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 used to verify bank accounts for individuals being considered for medical assistance. This form helps solve the problem of ensuring accurate financial information is provided to facilitate the application process.

This form requires the depositor to provide detailed information about their bank accounts, including balances as of specific dates. The form also asks about any additional accounts the individual has access to, such as IRAs, CDs, and safety deposit boxes. Additionally, the form requests federal tax information, which must be checked off accordingly.

The TX HHS Form H1239-FTI should be used when an individual is being considered for medical assistance and needs to provide verification of their bank accounts. The form can be completed by a Bank Representative or HHSC Staff, and it is essential that all information on Page 2 is accurately filled out and returned.