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West Virginia Income Maintenance Manual Chapter 18
West Virginia Income Maintenance Manual Page 42 Chapter 18 WV WORKS Activities/Requirements
18.6.5.B Instructions for Completion Instructions for completion are as follows: • Complete in triplicate. • Enter the case name and case number in the indicated spaces on the form. • Enter a check mark in the block beside each paragraph number to indicate that the participant understands the information. • The specified relative must sign the form. If the parent is also in the home, he must sign the form. • The Case Manager and participant must sign all copies. • Distribute copies to the participant, BCSE Child Support Specialist, and file one in the case record. 18.6.5.C Procedures When the Participant Refuses to Sign When the participant refuses to sign the DFA-AP-1, the action taken depends upon the reason for the refusal. When the participant indicates that he will not sign the DFA-AP-1 and, in doing so, indicates that he will not cooperate with BCSE, the Case Manager must determine if good cause exists for the refusal. If good cause does exist, no BCSE action is required or taken and no penalty is applied to the participant. If good cause does not exist, the WV WORKS case is referred to BCSE and a sanction is applied. The Case Manager must record in the eligibility system the circumstances involved in the determination of good cause. When the participant indicates that he will not sign the DFA-AP-1 but indicates that he will cooperate with BCSE after referral, the WV WORKS case is referred to BCSE and no penalty is applied. The Case Manager must record in the eligibility system that the content and purpose of the form were explained to the participant, that he refused to sign, the reason given for the refusal, and that the participant has indicated that he will cooperate with BCSE after the referral. The Case Manager must provide the participant with an unsigned copy of the DFA-AP-1 and this must also be recorded in the eligibility system. Refusal or other failure to sign the DFA-AP-1 does not constitute failure to cooperate with BCSE requirements as shown on the PRC. The above instructions are followed, and no sanction is applied.