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Effective Date: 1/1998


PDF: H1059.pdf


Updated: 7/1986


To provide income assistance supervisors a form to use

  • while observing an interview, and
  • as a training supplement.


Follow regional procedures for required use of Form H1059. Ensure the worker receives a copy.

Form Retention

Keep a copy in the worker's conference folder for as long as needed.


Form H1059 is self-explanatory.