DOC004_D044_D045_Correspondence_Inventory_CC.xlsx

XLSX spreadsheet 86 KB Posted Jun 24, 2026

Attached to: MAINTENANCE/OPERATIONS SERVICES FOR WV PATH
Solicitation number: CRFP 0511 HHR2600000001 7
Issued by: Kanawha County, West Virginia

About this file

Written by GovTribe AI · Jun 25, 2026

This document is a Correspondence Inventory (Deliverable D044) for the West Virginia Department of Health and Human Resources (DHHR) WV PATH system implementation, prepared by Optum as the solution provider. The inventory provides a consolidated, searchable Excel-based listing of all notices and correspondence generated by the WV PATH solution, including over 200 document entries with unique identifiers, titles, descriptions, legacy system mappings, frequency, retention requirements, and intended audiences across multiple programs including SNAP, WV WORKS (TANF), Child Care, Medicaid, and other income support services. Each document entry specifies the document's current status (existing or new), planned status (retain, retire, add, or modify), format (letter, notice, form, report), business unit ownership, trigger conditions (user action, workflow, or batch), sensitivity classifications (FTI, PHI, PII data), and technical specifications including whether documents are editable, interactive, or protected.

The correspondence inventory reflects configuration decisions made during design workshops and state approval sessions, with notations indicating documents to be retained as-is, modified, retired, or newly created based on WV DHHR business requirements and quality management standards. Documents marked for retention include client notifications, provider communications, quality assurance verification forms, and program-specific applications, while numerous legacy forms have been retired in favor of new system-generated alternatives or shelf documents. All documents are designated for output in either PDF or Word format with specifications for printing, mailing, central distribution, barcode/QR code inclusion, and accessibility requirements including bilingual and large-font options where applicable. The inventory serves as the authoritative source for all correspondence generation requirements, maintenance responsibilities, and operational procedures within the integrated WV PATH eligibility and enrollment system.

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Cover

DEL-044 Correspondence Inventory

Date: 06/01/2024

Version: 0.01

Review and Approval History
Date	Version	Revised By	Reason for Revision

Deliverable Requirement:	The Correspondence Inventory will provide a consolidated list of all Notices and Correspondence generated by the solution. The inventory will include a unique ID, title, description, frequency, retention, and audience.
	DHHR agrees that the Correspondence Inventory is complete and appropriate:

1. The deliverable provides a complete inventory of all notice and correspondence supported and generated by the solution.

2. The deliverable contains a unique ID, title, description, frequency, retention, audience, source (i.e. xPressions), and other details agreed to during reports design meetings.

3. The Correspondence Inventory will be in Excel and is searchable.

4. The deliverable contains a footnote stating it is maintained by Optum.

5. The deliverable is consistent with and follows the quality standards outlined in the Quality Management Plan.

Column Definition

Column Name	Column Definition
Unique Document ID	Unique ID for each item in the D044 Correspondence Inventory
Document Title	Title of correspondence
Document Description	Description of correspondence
Legacy Correspondence ID	The identifier for the Document in the legacy system (where available)
Legacy Correspondence Name	The name of the Document in the legacy system (where available)
Legacy Correspondence Description	The description of the Document in the legacy system (where available)
RFP ID	The unique ID for the item in the RFP inventory
RFP Name/Description	The name/description from the RFP inventory
Current Status	The current status of the item from the RFP inventory (i.e. Existing, New)
Planned Status	The proposed status of the item in the new solution (i.e. Retain, Add, Drop, Merge)
Planned Format	What format is planned for the item in the new solution (i.e. usually letter, notice, other correspondence but could be form, report or screen--some items listed in the RFP inventory in one format may be better suited to a new format in the new solution)
Intended Audience	Client, Provider, Court, State Agency, Federal Agency, Operations, Internal Business Unit
Correspondence Author	Person / Area responsible for the content of the Correspondence
Primary Business Unit Owner	Business Unit who owns the Correspondence
Secondary Business Unit Owner	Business Unit who has a stake in the Correspondence
Related Program	Program using the item (i.e. SNAP, TANF, Child Welfare, etc.)
Retention Period	How long the item must be retained in the system
Retention Scope	How the item must be retained (data only, physical document, both)
Language	Required languages for the item (English, Spanish, bi-lingual, other)
Large Font	Document is required to be printed in Larger than standard font
Related Functionality	High level functionality related to item.
OSCAR form Category	Form Category specific to OSCAR( Different from Related Functionality)
Trigger	What triggers document generation (user action, client/case workflow, batch workflow)
Frequency	Periodic cycle for batch workflows (daily, weekly, etc.)
FTI Data	Documents has sensitive data related to FTI: Federal Tax Information
PHI Data	Documents has sensitive data related to PHI: Protected Health Information
PII Data	Documents has sensitive data related to PII: Personally Identifiable Information
Interactive Screen	Does the document have an Interactive Cincom user screen (Yes/No)
Interactive Doc	Does the document work interactivly with the user within Cincom (Word, PDF or No)
Protected	Are there sections of the document that are protected? This only applies to Word Documents (Yes, No, N/A)
Edit?	Can the document be edited once it is generated from Cincom (Yes, No)
Final Doc Format	Final document output from Cincom (Word or PDF)
Specification ID	Specification ID from requirement specification document related to this report.
Action Item	Issues to be addressed outside of Inventory working session and parking lot session.
Parking Lot	Issues that require follow-ups or extended discussions.
Notes	Notes and comments
Outstanding Issues	Any open issues related to this document.

Document List

Unique Document ID

Document Title

Document Description

Legacy Document ID

Legacy Document Name

Legacy Document Description

RFP ID

RFP Name/Description

Current Status (RFP)

Planned Status

Related Program

Intended Audience

Document Author

Primary Business Unit Owner

Secondary Business Unit Owner

Related Functionality

OSCAR form Category

Trigger

Frequency

FTI Data

PHI Data

PII

Data

Static or Editable

Planned File Type

Specification ID

Action Item

Parking Lot

Notes

Outstanding Issues

Document Tracking ID

QC-SNAP

QC Error Findings Notice - SNAP

Notice of SNAP error findings. – Supervisor use only

N/A

QC Error Findings Notice - SNAP

Notice of SNAP error findings. – Supervisor use only.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01426

QC-NH-2

Personal funds verification for nursing home residents

QC-NH-2

Personal funds verification for nursing home residents.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01425

QC-NH

Authorized Rep/POA asset verification form for nursing home residents. QC-101 also required

QC-NH-1

Authorized Rep/POA asset verification form for nursing home residents. QC-101 also required.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01422

QC-Negative

QC Checklist for Negative Drop Cases

Used for incomplete negative cases

N/A

QC Checklist for Negative Drop Cases

Used for incomplete negative cases.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01467

QC-Active

QC Checklist for Active Drop Cases

Checklist used for incomplete active cases.

N/A

QC Checklist for Active Drop Cases

Used for incomplete active cases.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01466

QC-ACA

QC Error Findings Notice - ACA

Notice of ACA error findings. – Supervisor use only

N/A

QC Error Findings Notice - ACA

Notice of ACA error findings. – Supervisor use only.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01433

QC-365-A

Medical provider. – Medical expense deductions

QC-365-A

Medical provider. – Medical expense deductions.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01407

QC-365

Pharmacy. – Medical expense deductions

QC-365

Pharmacy. – Medical expense deductions.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01352

QC-363-M

Loan Verification – Mortgage company

QC-363-M

Loan Verification – Mortgage company.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01344

QC-363-L

Lot rent

QC-363-L

Lot rent.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01343

QC-363-H

Verification request of Homeowner’s Insurance to Insurance Company.

QC-363-H

Homeowner’s Insurance.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01341

QC-363

Landlord verification and information request.

QC-363

Landlord contact.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01339

QC-350

Client request for Child Support verification and information.

QC-350

Child support.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01303

QC-346

Client verification request of HUD, Rent and Utility information.

QC-346

HUD.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01295

QC-345

Student enrollment and work study verification request.

QC-345

Student income – Working at college.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01294

QC-342

Request to client to confirm Contributions/support – Non-court order/verify personal loans and gifts

QC-342

Contributions/support – Non-court order/verify personal loans and gifts.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01293

QC-335

Workers Compensation verification request.

QC-335

Workers Compensation.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01292

QC-332-336

Client verification of received benefits.

QC-332-336

VA/RR/Black lung.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01291

QC-323

Request for Provider verification for child receiving benefits.

QC-323

Child care.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01290

QC-311

Request to Employer for employment and earnings verification

QC-311

Employer/earnings verification.

F0901

QA-311

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01299

QC-223

Insurance Company request for Client Life Insurance verification.

QC-223

Life insurance .

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01289

QC-221

Request for Client's financial information from Financial Institution.

QC-221

Assessor’s office.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01288

QC-211

Bank accounts

QC-211

Bank accounts.

F1035

QA-211

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01736

QC-2

Used to confirm information received via telephone with client.

QC-2

Used to confirm info received via telephone

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01287

QC-150-A

Household composition

QC-150-A

Household composition.

F1038

QA-150

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01741

QC-150

Collateral contact

QC-150

Collateral contact.

F1038

QA-150

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01740

QC-140-A

Letter is sent to the Postmaster to receive current information / status of the Client's address

NQPO

QA-140-A

F1051

QA-140-A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01754

QC-111

School attendance client questionnaire and verification.

QC-111

School attendance – Questionable / Age 16-18 working.

F1055

QA-111

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01029

QC-106-A

Notification to local office of cooperation. – Remove Sanction

QC-106-A

Notification to local office of cooperation. – Remove Sanction.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01285

QC-106

Notification to local office of non-cooperation. – Sanction

QC-106

Notification to local office of non-cooperation. – Sanction.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01283

QC-105-B

Notification to local office of failure of third-party contact to cooperate. – No sanction

QC-105-B

Notification to local office of failure of third-party contact to cooperate. – No sanction.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01282

QC-105-A

Notice of client cooperation to local office to complete case comments.

QC-105-A

Notice of client cooperation to local office to complete case comments.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01281

QC-105

Notification to local office of failure to cooperate. – No sanction

QC-105

Notification to local office of failure to cooperate. – No sanction.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01280

QC-104

Reschedule appointment letter to client in home, office, or telephone. Worker mails Certified letter.

QC-104

Reschedule appointment in home, office, or telephone. – Certified letter.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01279

QC-103-A

Client 2nd Request for information not provided for Medicaid review.

QC-103-A

Information not provided for Medicaid review, 2nd request.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01276

QC-102

Request to client for additional information to complete audit.

QC-102

Information needed request.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01275

QC-101

Authorization for information

QC-101

Authorization for information.

F1034

QA-101

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01734

QC-100-1

Appointment letter with checklist, rescheduled interview.

QC-100-1

Appointment letter with checklist, rescheduled interview.

F1033

QA-100

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01732

QC-100

Appointment letter with checklist.

QC-100

Appointment letter with checklist.

F1033

QA-100

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01731

QC-1

Document provides the Client’s written statement to DHHR.

QC-1

Client written statement form.

N/A

Existing

Retain as is

Quality Assurance

Client, DHHR

State Office

Case Management

N/A

Worker Generated

On Demand

Editable

Word

GT0128

WAI_5004

N/A

D01273

PAY-0597

Client Payment History Report

Shows the payment history of the Client, Case or Provider for the selected amount of time as determined by the case worker at the time of generation.

PAY-0597

Client Payment History Report

N/A

Existing

Retain as is

Child Care, Child Welfare

Courts, DHHR

Case Management

N/A

Worker Generated

On Demand

Yes

Static

PDF

GT0142

N/A

D01015

OFS-WVW-10

WV WORKS Caretaker Relative Option

Documents the Caretaker Relative / Parent of a child and their decision on if they wanted to be included or excluded from the Child's payment group for WV WORKS payments.

OFS-WVW-10

WV WORKS Caretaker Relative Option

F1160

The solution must be able to generate the OFS-WVW-10, non-parent caretaker, form.

Existing

Retain as is

WV WORKS (TANF)

Client

Policy Department

Policy and Communication Department

Application Intake

N/A

Worker Generated

On Demand

Static

PDF

GT0142

N/A

D01278

N/A

No ID

Provider Corrective Action Plan

F0138

Provider Corrective Action Plan

Existing

Retire

Child Care, Child Welfare

N/A

Licensing

N/A

Child Care - is changing the number from DAY-0615 to CC-0615 and modified to meet screens

Child Welfare - Retired the Corrective Action Plan Documents and are tracked under different numbers.

RFP# F0138 Provider Corrective Action Plan (D00016) is the same as RFP# F0270 Child Care Corrective Action Plan (D00491)

Optum is RETAINING RFP# F0270 Child Care Corrective Action Plan (D00491) and RETIRE RFP# F0138 Provider Corrective Action Plan (D00016)

D00016

N/A

DAY-0546

Child Care Provider Services Agreement

F0306, F0307

Child Care Provider Services Agreement

Existing

Retire

Child Care

N/A

Case Management

N/A

WAI_6159

WAI_6188

N/A

Duplicates - F0135; F0306/F0307; Per WAI, RETAIN F0135 RETIRE F0306/F0307

D00071

N/A

DAY-0577

Certificate of Registration

F0136

Certificate of Registration

Existing

Retire

Child Care

N/A

Licensing

N/A

WAI_6165

WAI_6188

N/A

Session Notes: DAY-0576 is the license to be Retained, all others are to be retired

D00125

N/A

DAY-0576

License to Operate a Family Child Care Facility

F0137

License to Operate a Family Child Care Facility

Existing

Retire

Child Care

Child Care Provider

N/A

Licensing

N/A

WAI_6164

WAI_6167

WAI_6188

N/A

Session Notes: DAY-0576 format will be used for all Provider Types; generate under DAY-0577

D00271

N/A

F0146

The solution must have the ability to create the Negative Action Letter in accordance with West Virginia business rules.

Existing

Retire

Child Care

N/A

Case Management

N/A

WAI_6172

WAI_6188

N/A

D00274

N/A

F0140

The solution must be able to generate and print the child care provider license.

Existing

Retire

Child Care

N/A

Licensing

N/A

WAI_6166

N/A

Session Notes: DAY-0576 is the license to be Retained, all others are to be retired

D00275

N/A

F0312

Child Care Parent Native of Denial or Closure

Existing

Retire

Child Care

N/A

Eligibility Determination

N/A

WAI_6173

N/A

D00277

N/A

DAY-0619

Child Care Center License

F0275

Child Care Center License

Existing

Retire

Child Care

N/A

Licensing

N/A

WAI_6188

N/A

Inventory Review - Retire

D00279

N/A

DAY-0620

Family Facility License

F0269

Family Facility License

Existing

Retire

Child Care

N/A

Licensing

N/A

WAI_6188

N/A

Inventory Review - Reitre

D00291

N/A

GEN-0583

Provider Contact Summary

F0288

Provider Contact Summary

Existing

Retire

Child Care, Child Welfare

N/A

Case Management

N/A

WAI_6207

N/A

Session Notes: WV DHHR advised that the summary is not used. The form has been replaced by GEN-0005.

D00292

N/A

DAY-0621

Child Care Certificate

F0271

Child Care Certificate

Existing

Retire

Child Care

N/A

Case Management

N/A

WAI_6188

N/A

Inventory Review - Retire

D00492

N/A

DAY-0620?

Statement of Certification

F0274

Statement of Certification

Existing

Retire

Child Care

N/A

Case Management

N/A

WAI_6188

N/A

Inventory Review - Retire

D00493

N/A

NQRA

QA-104

F1052

QA-104

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

https://uhgazure.sharepoint.com/:w:/r/sites/enterpriseoperations/WV_IES/_layouts/15/Doc.aspx?sourcedoc=%7B6B51B0DF-2D3A-4D93-91BB-6134843BDD17%7D&file=20190619_WV_PATH_Configuration_Workshop_DS_156%20and%20157_Meeting_Notes.docx&action=default&mobileredirect=true&DefaultItemOpen=1&cid=080af78d-ff92-40d3-a7a3-feeb9a7ab6eb

D00965

N/A

ECE-CC-10H

Payemnt Training Quiz

N/A

Existing

Retire

Child Care

N/A

WAI_6189

N/A

Session Notes: WV DHHR advised the form is not needed in WV PATH.

D00978

N/A

NQRO

QA-105

F1053

QA-105

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01008

N/A

NQRP

QA-221

F1054

QA-221

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01011

N/A

ECE-CC-10I

Payemnt Training Quiz ANSWER Sheet

N/A

Existing

Retire

Child Care

N/A

WAI_6190

N/A

Session Notes: WV DHHR advised the form is not needed in WV PATH.

D01012

N/A

NQSA

QA-111

F1055

QA-111

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01025

N/A

ECE-CC-8B

Statement of Criminal Record

F0021

Statement of Criminal Record (CIB) -See CIB Forms below

Existing

Retire

Child Care

N/A

Investigation

N/A

Inventory Review

D01098

N/A

ECE-CC-10C

Fee Collection Instructions Form

N/A

Existing

Retire

Child Care

N/A

WAI_6181

N/A

D01130

N/A

NQSI

QA-345

F1056

QA-345

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01133

N/A

NQUC

QA-363

F1057

QA-363

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01134

N/A

ECE-CC-10A

Request for Payment form

N/A

The solution must be able to generate the Request for Payment form.

Existing

Retire

Child Care

N/A

Case Management

N/A

Inventory Review - Retire

Duplicate - of F1097

Keeping RFP item

D01139

N/A

F1091

The solution must have the capability to notify providers of registration renewal based on applied timeframes and business rules

Existing

Retire

Child Care

N/A

Case Management

N/A

WAI_6210

N/A

Per WAI we are to retire.

D01140

N/A

Child health assessment form

N/A

F1092

The solution must be able to generate the Child's Medical Record form (also known as the child health assessment form).

Existing

Retire

Child Care

N/A

Application Intake

N/A

WAI_6150

N/A

D01141

N/A

ECE-CC-1B

New Employment Verification Form

F1093

The solution must be able to generate the New Employment Verification Form.

Existing

Retire

Child Care

N/A

Application Intake

N/A

WAI_6160

N/A

Session Notes: This is a shelf document that is handed to the clients at the office if they are starting a new job. This is also on the R&R website. This is not needed for PATH and can be Retired.

D01142

N/A

Job Search Request Form

N/A

F1094

The solution must be able to generate the Job Search Request form.

Existing

Retire

Child Care

N/A

Case Management

N/A

WAI_6211

N/A

WAI to Retire from Inventory

D01143

N/A

F1095

The solution must be able to produce a billing and receipt form.

Existing

Retire

Child Care

Child Care Provider

N/A

Application Intake

N/A

WAI_6161

N/A

D01144

N/A

F1096

The solution must be able to produce the Fee Collection Instructions form.

Existing

Retire

Child Care

N/A

Application Intake

N/A

WAI_6162

N/A

Session Notes: This is a shelf document and is not need in PATH and can be retired from document inventory.

D01146

N/A

ECE-CC-10A

Request for Payment Form

F1097

N/A

Existing

Retire

Child Care

N/A

WAI_6184

N/A

D01147

N/A

ECE-CC-10A-1

Request for Payment of In-Home Child care services

N/A

Existing

Retire

Child Care

N/A

WAI_6185

N/A

Session Notes: Denise Richmond advised the form will continue as a shelf document. The form is not needed for WV PATH.

D01156

N/A

F1099

The solution must generate the Direct Deposit information materials.

Existing

Retire

Child Care

N/A

Application Intake

N/A

WAI_6163

N/A

Session Notes: Off the shelf – Not needed in PATH – the link to the site has been added to the Provider Home page footer

D01158

N/A

F1101

The solution must have the ability to alert the user when a monitoring visit is due based on WV Business rules.

Existing

Retire

Child Care

N/A

Unidentified

N/A

Inventory Review - Retain as is

Review with State; Need business rules

D01160

N/A

ECE-EE-10D

Billing and Receipt Form

N/A

Existing

Retire

Child Care

N/A

WAI_6202

N/A

Session Notes: WV DHHR advised the form is given to providers at orientation. The form is not needed in WV PATH.

D01165

N/A

ECE-CC-10B

Payment Form Instructions

N/A

Existing

Retire

Child Care

N/A

WAI_6186

N/A

Session Notes: Denise Richmond advised the document is frequently updated and is given to providers at orientation for training on billing. The form is not needed in WV PATH.

D01174

N/A

No ID

Collaborative Quarterly Report Form

F0046

Collaborative Quarterly Report Form

Existing

Retire

Child Care, Child Welfare

N/A

Provider

N/A

Child Welfare - Retire

Child Care - Inventory Review - CPS related - not needed for licensing

Retire for Child Care. Cross check to what CW needed

D01184

N/A

Child Care Center Emergency/Disaster Planning Form

Emergency Plan Child Care Center and Family Child Care Facility

N/A

Existing

Retire

Child Care

N/A

Application Intake

N/A

Inventory Review - Retain as is

Child Care Center Emergency/Disaster Planning Form (ECE-CC-32) was listed twice on the inventory under D01185 and D01782. Development was completed under D01782. Optum will RETIRE D01185 and RETAIN D01782.

D01185

N/A

ECE-CC-10E

Emergency Information Form

N/A

Existing

Retire

Child Care

N/A

WAI_6182

N/A

Session Notes: WV DHHR advised the form is provided to parents by local offices when applying for CC assistance, or providers may use the form for private pay. The form is not needed in WV PATH.

D01255

N/A

ECE-CC-10-G

Child Care Attendance Sheets

N/A

Existing

Retire

Child Care

N/A

WAI_6183

N/A

Session Notes: WV DHHR advised the form requires a wet signature and must remain a shelf document. The form is not needed in WV PATH.

D01258

N/A

QC-140-A

Post office contact – Address information request.

N/A

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

D01286

N/A

GEN-0200

Workload List Report

N/A

Existing

Retire

Child Care, Child Welfare

N/A

Administration

N/A

WAI_6148

WAI_6149

N/A

WAI_6148 - Retire from Child Care Documents

WAI_5751 - Child Welfare Related

D01296

N/A

NQEV

QA-311

F0901

QA-311

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01298

N/A

ECE-CC-27

Direct deposit informatiom

N/A

Existing

Retire

Child Care

N/A

WAI_6195

N/A

Session Notes: Sally Skuza reviewed the sample that is on the BCF site and stated it was reviewed on 04/06/2020 and was determined it was not needed in WV PATH. DHHR agreed it is not needed in PATH

D01302

N/A

GEN-0185

Client Information Report

N/A

Existing

Retire

Child Care, Child Welfare

N/A

Case management

N/A

WAI_6205

N/A

Session Notes: WV DHHR advised the form is not needed for CC.

D01315

N/A

ECE-CC-3)

Child's Medical Record

client

N/A

Existing

Retire

Child Care

N/A

WAI_6196

N/A

D01325

N/A

NQWT

QA-160

F1058

QA-160

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01333

N/A

GEN-0183

Referral Acceptance Snapshot Report

N/A

Existing

Retire

Child Care, Child Welfare

N/A

Intake

N/A

WAI_6204

N/A

D01346

N/A

GEN-0199

Tickler List Report

N/A

Existing

Retire

Child Care, Child Welfare

N/A

Administration

N/A

WAI_6146

N/A

D01347

N/A

PRL-0542

Provider Information Report

N/A

Existing

Retire

Child Care, Child Welfare

Child Care Provider

N/A

Provider

N/A

Child Welfare - Pending with State

Child Care - Inventory Review - Review Not used for Child Care (Michelle)

Not Subisdy (Kevin)

D01354

N/A

TRN-0201

Individual Training Record Report

N/A

Existing

Retire

Child Care, Child Welfare

N/A

Administration

N/A

WAI_6144

N/A

Session Notes: Not used for Child Care (Michelle), Not Subisdy (Kevin) - Optum to Retire for Child Care

D01390

N/A

ECE-CC-6A

Child Care Provider Services

Requirements Checklist

N/A

Existing

Retire

Child Care

N/A

WAI_5049

WAI_6198

N/A

Inventory Review; Not Subsidy (Kevin); No other comments

Per Session (DS-71) this is the inspection checklist which are covered under CC-0800, CC-0801, CC-0802, CC-0803 andCC-0804. This line item is being RETIRED.

D01413

N/A

ECE-CC-6E

certify that the home and the inhome

provider meet the health and safety requirements

N/A

Existing

Retire

Child Care

N/A

WAI_6199

N/A

Session Notes: WV DHHR advised that the form is only used for a small number of providers and is only used when a client is approved for services but the services need to be in the client’s own home. The form will remain a shelf document. The form is not needed for WV PATH.

D01420

N/A

TRN-0576

Training Enrollment List Report

N/A

Existing

Retire

Child Care, Child Welfare

N/A

Administration

N/A

WAI_6145

N/A

Session Notes: Not used for Child Care (Michelle),

Not Subisdy (Kevin) - Optum to Retire for Child Care

D01431

N/A

W-9

DEPARTMENT OF HEALTH AND HUMAN RESOURCES

Provider Tax Identification Reporting Form

WV DHHR W9

F0016

WV DHHR W9

Existing

Retire

Child Care, Child Welfare

Child Care Provider

N/A

Provider

N/A

PDF

N/A

WAI_6209

N/A

WAI_6209 - Optum to Retire DHHR Provider Tax Identification Reporting Form (W-9) from Document Inventory

D01442

N/A

F0130

The solution must be able to generate the Cancellation of Provider Services Agreement Notice.

Existing

Retire

Child Care

N/A

Licensing

N/A

WAI_6170

N/A

D01701

N/A

DAY-0614

Application for Child Care Services

F0188

Application for Child Care Services

Existing

Retire

Child Care

N/A

Application Intake

N/A

WAI_6155

WAI_6188

N/A

D01711

N/A

NNF3

QC FREE FMT LETTER

F1030

QC FREE FMT LETTER

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01727

N/A

NQAP

QA-100

F1033

QA-100

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01730

N/A

NQAU

QA-101

F1034

QA-101

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01733

N/A

NQBA

QA-211

F1035

QA-211

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01735

N/A

NQBD

QA-110

F1036

QA-110

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01737

N/A

NQBS

QA-110-A

F1037

QA-110-A

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01738

N/A

NQCC

QA-150

F1038

QA-150

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01739

N/A

NQCV

QA-183-342

F1039

QA-183-342

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01742

N/A

NQDS

QA-181

F1040

QA-181

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01743

N/A

NQHV

QA-346

F1041

QA-346

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01744

N/A

NQIH

QA-102

F1042

QA-102

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01745

N/A

NQIL

QA-103

F1043

QA-103

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01746

N/A

NQLC

QA-140

F1044

QA-140

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01747

N/A

NQLI

QA-223

F1045

QA-223

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01748

N/A

NQMC

QA-120

F1046

QA-120

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01749

N/A

NQMS

QA-120-A

F1047

QA-120-A

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01750

N/A

NQNC

QA-106

F1048

QA-106

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01751

N/A

NQNH

QA-110-C

F1049

QA-110-C

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01752

N/A

NQPC

QA-365

F1050

QA-365

Existing

Retire

Quality Assurance

N/A

WAI_5004

N/A

As per DS-157 session notes State will send the documents to WAI_5004 that we ARE to produce. All others will be RETIRED.

Session Notes:

D01753

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Jun 25, 2026.