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Effective Date: 
4/1995

Documents

Instructions

Updated: 4/1995

PURPOSE

  • 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.

PROCEDURE

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.

Transmittal

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.

Form Retention

There is no retention required for Form H1040-A.

DETAILED INSTRUCTIONS

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.