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.
- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- 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.
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To request information about an applicant/recipient's insurance policies.
When to Prepare
The worker sends Form H1238 to insurance companies to get pertinent information about insurance policies.
Number of Copies
The worker completes an original, typed or legibly handwritten. He records the date he sent the form on Form H0007-A, Financial Services Activity Record, or prepares a copy of Form H1238 for the case record. (Follow regional instructions.)
The worker sends the original to the appropriate insurance company and keeps the duplicate (if any) in the case record. Attach Form H0003, Authorization To Furnish Information (signed by the applicant, recipient, or responsible person), to the original.
If a copy is made for the case record, keep the copy for three years.
To — Enter the name and address of the insurance company.
From — Enter the worker's name and local office mailing address.
ApplicantIRecipient Information — Enter the name of the insured, the insurance policy number(s), if known, and any pertinent comments.
The worker signs the form and enters the date and his telephone number. An insurance company representative completes the other items on the form.