application. Issue a new Form H1019 with an X in the appropriate SNAP category if denying a household's TANF or Medicaid case and the household continues receiving SNAP.

Enter the case name, case number(s), and date in the top section.

Reported Change — The client or staff enters an explanation of the changes with the effective date and the duration of each change.

Signature — The person reporting the change signs the form and enters the date of the report in the appropriate spaces. The person receiving the information signs the form and completes it in as much detail as possible if the change is reported by phone.

Signing up to Vote

Voter Registration — Give form VR30, Texas Voter Registration Application, to people who show an interest in registering to vote and who meet the voting registration requirements. Authorized representatives or representative payees may also take form VR30 to the client to complete. Mail form VR30 when the client does not have a face-to-face interview or the client reports a change of address by phone or by mail. Help complete Form VR30, if asked.

Ask the client to sign Form H1350, Opportunity to Register to Vote if the applicant or client declines to register to vote during a face-to-face interview. Mail Form H1350 to a person who did not have a face-to-face interview who declines the opportunity to register to vote, based on receipt of form VR30.

Voter Registration Status — Check the appropriate box under Agency Use Only and sign.