Form H1277, Notice of Opportunity to Designate Funds for Burial

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Effective Date: 12/2019



Updated: 4/2020



To advise clients with excess resources that they can designate liquid resources as burial funds and have up to $1,500 excluded from the eligibility determination.



When to Prepare

Prepare Form H1277 by the third day after determining that a client has been denied for excess resources and that the client has liquid resources to which the burial fund exclusion could be applied.

Number of Copies

Prepare an original and one copy of Form H1277.


Send the original Form H1277 to the client at their mailing address or that of their responsible party. A self-addressed envelope is included. File the copy in the case record.


Detailed Instructions


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

Date — Self-explanatory.

HHSC Staff — Self-explanatory.

Office Address and Phone Number — Enter the caseworker's complete office address and phone number.

I have determined that on — Enter the date the preliminary decision of ineligibility was made.

Please contact me before — Enter a date that is seven workdays from the date of this form.