TX HHS Form H1854. Affidavit for Unauthorized Use of Electronic Benefit Transfer (EBT) Benefits

This form is used when a SNAP household in Texas discovers that someone has accessed and spent their EBT (Lone Star Card) benefits without permission. It is an official affidavit required by the Texas Health and Human Services Commission (HHSC) before replacement benefits can be considered. Because Texas strictly regulates timing and verification for unauthorized transactions, completing this form accurately and promptly is essential.

Purpose of Form H1854

Form H1854 allows a SNAP household to formally report fraudulent or unauthorized use of their Lone Star Card benefits. By submitting this affidavit, the household confirms the specific transactions that were not made by them, explains how the fraud occurred (if known), and provides HHSC with the information needed to evaluate a request for benefit replacement.

This form is legally binding. The person signing it does so under penalty of perjury, meaning the information must be accurate and complete.

Why This Form Is Required

Texas requires a written affidavit before issuing replacement SNAP benefits to prevent duplicate claims, confirm the cardholder took required steps (such as requesting card replacement), and document the suspected method of fraud. Federal SNAP regulations allow states to replace benefits only when the household demonstrates that the loss was truly unauthorized.

Overview of Each Section of the Form

Part I — How to Find Your Lone Star Card Transaction History

This section explains how the household can verify and document the unauthorized transactions. HHSC requires applicants to review their own transaction records before submitting the affidavit. You can access the transaction history through:

• YourTexasBenefits.com (web portal)
• Your Texas Benefits mobile app
• Lone Star Help Desk (800-777-7328)

The form emphasizes reviewing at least the last 30 days and noting the exact transaction details. Missing or incorrect transaction information is one of the most common reasons HHSC delays or denies replacement requests.

Part II — Claim of Unauthorized Use

Here, the household lists every unauthorized SNAP transaction: the date, amount, retailer, and address. Only SNAP transactions are eligible—other EBT benefits such as TANF are not covered by this form.

If more than five transactions were affected, the household must attach an additional sheet. HHSC needs the complete list to determine the total amount eligible for replacement.

Part III — Explanation of Unauthorized Use Transactions

This section helps HHSC understand how the fraud occurred and whether the cardholder took required steps after discovering it. The form asks about:

• Whether the household still has the physical card
• Whether a replacement card and PIN were requested
• The suspected method of fraud (skimming, cloning, unknown, or other)
• Any additional details beyond the table in Part II

Texas requires the household to request a replacement card before signing the affidavit. If they have not done so, the process stops until they replace the card.

Part IV — SNAP Household Information

This section identifies the SNAP case and includes:

• Case number
• HHSC office
• Household name
• Mailing address
• Dates of discovery, reporting, and HHSC receipt of the form

Accurate dates are important: HHSC considers replacement requests only if the form is obtained within 30 calendar days from the date the household discovered the unauthorized use.

Part V — Affidavit Signature

By signing, the household certifies the information is true. Providing false information may result in criminal prosecution. HHSC staff also signs and dates the form to confirm receipt.

When You Must Submit This Form

• When you notice unauthorized or fraudulent SNAP transactions.
• When you still have the card but benefits were stolen electronically.
• When fraud occurred due to skimming, cloning, or unknown digital theft.

You should not submit this form if:

• You voluntarily shared your PIN with someone who later misused it.
• You lost your card but did not request a replacement promptly.
• The transactions were made by authorized household members.

Who Has the Right to File

• The Head of Household listed on the SNAP case
• Another responsible household member

A third party cannot file the affidavit unless officially designated by the household and recognized by HHSC.

Common Mistakes to Avoid

• Waiting longer than 30 days to request the form after discovering fraud.
• Failing to request a replacement card before signing the affidavit.
• Listing incomplete transaction details.
• Reporting TANF transactions (this form is for SNAP only).
• Incorrect discovery or reporting dates.

Practical Tips for Completing the Form

• Gather your transaction records before filling out Part II.
• Double-check retailer names and addresses to avoid delays.
• Immediately freeze your Lone Star Card in the app once you notice unusual activity.
• Call the Lone Star Help Desk if you cannot identify and verify a transaction.
• Submit the form as soon as possible to your local HHSC office.

Real-Life Examples

• A Houston family discovers multiple late-night transactions in another city, even though they still have their card. They file Form H1854 after confirming card skimming.
• An elderly cardholder notices purchases at a store they have never visited. Their caregiver helps them retrieve records through the mobile app and complete the affidavit.
• A household finds repeated small unauthorized charges, likely from a cloned card. They report the issue, request a new card, and file the affidavit with supporting history.

Documents You May Need to Attach

• Printed transaction history (web or app)
• Additional pages listing unauthorized transactions
• Notes or documentation from calling the Help Desk
• ID verification if HHSC requests clarification

FAQ

• How long do I have to file Form H1854? You must request the form from HHSC within 30 days of discovering unauthorized use.
• Will HHSC automatically replace the stolen SNAP benefits? Not automatically. HHSC reviews the affidavit and transaction data to confirm eligibility.
• Can benefits be replaced more than once? Yes, but each case is reviewed separately and must meet federal guidelines.
• Do I need a police report? No, but HHSC may ask for additional details depending on the nature of the fraud.
• What if I shared my PIN with someone? HHSC will not replace benefits if the misuse occurred due to voluntary PIN sharing.
• Can I file online? The affidavit must be submitted to an HHSC office, not online.
• What happens after I submit the form? HHSC reviews the affidavit, verifies the transactions, and decides whether to issue replacement benefits.

Micro-FAQ (Short Answers)

• Purpose? To report stolen SNAP EBT benefits and request replacement.
• Who files? Head of Household or responsible SNAP household member.
• Deadline? Must be requested within 30 days of discovering fraud.
• Attachments? Transaction history and any additional transaction lists.
• Submit to? A local HHSC office.
• Requires replacement card? Yes, you must request a new card before signing.
• Covered benefits? SNAP only.
• Skimming allowed? Yes—skimming and cloning are eligible forms of fraud.
• Online submission? No.

Related Forms

• Texas Form H1010 — Application for Benefits
• Texas Form H1020 — Request for Information or Action
• Texas Form H1800 — SNAP Food Benefits Addendum
• EBT Lone Star Card Replacement Request

Form Details

• Form Name: Affidavit for Unauthorized Use of EBT Benefits
• Form Number: H1854
• State: Texas
• Edition: May 2023
• Agency: Texas Health and Human Services Commission (HHSC)