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Effective Date: 
12/2001

Documents

Instructions

Updated: 4/1998

PURPOSE

Form H1256 is an optional form. It may be used to explore and document how a recipient's financial affairs are handled if the recipient does not report an active bank account.

PROCEDURE

When to Prepare

A Medicaid eligibility caseworker sends Form H1256 to a recipient or responsible person when the recipient does not have an active bank account.

Number of Copies

Complete one original.

Transmittal

Send the original to the recipient or responsible party. After the form is completed, signed, and returned to the caseworker, he files it in the miscellaneous section of the recipient's case record.

Form Retention

The form is retained for three years after the case is closed or denied.

DETAILED INSTRUCTIONS

Self-explanatory.