Form H1239-FTI, Request for Verification of Bank Accounts - FTI

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Effective Date: 12/2010


Updated: 12/2010


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.

Form Retention

If a copy is made for the case record, keep the copy according to the retention requirements of the case record.

Detailed Instructions

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.