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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 3 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits DFA-SLA-1 with DFA-SLA-S1

Application for Healthcare Coverage with Supplement

For a family or when there is more than one individual in the household applying for health care coverage only.

AIDS Drug Assistance Program (ADAP) DFA-2 Application for All Programs of Assistance Applicant is being considered for all programs. The Worker and the client or his authorized representative decide on a reasonable time for the information to be returned. • The ADAP eligibility determination must be based on current client circumstances. • From the date of application, defined in Section 1.23, the applicant must return the completed ADAP application to the Worker within 30 days.

DFA-SLA-1 with DFA-SLA-S1 Application for Healthcare Coverage – Long Form with Supplement For a single individual applying for health care coverage only.

DFA-SLA-2 with DFA-SLA-S1 Supplement for Healthcare Coverage - Short Form with Supplement For a single individual applying for health care coverage only.