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West Virginia Income Maintenance Manual Acronyms, Forms, and Glossary

West Virginia Income Maintenance Manual Page 25

Acronyms, Forms, and Glossary

Form Abbreviation/Code Form Name Chapter (s) DFA-WVW-NL-2 WV WORKS Sup. Serv. Reg. Denied Memo 18 DFA-WVW-NL-3 WV WORKS Continued Sup. Serv. Req. Denied 18 DFA-WVW-VERIF-1 TANF Verification - Months Used 7, 18 DFA-WVW-VERIF-2 Protective Payee Verification 10, 18 DHS-1 Deferral and Communication Form 1, 10, 11, 18, 23, 24 DHS-3 Written Statement from SSA 7, 24 DS-1350 Certification of Report of Birth 7 EOIR-26 Notice of appeal; date stamped by the Office of the Immigration Judge 15 ES-AP-225 Verification of Loan Conditions 4 ES-IN-1 Statement of Monthly Living Expenses 4 ES-NH-3 Notice of Client's Contribution Toward His Cost of Care 24 ES-NL-D Notification Letter: Action Taken on Your Request for an Assessment of the Assets Belonging to Both You and Your Community Spouse 24 ES-REPAY-1 Repayment Agreement 11 ES-RT-3 Disability/Incapacity Evaluation Form 1, 13, 26 FS-240 Consular Report of Birth Abroad of a Citizen of the United States of America 7 FS-240 Report of Birth Abroad of a Citizen of the U.S. 15 FS-545 Certification of Birth Abroad 7 FS-545 Certificate of Birth 15 FS-D-2

16 FSPU-9 SNAP FLSA Work Hours Calculation 18 G-845 Document Verification Form 15 HS-3 Referral to Outside Agencies 8, 13 I-151 Green Card (USCIS Form) 15 I-197 U.S. Passport 15