Downloading a Form to Your Computer

  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 application. 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: 
12/2006

Documents

Instructions

Updated: 10-2002

Purpose

  • To arrange an appointment with an applicant/recipient.
  • To return a Form H1200 for completion.
  • To notify an applicant that there has been a delay in determining eligibility because more information is needed or an appointment was missed.
  • To notify an applicant/recipient of the reason(s) for the delay in determining/redetermining eligibility.
  • To notify an applicant/recipient of the information needed in order to take necessary action in the case.

Procedure

When to Prepare

Form H1235 is prepared when

  • an appointment is needed with an applicant, recipient, or responsible party.
  • an appointment has been missed and a new appointment is needed.
  • Form H1200 is incomplete.
  • action cannot be taken in a case without additional information.

Number of Copies

Form H1235 is completed in triplicate.

Transmittal

The caseworker sends the original to the client at his address or that of his responsible party. In vendor cases, the first copy is sent to the nursing facility/ICF-MR facility/state supported living center, and the second copy is filed in the case record. In nonvendor cases, either the first or second copy is filed in the case record.

Form Retention

The caseworker may destroy the case record copy when the information is obtained or the appointment is kept.

Detailed Instructions

Heading — Enter the name of the client and his mailing address or that of his responsible party.

Date — Self-explanatory.

Program — Check the appropriate box(es) to indicate the type of application/case - i.e., QMB, MAO, three months prior, or other.

HHSC Staff — Self-explanatory.

Office Address and Telephone No. — Enter the caseworker's complete office address and telephone number.

AN APPOINTMENT HAS BEEN MADE FOR YOU AT: — Check this box if an appointment is being scheduled for an applicant, recipient, or responsible party.

Enter the date of the appointment, the time (denoting a.m. or p.m.), and the address at which the interview will be held.

THERE BEEN A DELAY IN DETERMINING YOUR ELIGIBILITY BECAUSE: — Check this box if an eligibility decision is delayed on an application because more information is needed or an appointment was missed.

Check the appropriate box(es) to indicate the reason for delay - i.e., an appointment was missed or more information is needed.

You missed your appointment on ... — Enter the date (e.g., December 4, 1992) of the previously scheduled appointment that was missed.

We need more information. Before we can make a decision ... you must provide the following information: — Indicate, using wording the client can understand, the information needed in order to take action on the case.

Please return this form by ... — Enter a reasonable due date by which this form and the requested information must be received. Reasonableness of due date is determined by the type of information requested.