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West Virginia Income Maintenance Manual Chapter 20

West Virginia Income Maintenance Manual Page 82 Chapter 20 Emergency and Special Assistance Programs

APPENDIX B: PUBLIC FORMS Form Number Form Title DFA-67-A Burial Billing Form DFA-BU-1 Application for Burial Benefits DFA-BU-2 Affidavit of Responsible Relative DFA-EA-1 Application for Emergency Assistance DFA-TA-2 Tel-Assistance/Lifeline Application DFA-TA-3 Tel-Assistance/Lifeline Fact Sheet