Form 3068, Request for Information

Effective Date
01/2020
Document
Document
3068.pdf (141.03 KB)
Document
Document
3068-S.pdf (142.31 KB)

 

Instructions

Updated: 1/2020

 

Purpose

Form 3068 is used to:

  • Notify the applying household that their application is not complete and what additional information is needed;
  • Notify the eligible household that additional information is needed for their case record and what additional information is needed; and
  • Notify the household regarding the date by which the additional information is needed.

 

When to Prepare

Complete an original and one copy of Form 3068. Issue the original to the household and file the copy in the case record.

 

Form Retention

Maintain at least until the end of the third complete state fiscal year following the date on which Form 3068 is submitted.

 

Detailed Instructions

Client’s Name, Street Address, City, State and ZIP Code – Enter the client’s name, street address, city, state and ZIP code in the fields provided.

Date, Case Record No., Office Address and Area Code and Phone No. – Enter the date, case record number, office address and area code and phone number in the fields provided.

Check the appropriate boxes of information needed. If other items are needed, enter in the space provided.

Enter the date the household must provide the requested information.

Staff Signature and Area Code and Phone No. – Sign the form and provide the area code and phone number.