Form H1272, Declaration of Resources

Instructions for Opening a Form

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Effective Date
03/2001
Document
H1272.pdf (100.91 KB)
Document
H1272.doc (261 KB)

Instructions

Updated: 7/1991

PURPOSE

To serve as a reporting document for couples who request a resource assessment.

PROCEDURE

When to Prepare

Complete Form H1272 when the couple or responsible party requests an assessment.

Number of Copies

Complete only an original.

Transmittal

Send the original to the couple or responsible party.

Form Retention

Keep in case record for three years after case is denied.

DETAILED INSTRUCTIONS

The worker completes the top portion of the form. The client completes the rest of the form.