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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 7 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 Application for Healthcare Coverage For a family or when there is more than one individual in the household applying for health care coverage only.

DFA-SLA-2 Application for Healthcare Coverage – Short Form For a single individual applying for health care coverage only. Pregnant Women DFA-2 or

WV PATH Application for All Programs of Assistance Applicant is being considered for all programs. • When an interview is conducted, the Worker and the client decide on a reasonable time for the information to be returned. • When the application is returned by mail, left at the office or submitted by WV PATH and additional information is required, the client must be given at least 10 days after the mailing date of the request for additional information to respond. • Action must be taken to approve, deny or withdraw the application within 13 business days of the date a complete application is received in the county office. • If additional information or verification is required after the complete application is received, the Worker must request it immediately to allow the client 10 days to provide it and to complete the application within 13 business days.

DFA-SLA-1 Application for Healthcare Coverage For a family or when there is more than one individual in the household applying for health care coverage only. DFA-SLA-2 Application for Healthcare Coverage – Short Form For a single individual applying for health care coverage only. Qualified Disabled Working Individuals (QDWI)