Page 67

West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 34 Chapter 1 Application/Redetermination Process

1.3 APPLICATION FORMS The forms described in this section are used to make an application for programs and Medicaid coverage groups included in the Income Maintenance Manual (IMM) such as the Supplemental Nutrition Assistance Program (SNAP), WV WORKS, Low-Income Energy Assistance Program (LIEAP), School Clothing Allowance (SCA), and health coverage programs that include Medicaid, the West Virginia Children’s Health Insurance Program (WVCHIP), and qualified health plans. The application: • Is used for gathering client information which is used to determine eligibility and the need for other services offered by the Department of Human Services (DOHS). • Is a fact sheet containing relevant information about the assistance group (AG) and other members of the household who are not included in the AG? • Serves as a legal document and may be used in any court case. Program-specific instructions for application completion or usage are described in the application procedures under each program and coverage group section and summarized in Appendix A. 1.3.1 COMMON APPLICATION FORMS The applications listed below can be used to apply for one or more programs including SNAP, WV WORKS, Medicaid, and WVCHIP. 1.3.1.A Application for Benefits DFA-2 The DFA-2 is also known as the “CAF” or Common Application Form. 1.3.1.A.1 Purpose The DFA-2 can be used to apply for most Division of Family Assistance (DFA) programs including SNAP, WV WORKS, and Medicaid as well as WVCHIP.

loading…

Page 67

Official source

West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 34 Chapter 1 Application/Redetermination Process

1.3 APPLICATION FORMS The forms described in this section are used to make an application for programs and Medicaid coverage groups included in the Income Maintenance Manual (IMM) such as the Supplemental Nutrition Assistance Program (SNAP), WV WORKS, Low-Income Energy Assistance Program (LIEAP), School Clothing Allowance (SCA), and health coverage programs that include Medicaid, the West Virginia Children’s Health Insurance Program (WVCHIP), and qualified health plans. The application: • Is used for gathering client information which is used to determine eligibility and the need for other services offered by the Department of Human Services (DOHS). • Is a fact sheet containing relevant information about the assistance group (AG) and other members of the household who are not included in the AG? • Serves as a legal document and may be used in any court case. Program-specific instructions for application completion or usage are described in the application procedures under each program and coverage group section and summarized in Appendix A. 1.3.1 COMMON APPLICATION FORMS The applications listed below can be used to apply for one or more programs including SNAP, WV WORKS, Medicaid, and WVCHIP. 1.3.1.A Application for Benefits DFA-2 The DFA-2 is also known as the “CAF” or Common Application Form. 1.3.1.A.1 Purpose The DFA-2 can be used to apply for most Division of Family Assistance (DFA) programs including SNAP, WV WORKS, and Medicaid as well as WVCHIP.