Effective Date
Instructions
Updated: 5/1991
Purpose
To notify the client or state supported living center resident's responsible party that it is time to review the case.
When to Prepare
Send Form H1233, along with the Form H1200, Application for Assistance (Aged and Disabled), to the client or responsible party when a review is due.
Number of Copies
Complete an original. Note on Form H0007-A or prepare a copy for the case record.
Transmittal
Send the original to the client at his address or that of his responsible party. For state supported living center residents, send Form H1233 to the responsible party.
Form Retention
If a copy is made for the case record, keep that copy according to the retention requirements of the case record.
Detailed Instructions
Inside Address
Enter the name of the client and his mailing address or that of his responsible party.
Date — Self-explanatory.
HHSC Staff — Self-explanatory.
Office Address and Telephone Number — Enter the caseworker's complete office address and telephone number.
It is time to review your eligibility for assistance — Check this box if the applicant does not reside in a state supported living center.
The Health and Human Services Commission is helping meet the needs of — Check this box if the client is a state supported living center resident. Enter the name of the client.
In addition to the Form H1200, please complete the following forms.... — Enter the form number of each additional form enclosed.
Comments Section — Include other requests for information and instructions.