Form H1273, Request for Assessment Information

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Effective Date: 10/1998


Updated: 8/2001


To advise a couple who has requested a resource assessment that

  • required verification of resources has not been received, and
  • their assessment request will be dropped if the verification is not submitted by the specified date.


When to Prepare

Complete Form H1273 if the couple has not submitted verification documentation by the 15th calendar day following the receipt of a completed and signed Form H1272, Resource Assessment Declaration.

Number of Copies

Complete only an original.


Send Form H1273 to the couple if the couple has not submitted verification documentation within the required time frames.

Form Retention

Keep Form H1273 in the case record for three years after the case is denied.


Address— Self-explanatory.

Date— Self-explanatory.

Eligibility Specialist— Self-explanatory.

Office Address and Telephone Number— Self-explanatory.

Blanks— Check the box opposite the appropriate entry to indicate the type of information that is needed.

Date Blank— Enter the date that is 30 days from date that the completed and signed Form H1272 was received.