Form H1236, Notification of Receipt of Application

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Effective Date

3/2026
H1236.pdf , H1236.doc

Availability

The notice is prepopulated and automatically generated out of the system. It is mailed directly to the facility or agency.

Instructions

Updated: 3/2026

Purpose

Notifies the facility that: 

  • a client submitted an application for assistance; and 
  • more information is requested to complete the client’s application. 

Procedure

When to Prepare

The notice is sent within 10 calendar days from receipt of an application. 

Transmittal

The notice is automatically generated out of the system. It is mailed directly to the facility or agency.