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Effective Date: 
12/2006

Documents

Instructions

Updated: 5/1998

PURPOSE

To give advance notice to clients who have established a trust that the trust will affect their eligibility and to give them an opportunity to provide evidence of undue hardship.

PROCEDURE

When to Prepare

Complete Form H1281 when a client will be denied because of trust policies.

Number of Copies

Prepare an original and one copy.

Transmittal

Send the original Form H1281 to the client at his mailing address or that of his responsible party. A self-addressed envelope is included to facilitate a response. File the copy in the case record.

Form Retention

Keep Form H1281 in the case record for three years.

DETAILED INSTRUCTIONS

Inside Address— Enter the name of the client and his mailing address or that of his responsible party.

Date— Self-explanatory.

Worker— Self-explanatory.

Office Address and Telephone Number— Enter the caseworker's complete office address and telephone number.

Trust Information— Indicate whether the trust is a countable resource or producing countable income.

You may provide evidence...If you wish to do so, please contact me before— Enter a date that is seven workdays from the date of this form.