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Effective Date: 
5/2003

Documents

Instructions

Updated: 5/2003

PURPOSE

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.

PROCEDURE

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.

Transmittal

File the completed form on the right side of the case folder with the appropriate application or change form.

Retention

See the Texas Works Manager's Guide.

DETAILED INSTRUCTIONS

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.