PURPOSE

• To request a replacement Form H1000-B with the current budgeted job number (BJN) if the latest form is lost or damaged.
• To request a replacement Form H1000-B with a new BJN if the latest form is lost or damaged.
• To request Form H1000-B if a worker needs to take action on a transferred case record but does not have a current Form H1000-B.

PROCEDURE

When to Prepare

Complete Form H1004 if

• Form H1000-B is lost or damaged, or submitted but not returned in reasonable time.
• The worker receives a casefolder, transferred from another office, that does not contain a current Form H1000-B. Note: Coordinate with the office that sends the case record before using Form H1004 for transfers.

Number of Copies

An original and one copy.

Transmittal

Send the original to the data communications unit (DCU), which enters the data into the SAVERR computer file. This generates an updated sequence Form H1000-B sent to the mail code requested. File the copy of Form H1004 in the case record.

Form Retention

Destroy the original when no longer needed. Keep the case record copy at least one year.

DETAILED INSTRUCTIONS

Complete Section I or II. Do not complete both.

Section I —  Request for Replacement Form H1000-B with Same BJN — Enter the case number, category, and case name. The updated Form H1000-B will have the same BJN information.

Section II —  Request for Replacement Form H1000-B with New BJN — Enter case number, category, case name, and the BJN, mail code, and county code of the office receiving the updated form. Check the appropriate box if the form is used for a transferred case record.

Section III —  Requested By/Approval — Sign the form and enter your employee number and the date. The unit supervisor signs approved requests and enters the date he approved.

Section IV —  Comments — Enter facts about lost or damaged Forms H1000-B. If Section II is used, explain the reason for the BJN change.