Hhsc form 1239-2026

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4.8 out of 5

226 votes

The document is a request form for bank account verification related to a depositor being considered for medical assistance. It includes sections for the depositor's information, bank representative details, and requests for account balances and additional account information. The form emphasizes the need for accurate completion and return of the information to the eligibility specialist.

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Click ‘Get Form’ to open hhsc form 1239 in the editor.
Begin by entering the 'Name of Depositor' and 'Account No.' in the designated fields. Ensure accuracy as this information is crucial for verification.
In the comments section, provide any additional relevant information that may assist in the verification process.
Check the appropriate box under 'FEDERAL TAX INFORMATION' to indicate whether you have federal tax information available.
Complete Page 2 by filling in details requested from the bank representative, including account types, balances, and authorized signatures.
Ensure all sections are filled out completely before saving your changes. Use our platform’s features to sign and distribute the form as needed.

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Versions	Form popularity	Fillable & printable
2010	4.8 Satisfied (226 Votes)
2009	4 Satisfied (56 Votes)

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h1239 rev 12 2015 2 eng

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