Downloading a Form to Your Computer
Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.
Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.
If still having trouble viewing or downloading a form, click here.
- To make a record explaining why a case is in suspense.
- To record the date on which a case is to be removed from the suspense file.
- To provide the clerk with information about the disposition of the case.
When to Prepare
The worker prepares Form H1040-A when he cannot take action on a case until necessary information is provided by the client or until a specified period of time has passed. This may include denials for missed appointments, requests for additional information from the client, and follow-up activities by the worker.
Number of Copies
The worker prepares one copy of Form H1040-A.
The worker attaches Form H1040-A to the upper right corner of the case record and files the case in the suspense file. The worker removes the form from the case record and destroys it when the suspense period is over.
There is no retention required for Form H1040-A.
Pull Date — The worker enters the date on which the case is to be removed from the suspense file.
Case Name/Worker Name — Self-explanatory.
Reason in Suspense
Missed Appointment — Check this box if the case is being held because the client missed an appointment.
Additional Information Needed — Check this box if additional information is needed to make the eligibility determination.
Action To Be Taken
Need to See — Check this box if the worker needs to talk to the client when the requested information is brought in.
Mail Out — Check this box to request that certain forms be mailed on the "pull date." Indicate the forms to be mailed.
Return To — Check this box when the case record should be returned to the worker or other staff member on the "pull date." Enter the name of the staff member to whom the case record should be returned.
Remarks — The worker may use this section to request return of the case record when the Form H1000-B turnaround document is received, to request notification when the action indicated has been taken, or to request any other appropriate action.