Texas Form H2583, the Choices Information Transmittal, is a two-way form that Choices program staff and Texas Works staff at the Health and Human Services Commission (HHSC) use to communicate about a TANF client’s case. Choices staff complete Part I to report a client’s new employment, request a change in exempt or nonexempt status, flag a TANF-UP parent switch, send medical records, or ask a general question. Texas Works staff reply in Part II. The form is available in PDF and Word from the HHSC forms page at hhs.texas.gov.
When To Send the Form
Choices staff should prepare an H2583 whenever one of these things happens with a client:
- The client becomes employed and Texas Works needs the job details to adjust the TANF grant.
- New information suggests a nonexempt client should be reclassified as exempt, or the reverse.
- In a two-parent TANF-UP household, the parents want to swap which one carries the work participation requirement.
- Medical documentation is being sent to support an exemption or a work limitation.
- Choices staff need any other information from Texas Works about the client’s case.
Filling Out Part I
Part I is for the Choices staff member. Start at the top with the routing information: the receiving Texas Works office in the “To” field, your name or office in the “From” field, and the sending office’s address and mail code so Texas Works knows where to send Part II back. Then enter the client’s full legal name and Social Security number.
Underneath, check either “nonexempt” or “exempt” to show the client’s current status. That single mark tells Texas Works at a glance whether the client is currently required to participate in Choices activities.
Pick the Reason You Are Writing
Part I gives you four checkboxes. Mark the one that fits your reason for sending the form:
- Reconsider nonexempt status. Use this when you have information suggesting the client should be reclassified as exempt, and explain the circumstances in the Comments field.
- Client employed. Use this when the client has started a job. Checking it triggers the employment detail fields below.
- Medical information attached. Use this when you are sending medical records, such as a physician’s statement supporting an exemption.
- Inquiry or other request. Use this for anything that does not fit the other three, such as asking for updated eligibility information or clarifying case status.
Employment Details
If you checked “Client employed,” complete the employment section so Texas Works can recalculate the family’s income against TANF thresholds. The form asks for:
- Job title
- Date hired
- Date the first check was or will be received
- Hourly wage or salary
- Average number of hours worked per week
- How often the client is paid (daily, weekly, every two weeks, monthly, or twice monthly)
- Whether the employer offers medical insurance
- Whether the Texas Workforce Commission or the Local Workforce Board is paying for the client’s child care
The wage figure and the hours figure need to be accurate. Texas Works uses them directly to adjust the grant.
Comments and Signature
Use the Comments field to add anything the checkboxes do not capture: the facts behind an exemption request, unusual employment circumstances such as seasonal work or variable hours, or a probationary period. Sign the form, date it, and include your mail code.
Part II: The Texas Works Response
Part II is short. Texas Works staff reply using the Comments field, whether that means confirming an exemption change, following up with a question about the employment data, or answering the inquiry that prompted the form. They sign, date, and enter their mail code before returning it.
Exemption Categories That May Prompt a Reconsideration Request
Because status reconsideration is one of the main reasons to send an H2583, it helps to know which categories Texas recognizes. Nonexempt TANF recipients must take part in employment activities or face sanctions that can reduce or end the family’s TANF grant and affect the adult’s Medicaid coverage. Exempt clients are excused. The common categories include:
- Child under 19.
- Disability expected to last more than 180 days, documented by Form H1836-A (Medical Release/Physician’s Statement).
- Caring for an ill or disabled child, documented by Form H1836-B. This applies even if the child is not part of the certified TANF group.
- Age 60 or older, with proof of age.
- Single parent with a child under one, applied at initial application and only for the first child.
- Pregnant and unable to work, supported by proof of pregnancy (Form H3037 or equivalent) and Form H1836-A confirming the limitation is pregnancy-related.
- Caring for a disabled adult whose disability is expected to last more than 180 days, documented by Form H1836-B.
- Single grandparent age 50 or older caring for a child under three.
When you have reason to believe a nonexempt client fits one of these categories, attach the supporting medical form to the H2583. Sending the documentation with the transmittal speeds up the review.
Submitting the Form
The H2583 is an internal communication between two state program offices. The “To” and “From” fields with address and mail code show that it moves through HHSC’s internal mail system. Send the completed form to the Texas Works unit that handles the client’s case, using the address and mail code on file for that office, and keep a copy so you can follow up if Part II does not come back in a reasonable time.
The form carries a Social Security number and sometimes medical records, so treat it as confidential. Whatever transmission method you use needs to meet the privacy and security standards for TANF case records. When medical documentation is attached, the “Medical information attached” checkbox tells the receiving office that sensitive records are inside.