Case Number: 1026067389

09/12/2019

Need Help? Call 2-1-1

or for out of the state callers,
call 1-877-541-7905
Fax: 1-877-447-2839
Ms. Pura Fernandez
PO Box 1185 Mail: Texas Health and Human Services
Brackettville TX 78832-1185 Commission
PO Box 149024
Austin Texas 78714-9024
If you have a hearing or speech disability,
call 7-1-1 or any relay service.

To find out if you can get or keep getting benefits, we need more facts from you:
You are getting this packet because either: (1) you applied for benefits, (2) you reported a change to your case, or (3)
we must check your income to see if you can still get benefits.
Inside this packet you will find:
• A list of the items we need from you.
• A pre-paid envelope.

You also might find other forms you can fill out and send to us.
Send us the items by 09/23/2019
If you need help, call us at 2-1-1 or 1-877-541-7905. After you pick a language, press 2. We can take your call
Monday to Friday, 8 a.m. to 6 p.m. Central Time.

You still need to send us the items by this due date.

If you don't send us your items by this date,

you might not get benefits or your benefits might end.

There are 4 ways to send us the items we need:

Pick one of these ways to send the items back to us:
• YourTexasBenefits.com: You can upload your items online.

• Your Texas Benefits Mobile App: You can upload your items using the mobile app.
The app is free to download in the Google Play and Apple iTunes stores.

• Mail: Mail this letter and the items we need in the pre-paid envelope that came in this packet.

•
Fax: Fax this letter and the items we need to 1-877-447-2839.

Don't forget:
• Put your case number on everything you send us.
• If you send us a letter or statement showing proof of facts we need, make sure the person who writes it
includes: (1) their name, (2) their address, (3) their phone number, (4) the date they wrote it, and (5) their
signature.

Form 1020 /August 2016

T-01020-0553905817 Page 1 of 4
Benefit programs affected and due date:

Program EDG number Due date

For Food Stamp benefits: 635421031 10/11/19

If you're afraid that giving us facts about someone could cause harm (physical or emotional) to you or
your child:
If you're applying for or renewing Medicaid or CHIP benefits, you might not need to give us facts about that
person. You might be able to get the "Family Violence Exemption."
Let us know if you're afraid to give facts about someone:

• Phone: Call 2-1-1 or 1-877-541-7905 (after picking a language, press 2).

• Mail: TEXAS HEALTH AND HUMAN SERVICES COMMISSION,P O Box 149024,

Austin, Texas 78714-9024
• In person: At a benefits office. To find one near you, go to YourTexasBenefits.com or call 2-1-1 or
1-877-541-7905 (after picking a language, press 1).
• Fax: 1-877-447-2839.

Form 1020 /August 2016

T-01020-0553905817 Page 2 of 4
 LIST OF INFORMATION NEEDED AND/OR ACTION REQUIRED:
Name(s) Program(s) Information/Action Requested Acceptable Verification/Proof
Pura Fernandez Food Stamps Read, sign, and date the form we sent with this Form H1808-SNAP Work Rules
letter-

Form 1020-A / August 2016

T-01020-0553905817 Page 3 of 4
 Texas Health and Human Services Commission
PO Box 149024
Austin Texas 78714-9024

Case Number:1026067389

The enclosed Missing Information form (Form 1020) includes a list of documents you need to send to us
so we can determine your eligibility for services.

See page 1 to find out how to send us your forms.

El formulario adjunto de información faltante (Formulario 1020) incluye una lista de documentos que
usted necesita enviarnos para que podamos determiner si usted reúne los requisitos para los servicios.

Vea la página 1 para saber cómo enviarnos sus documentos.

T-01020-0553905817

Form 1020B / August 2016

Page 4 of 4
Texas Health and Human Form H1808
Services Commission SNAP Work Rules April 2015-E

Name SNAP EDG number Date

Pura Fernandez 635421031 09/12/2019

Work rules:
You must follow these work rules to get SNAP benefits.
• Reply to all letters from jobs or work programs.
• Work at the job or train in the program you are in.
• Accept a job if you are offered one.
• Don't quit a job or work program without a good reason. If you're not sure if you have a good reason, call HHSC to check.
Call toll-free 2-1-1 or 1-877-541-7905 (after you pick a language, press 2).

If you don't follow the work rules:

The penalties are:

• 1st time: No SNAP benefits for 1 month or longer.

• 2nd time: No SNAP benefits for 3 months or longer.
• 3rd time: No SNAP benefits for 6 months or longer.

Penalties usually end when the work rules are followed again.

Your rights and responsibilities:

• You don't have to take a job if: (1) it pays less than minimum wage, or (2) the work program staff finds a reason why that
job isn't right for you.
• You can appeal a decision made about your case.
• If you move, tell the job or work program and the Texas Health and Human Services Commission (HHSC) your new
address.
• Tell HHSC if the amount of money you get from a job or work program changes.
• Tell HHSC if you get a new job or start a new work program.
• Let HHSC know if you can't meet a work rule.

By signing this form, I agree to follow the SNAP work rules.

9/16/2019
Sign here Date

See next page for a list of items you need

to take with you when you go to a job
interview.

T-H1808-0553905817
 Form H1808
Items needed for a job interview: Page 2 / 04-2015-E
You must take proof of: (1) your identity, and (2) citizenship or immigration status.
Items that prove both identity and citizenship or immigration status:
No other proof is needed if you take an item from this list.

• U.S. passport.
• Foreign passport that: (1) is stamped "Processed for I-551," or (2) has an attached I-94 showing the same name and
stamped "Employment Authorized."
• Forms N-560, N-561, N-550, or N-570 (certificate of U.S. citizenship or naturalization).
• Form I-151 or Form I-551 with your photo on it.
• Form I-688 (temporary resident card).
• Form I-688-A (employment authorization card).
• Form I-688-B (employment authorization document).
Items that prove only identity:
If you take one of these items, you also must take proof of citizenship or immigration status.

• State ID card or driver's license with your photo on it.

The following items can be used without a photo if they have your
name, date of birth, sex, height, eye color, and address.
• School ID.
• Voter registration card.
• U.S. Coast Guard or military ID card.
• U.S. draft record.
• ID card from a government agency.
• Canadian driver's license.
• Native American tribal document proving U.S. citizenship.

Items that prove only citizenship or immigration status:

If you take one of these items, you also must take proof of identity.
• Social Security card from the Social Security Administration (SSA), unless the card is stamped "Not valid for employment
purposes."
• A receipt from the SSA for an application for a Social Security number. This is accepted only for a limited time after the
receipt.
• Original or certified copy of a birth certificate proving U.S. citizenship (including Forms FS-545 or DS-1350, State
Department birth certificates).
The following items must be originals, not copies:
• U.S. Citizenship and Immigration Services (USCIS) employment authorization.
• Form I-327 (re-entry permit).
• Form I-571 (refugee travel document).
• Form I-197 (U.S. citizen ID card).
• Form I-179 (resident citizen ID card).
• Native American tribal document if not already used for proof of identity.

T-H1808-0553905817