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West Virginia Income Maintenance Manual Chapter 1

West Virginia Income Maintenance Manual Page 35 Chapter 1 Application/Redetermination Process

Because the DFA-2 can be used for multiple programs, denial of an application for one program may lead to approval for another. The DFA-2 which contains, at a minimum the applicant’s name, address, and signature is used to protect the date of application for SNAP, Medicaid, and Emergency Assistance (EA). 1.3.1.A.2 Submission Format The DFA-2 may be: • Completed by the Worker in the eligibility system; or, • Completed on paper, known as the DFA-2 shelf document, when circumstances do not permit completion of the application process in the eligibility system. 1.3.1.A.3 Related Forms ➢ Rights and Responsibilities DFA-RR-1 The DFA-RR-1 is required each time a DFA-2 or DFA-5 is completed. The client must read, or have read to him, all the statements preceding his signature before signing the form. He must also indicate his understanding of, or agreement with, each statement by checking the appropriate block beside the statement. The Worker must provide any explanation and information the client needs to understand the statements. After completing all applicable sections, the client signs the form. For WV WORKS, when both parents are in the home, both must sign. Failure to sign the form results in ineligibility. When a client checks “no” to an item, it does not result in immediate ineligibility. The client has to actually fail to comply with the requirement in order to result in ineligibility. Rights and Responsibilities Example: The client applying for SNAP benefits checks “no” to the statement concerning the requirement to cooperate with Quality Control (QC). The AG is eligible, and benefits are approved. QC selects the case for review in the second month. The client refuses to cooperate and, only then, is notice of closure sent. ➢ Document for Protection of Application Date DFA-5