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.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. 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.

Effective Date: 



Updated: 5/2003


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.