MA705I

A Financial Account Ownership Form (DE-117), must be completed and mailed out to each account owner.

Did the customer and each account owner sign and complete a Financial Account Ownership Form (DE-117)?

• If YES, continue to Step 3

• If NO, STOP. The account rebuttal is not successful. A completed DE-117 must be completed for each account owner.

Was the following information provided?

• Account records for the time frame being rebutted showing the deposits and withdrawals

• Account records or statements from the financial institution showing the customer’s portion of the funds (if any) being removed from the account and the customer is no longer listed as an owner or signer

  • If YES to both, continue to step 4.

  • If NO to either item, STOP. The account rebuttal is not successful. All required information will need to be received to allow the account rebuttal.

NOTE     If the customer’s name is unable to be removed from the account, submit a PCR to the Office of Eligibility Policy (OEP).

The customer has provided all proof needed to rebut the financial account. Remove the financial account from HEAplus and continue to process the case.

NOTE     If the account rebuttal needs to be reviewed by OEP, submit a PCR.