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West Virginia Income Maintenance Manual Chapter 21

West Virginia Income Maintenance Manual Page 25 Chapter 21 Low Income Energy Assistance Program (LIEAP)

21.4.7.C Section III – Signatures and Statements of Liability Items A through G of the DFA-LIEAP-1 must be completed. If the client marks No on any item, the Worker must resolve any confusion or misunderstanding. If the client continues to answer No to any item, he should be informed that his benefits may be delayed or possibly denied. The client must sign and date the application. If someone else assisted the client, that person must also sign and date the form. 21.4.8 COMPLETION OF FORM DFA-LIEAP-1b Section I of the DFA-LIEAP-1b is provided for the use of sub-grantee staff. If the application was received by another agency or by mail, the appropriate space must be marked. When the application is received by the DOHS directly from the client (via mail or office visit), the Worker skips Section I of the shelf document DFA-LIEAP-1b and goes on to complete Section II. Section II is provided for the use of the DOHS Worker only. Other agencies do not complete this section. When the application is received by the DOHS directly from the client (via mail or office visit), the Worker completes this section. Items C through G are intended for completion after the application is processed in the eligibility system. When the application is received initially by another agency, Section I must be completed, and the other agency staff must enter his signature, title and the date before sending the form to the DOHS. The other agency never completes Section II. In receiving applications for Regular LIEAP, workers from other agencies must observe the following guidelines: • All questions on the application form must be answered, and all program policy must be followed. NOTE: The Worker or Other Agency must use shelf document DFA-LIEAP-1b to document the application process.