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West Virginia Income Maintenance Manual Acronyms, Forms, and Glossary

West Virginia Income Maintenance Manual Page 27

Acronyms, Forms, and Glossary

Form Abbreviation/Code Form Name Chapter (s) N-561 Certificate of Citizenship 15 NMRL Eligibility System Notice 1 OFS-JO-1

18 OFS-Release 1 Release of Confidential Applicant/Recipient Information 17 OFS-Release 1 (NMR4) Release of Confidential Applicant/Recipient Information 18 PAS-2005 Patient Medical Evaluation 13 SSA-1020-OCR-SM Original Social Security Form 25 SSA-2253 Enumeration at Birth (EAB) Receipt 2 SSA-234 Public Assistance Agency Information Request and Report 23 SSA-420-OCR-SM Original Social Security Form 8 V-92 Visa 92 15 W-2 Wage and Tax Statement 15 W-2c Statement of Corrected Income and Tax Amount 15 WV-BMS-IDD-1 WV I/DD Waiver Application 24