TX HHS Form H1239. Request for Verification of Bank Accounts

The TX HHS Form H1239, "Request for Verification of Bank Accounts," is a crucial document used to verify bank accounts for medical assistance eligibility. This form helps resolve the issue of ensuring accurate financial information for individuals being considered for medical benefits.

This form requires specific information from the bank representative, including the bank name and address, insurance company address (if applicable), and the depositor's name. The form also asks about any additional accounts the person has access to, such as IRAs, CDs, or safety deposit boxes. Additionally, it requests all balances as of close of business on specific dates.

The form should be completed by the bank representative and submitted along with a signed authorization to release information. Common scenarios for using this form include when an individual is being considered for medical assistance and needs their financial information verified. The form explicitly mentions that if any accounts have been closed, the account number(s), closing date, and closing balance must be provided.