TX HHS Form H1239-FTI. Request for Verification of Bank Accounts - FTI

The TX HHS Form H1239-FTI, Request for Verification of Bank Accounts - FTI, is a crucial document that helps medical assistance applicants provide accurate financial information. This form is typically used in situations where an individual is being considered for medical assistance and requires verification of their bank accounts.

This form requests detailed information about the applicant's bank accounts, including balances as of specific dates. The form also asks about any additional accounts to which the individual has access, such as IRAs, CDs, and safety deposit boxes. Additionally, the form requires a signed authorization to release information and confirmation of federal tax information.

To complete this form, applicants must provide all required information and follow the instructions provided. The form is typically completed by the applicant or their representative, with the assistance of HHSC staff or bank representatives as needed. By providing accurate and timely information, applicants can facilitate a smoother verification process and ensure that their medical assistance application is processed efficiently.

• This form is used in situations where an individual is being considered for medical assistance.
• The form requests detailed information about the applicant's bank accounts, including balances as of specific dates.
• A signed authorization to release information and confirmation of federal tax information are also required.