TX HHS Form H1172. EBT Card. PIN and Data Entry Request

The TX HHS Form H1172, EBT Card, PIN and Data Entry Request, is a crucial document for individuals seeking to request the issuance of an Electronic Benefits Transfer (EBT) card. This form helps solve the problem of obtaining a new or replacement EBT card, which is essential for recipients of government assistance programs such as Temporary Assistance for Needy Families (TANF) and Supplemental Nutrition Assistance Program (SNAP). The form is typically used in situations where an individual needs to request a new card due to loss, theft, or damage.

The form requires the primary cardholder's personal information, including name, date of birth, social security number, mailing address, and gender. Additionally, the form asks for the reason for requesting a new card and whether the identity was verified at the time of issuance. The form also includes sections for notification of issuance and receipt verification, which serve as proof that the individual has received the requested item.

To complete this form, individuals must provide all required information and sign the document to indicate their consent. The form is typically submitted to EBT issuance staff for data entry, who will then process the request and issue a new card if necessary. Key points to note include:

• The form is used to request the issuance of an EBT card.
• The primary cardholder must provide personal information and sign the document.
• The form includes sections for notification of issuance and receipt verification.