Updated On | [date-and-time] | Updated By | [User Name] [View History] |
---|---|---|---|
Effective Date of Change | [Date] | ||
Approval Requested | [True] | Approval Status | [Approved] [View History] |
Resource Transfer Evidence Details
Household Member | [Full Name] |
---|---|
Recipient Name | [Full Name] |
Resource Type | [field-value] |
---|---|
Item Type | [field-value] |
Transfer Reason | [field-value] |
Transfer Date | [Date] | Fair Market Value | [Amount] |
---|---|---|---|
Amount Received | [Amount] | Uncompensated Value | [Amount] |
Transfer on Behalf of this Participant | [True] | Attempted To Regain Possession | [True] |
Legally Binding Document In Place | [True] |
Comments
[Comments] |