Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
To request information about clients' bank accounts.
When to Prepare
The caseworker sends Form H1239-FTI to a bank to get information about the bank accounts of a client.
Number of Copies
The caseworker completes an original and makes a note on Form H0007-A, Activity Record, or prepares a copy for the case record. (Follow regional instructions).
The caseworker sends the original to the financial institution.
If a copy is made for the case record, keep the copy according to the retention requirements of the case record.
Inside Address — Enter the name and address of the financial institution.
Enter the date, name of the eligibility specialist, and the office mailing address and telephone number.
Enter the name of the client. Enter the account number(s), if known.
Enclose Form H0003, Authorization to Furnish Information, and a return envelope.
Federal Tax Information — If the request is based on information obtained on an Automated System for the Office of Inspector General (ASOIG) Match Worksheet, check the Yes box. Do not include a copy of the ASOIG Match Worksheet with the request. If the request is not based on information obtained on an ASOIG Match Worksheet, check the No box.
The caseworker signs on Page 1, and enters the date and local office telephone number. The caseworker enters the Return Form To: information on Page 2. The bank representative completes all other items on Page 2.