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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 8 Chapter 1 Application/Redetermination Process

Program and Form ID Name of Form When to Use Due Date of Additional Information Agency Time Limits DFA-2 or

WV PATH Application for All Programs of Assistance Applicant is being considered for all programs. The client must be given at least 10 days after the date the verification checklist or DFA-6 is mailed to return the information. The Worker must send a copy of the DFA-2 or DFA-MA-1 to the BMS Buy-In Unit within 30 days of the date of application, when the client is eligible for QDWI.

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. QMB, SLIMB, QI-1 DFA-2 or

WV PATH Application for All Programs of Assistance Applicant is being considered for all programs. • When the client visits the office and an interview is conducted, the Worker and client decide on a Eligibility system action to approve, deny or withdraw the application must be taken within 30 days of the date of application.