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

The TX HHS Form H1072, One Time Temporary Assistance for Needy Families (OTTANF) Acknowledgement, is a crucial document that helps individuals and families navigate the complexities of government assistance programs. This form is used in situations where an individual or family receives a one-time cash payment from the OTTANF Program, which provides temporary financial support to those in need.

The key features of this form include understanding the conditions and responsibilities associated with receiving an OTTANF payment. Specifically, individuals and families must acknowledge that they cannot receive any TANF-related benefits in Texas for 12 months after receiving the one-time cash payment. This includes TANF, TANF-SP, and OTTANF. Additionally, applicants understand that future events such as unemployment, absence, physical or mental incapacity, or death will not allow them to receive any TANF or TANF-related benefits for 12 months.

To complete the form, applicants must provide their name and date of birth, as well as sign the document with an original signature. It is essential to note that there are no Medicaid benefits associated with the OTTANF payment; however, individuals can apply for a Medical Program if needed. The following key points summarize the requirements and situations where this form is used:

• Receives one-time cash payment from the OTTANF Program
• Cannot receive any TANF-related benefits in Texas for 12 months
• Must sign the document with an original signature
• No Medicaid benefits associated with the OTTANF payment, but can apply for a Medical Program