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Effective Date: 



Updated: 4/2007


To advise clients with excess resources that they can designate liquid resources as burial funds and have up to $1,500 excluded from the eligibility determination.


When to Prepare

Prepare Form H1277 by the third day after determining that a client has been denied for excess resources and that the client has liquid resources to which the burial fund exclusion could be applied.

Number of Copies

Prepare an original and one copy of Form H1277.


Send the original Form H1277 to the client at his mailing address or that of his responsible party. A self-addressed envelope is included. File the copy in the case record.

Form Retention

Keep Form H1277 in the case record for three years.

Detailed Instructions

Inside Address — Enter the name of the client and his mailing address or that of his reponsible party.

Date — Self-explanatory.

HHSC Staff — Self-explanatory.

Office Address and Telephone Number — Enter the caseworker's complete office address and telephone number.

I have determined that on — Enter the date the preliminary decision of ineligibility was made.

Please contact me before — Enter a date that is seven workdays from the date of this form.