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Effective Date: 



Updated: 4/2001


To provide a means of requesting the amount of benefit paid to a beneficiary of the Teacher Retirement System.


When to Prepare

The Medicaid eligibility worker or CCAD worker prepares Part I of Form H1297 to request benefit information from the Teacher Retirement System.

Number of Copies

The worker prepares an original and two copies.


The worker mails the original and first copy to the Teacher Retirement System. He retains the second copy in the case folder. When the reply is received from the Teacher Retirement System, he destroys the copy.

The Teacher Retirement System staff completes Part II of Form H1297 and returns the original to the worker.

Form Retention

The original of Form H1297 is kept in the case folder for three years after denial of the client.