Page 1601

West Virginia Income Maintenance Manual Chapter 18

West Virginia Income Maintenance Manual Page 183 Chapter 18 WV WORKS Activities/Requirements

Section III Effective EIP Training Dates: Date the placement is to begin and the estimated ending date Employer’s Product or Service: The business in which the employer is engaged Payment Schedule: Monthly itemized invoice. EIP payments are made monthly upon receipt of the DFA-TS-12 or other appropriate time sheet Section IV Identify the total fixed price the EIP Agreement cannot exceed. Enter the dollar amount the Agreement cannot exceed. (Example: $5.15 x 200 ÷ 50% = $515.00) Section V Signatures: Enter signatures, titles, date signed Section VI Location and Person in Charge: Enter the location of the placement and the person in charge Statement of Employer’s Need for EIP: A brief statement of the Employer’s need for the EIP is to be entered here. (If additional space is needed attach a separate sheet of paper.) Job Description: A brief job description is to be entered here. (If additional space is needed attach a separate sheet of paper or the OFS- JO-1 may be used.) Section VII Concurrence of the Collective Bargaining Agent: If the occupation is subject to collective bargaining, enter the name, title and union affiliation of the bargaining representative. Section VIII General Provisions to the EIP Agreement: The employer’s authorized representative must read this section. His signature signifies that these conditions will be followed.

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Page 1601

Official source

West Virginia Income Maintenance Manual Chapter 18

West Virginia Income Maintenance Manual Page 183 Chapter 18 WV WORKS Activities/Requirements

Section III Effective EIP Training Dates: Date the placement is to begin and the estimated ending date Employer’s Product or Service: The business in which the employer is engaged Payment Schedule: Monthly itemized invoice. EIP payments are made monthly upon receipt of the DFA-TS-12 or other appropriate time sheet Section IV Identify the total fixed price the EIP Agreement cannot exceed. Enter the dollar amount the Agreement cannot exceed. (Example: $5.15 x 200 ÷ 50% = $515.00) Section V Signatures: Enter signatures, titles, date signed Section VI Location and Person in Charge: Enter the location of the placement and the person in charge Statement of Employer’s Need for EIP: A brief statement of the Employer’s need for the EIP is to be entered here. (If additional space is needed attach a separate sheet of paper.) Job Description: A brief job description is to be entered here. (If additional space is needed attach a separate sheet of paper or the OFS- JO-1 may be used.) Section VII Concurrence of the Collective Bargaining Agent: If the occupation is subject to collective bargaining, enter the name, title and union affiliation of the bargaining representative. Section VIII General Provisions to the EIP Agreement: The employer’s authorized representative must read this section. His signature signifies that these conditions will be followed.