To request information from banking institutions or credit unions regarding a client's checking and/or savings account, as well as any certificates of deposit, individual retirement accounts, etc., that the client may own.
When to Prepare
Use this form to verify account information.
Number of Copies
Give or mail the client or financial institution one copy of the form with an addressed, stamped envelope.
File the completed form on the right side of the case folder with the appropriate application or change form.
See the Texas Works Manager's Guide.
Staff enters the
- date, advisor's name, office address, and telephone number;
- name and address of the financial institution in the window space;
- case name and case number;
- account holder's name and SSN;
- joint account holder's name and SSN, if applicable;
- date the information is due; and
- account holder's name in the space giving his permission for release of the requested information. The account holder signs and dates the form in the appropriate spaces.
The financial institution completes the remainder of the form. All items are self-explanatory.
Note: Do not enter Tax-Sensitive Information on the form before sending it to banking institutions or credit unions. See procedures in C-1000.