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206 The VaCMS will pre-fill the identifying information for the applicant/recipient the worker contact information.

The bottom of the form provides space for the worker to type in the information to be communicated.

This form is available in the VaCMS. Completing this form in the VaCMS automatically saves a copy of the form in the case record. The form is printed and sent to the applicant/recipient. The Correspondence ID# and mailing date must be recorded in the case narrative, if printed locally.

The last page of the form provides information on the fair hearings and appeal process.

Appendix P. Child Care Verification Checklist Instructions

NUMBER 032-12-0127-00-eng (03/17)

PURPOSE OF FORM To notify applicant/recipient as to information they must provide in order for determination/redetermination of eligibility.

USE OF FORM To provide applicant/recipient with a list of items to be submitted in order to verify and to document required documentation for eligibility to be determined.

COPIES One copy for the case record. One copy must be sent to the applicant/recipient.

INSTRUCTIONS FOR PREPARING THE FORM Any time a requirement for determination of eligibility needs to be verified or to be documented, a verification checklist should be provided to the applicant/recipient.

This form will be included in the redetermination package sent to the recipient.

A copy must be generated to send to the applicant/recipient. The worker will complete the form after printing it. A copy must be kept in the case record. The worker must record in the case narrative that the form was provided to the applicant/recipient as documentation.

Appendix Q. Childhood Immunization Certification Instructions

NUMBER 032-03-0960-03-eng