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West Virginia Income Maintenance Manual Acronyms, Forms, and Glossary

West Virginia Income Maintenance Manual Page 24

Acronyms, Forms, and Glossary

Form Abbreviation/Code Form Name Chapter (s) DFA-TA-3 Tel-Assistance/Lifeline Fact Sheet 20 DFA-TA-34 WV WORKS Training Agreement 17, 18 DFA-TS-12 Participant Time Sheet 17, 18 DFA-UH-5 (NMUS) Application for Undue Hardship Waiver 24 DFA-V-1 Vehicle Estimate Form 5, 7 DFA-WVSC-1 West Virginia School Clothing Allowance Form 1, 19 DFA-WVW-1 Eligibility Determination Computation Sheet 9 DFA-WVW-3 DCA Agreement 1 DFA-WVW-3a WV WORKS Initial Self-Sufficiency Appraisal Form 1, 18 DFA-WVW-3b Caretaker Relative Assessment 18 DFA-WVW-3c Pandemic Diversionary Cash Assistance Agreement

DFA-WVW-4 Orientation to WV WORKS 1 DFA-WVW-5 Notice of Pending Closure of Benefits 14 DFA-WVW-6 Case Staffing Information 14 DFA-WVW-10 WV WORKS Caretaker Relative Option 1, 3 DFA-WVW-15 WV WORKS Transitional Benefit Option 18 DFA-WVW-25 Employer Contact Form 18 DFA-WVW-40 EHI and Learning Needs Screening Declination Form 18 DFA-WVW-70 Referral for Training/Services 18 DFA-WVW-75 WV WORKS 4th Sanction and Subsequent Sanctions 14 DFA-WVW-100-A 55 Month Letter 18 DFA-WVW-100-B Request for Extension 18 DFA-WVW-Bridge-1

DFA-WVW-CCG-2 Self Sufficiency Appraisal Addendum and Coaching Guide 1, 18 DFA-WVW-DAST-1 Drug Use Questionnaire 1, 3, 10, 14, 18 DFA-WVW-FLSA-1 Fair Labor Standards Act Computation Sheet 18 DFA-WVW-JR-1 Job Retention 30-90 day Follow-up Checklist 18 DFA-WVW-NL-1 WV WORKS Pending Change of Benefit Notice 9, 14