TX HHS Form H1072. One Time Temporary Assistance for Needy Families (OTTANF) Acknowledgement

This document serves as the applicant’s official acknowledgement of the rules attached to receiving a one-time $1,000 payment under the One-Time Temporary Assistance for Needy Families (OTTANF) program in Texas. Although the form appears short, it carries significant legal and practical consequences for families considering this type of financial support. Below is an expanded explanation written in clear, practical language to help applicants understand what they are signing and why it matters.

Purpose of Form H1072

Form H1072 confirms that an applicant understands the trade-offs involved in accepting the OTTANF payment. Unlike regular TANF benefits, OTTANF is designed to provide immediate assistance during a short-term crisis, but it restricts the household from receiving other TANF-related benefits for the next 12 months. Because of this limitation, the State of Texas requires each applicant to formally acknowledge these rules in writing.

What the Form Actually Means

The form ensures the applicant understands three main points:

• Your household receives a single payment of $1,000.
• For the next 12 months, no one in your household can receive TANF, TANF-SP, or another OTTANF payment.
• The payment does not include Medicaid, but you may still apply separately for a Medical Program.

Explanation of Each Key Section

Applicant Information

This section (Name, Date of Birth, Case Number) identifies the applicant legally. Errors here can delay processing or invalidate the acknowledgement.

Understanding the 12-Month Ineligibility Rule

This is the central part of the form. It clarifies that accepting the OTTANF benefit blocks the household from accessing any TANF-related benefits for one year—regardless of what happens in the household during that period. Typical misunderstandings include assuming that a job loss, medical issue, or the absence of a parent resets eligibility. The form explicitly states that it does not.

Clarification About Medicaid

Some applicants mistakenly believe the OTTANF payment automatically comes with Medicaid. It does not. The form reminds applicants that Medicaid is a separate program requiring its own application, though there is no restriction against applying for it.

Signature Requirement

All copies of the form must contain an original signature. Texas agencies do not accept photocopied signatures for this document. This requirement is intended to ensure that the applicant personally acknowledges the conditions.

Common Mistakes When Completing Form H1072

• Assuming you can reapply for TANF if circumstances worsen within the next year.
• Believing you automatically keep Medicaid coverage after accepting OTTANF.
• Signing without understanding the long-term impact on family benefits.
• Submitting a scanned or copied signature instead of an original.

When You Should — and Should NOT — Use This Form

When it is appropriate:

• Your family is experiencing a short-term crisis that a $1,000 payment can help resolve.
• You do not plan to apply for TANF or TANF-SP within the next 12 months.
• You understand you must seek other assistance, such as SNAP or Medicaid, separately.

When it may not be appropriate:

• Your household is likely to need ongoing TANF assistance in the near future.
• You expect potential job loss or medical hardship within the next year.
• You mistakenly believe this payment will renew TANF eligibility.

Typical Real-Life Situations Where This Form Is Used

• A single parent who recently moved for work needs help paying deposits for housing but expects stable income soon.
• A family recovering from a temporary emergency—such as car repairs or sudden loss of childcare—needs immediate support.
• Parents who recently reconciled and no longer qualify for traditional TANF but still need short-term help.
• A household that experienced a brief crisis (e.g., temporary unemployment) but has already secured new employment.

Documents You May Need

• Proof of identity (ID or driver’s license)
• Proof of residency
• Case number from Texas Health and Human Services
• Any documents explaining the temporary crisis (if requested)

Practical Tips for Filling Out the Form

• Review the 12-month ineligibility rule carefully before signing.
• Use your legal name exactly as it appears in your case file.
• Submit an original signature—no copies or digital signatures.
• If you need medical coverage, file a separate Medicaid or Medical Program application.
• Ask a caseworker to clarify anything unclear before signing.

FAQ

• Does accepting OTTANF block all benefits? No, only TANF-related benefits. Programs like SNAP or Medicaid remain separate.
• Can I get TANF again if my job ends? No. The 12-month ineligibility applies even if your situation worsens.
• What if a parent leaves the home? This does not restore TANF eligibility during the 12-month period.
• Does OTTANF include Medicaid? No. You must apply separately for medical benefits.
• Can the payment be repeated? No. This is a one-time payment per 12-month period.
• Who can sign the form? The head of household or the spouse listed on the case.
• Why is an original signature required? To confirm the applicant personally acknowledges the legal conditions.

Micro-FAQ

• Purpose? To confirm the applicant understands the limits of the OTTANF program.
• Who files? Applicants receiving a one-time $1,000 OTTANF payment.
• Deadline? Must be submitted before payment is issued.
• Attachments? Typically none, unless requested by a caseworker.
• Submitted to? Texas Health and Human Services.
• Medicaid included? No.
• Can TANF be requested later? Not for 12 months.
• Original signature? Required.
• Is the payment recurring? No, one-time only.

Related Forms

• TANF Application Form H1010
• TANF-SP Eligibility Form
• Texas Medicaid Application
• OTTANF Supporting Documentation Checklist

Form Details

• Form Name: One Time Temporary Assistance for Needy Families Acknowledgement
• Form Number: H1072
• State/Agency: Texas Health and Human Services
• Edition: June 2025