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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 11 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

WV PATH Application for All Programs of Assistance Applicant is being considered for all programs. Additional information related to medical bills is due 30 days from the date of application. See SSI-Related Aged, Blind, Disabled above.

DFA-SLA-1 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. DFA-SLA-2 Application for Healthcare Coverage – Short Form with Supplement For a single individual applying for health care coverage only. Transitional Medicaid