TX HHS Form H1276. Burial Fund Designation Worksheet

The Burial Fund Designation Worksheet (Form H1276) is a practical tool designed to help individuals designate their burial funds for the purpose of determining countable resources in certain situations. This form is typically used by individuals who are applying for or receiving benefits from government programs, such as Medicaid or Supplemental Security Income (SSI), where the value of their burial fund must be considered.

The form requires the individual to provide information about their burial arrangements, including the total face value of all excluded life insurance policies and any designated burial funds. The individual must also calculate the countable resource amount by applying a percentage to the current total value of their designated burial funds. This calculation is used to determine whether the individual's burial fund exceeds the allowed limit.

Key features of this form include the requirement to provide detailed information about the individual's burial arrangements and the need to calculate the countable resource amount using a specific formula. The form also emphasizes the importance of considering interest, dividends, or inflation when calculating the value of the designated burial funds. By completing this form, individuals can ensure that their burial fund is properly accounted for in determining their eligibility for government benefits.

• The Burial Fund Designation Worksheet (Form H1276) is used to determine countable resources for government benefit programs such as Medicaid and SSI.
• The form requires the individual to provide information about their burial arrangements, including excluded life insurance policies and designated burial funds.
• The form calculates the countable resource amount by applying a percentage to the current total value of designated burial funds.