93 INF-41: Introduction of "Bank Inquiry and Clearance MA-Only" (DSS-4369)
The purpose of this Informational Letter is to introduce the DSS-4369 "Bank Inquiry and Clearance MA-Only" form. This form should be used when a district is determining eligibility for a Medical Assistance Only applicant/ recipient and it is necessary to have a written collateral contact with a bank or other banking institution. The district should complete the appropriate areas on the form and send it directly to the bank. The bank should complete the back of the form and return it directly to the district.
