DOC004_D044_D045_Correspondence_Inventory_FA.xlsx

XLSX spreadsheet 120 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 is a correspondence inventory document for the West Virginia Department of Health and Human Resources (DHHR), specifically cataloging forms, notices, and letters used across multiple benefit programs including SNAP, Medicaid, WV WORKS (TANF), LIEAP, School Clothing Allowance, and other income support services. The document tracks over 400 correspondence items with detailed metadata including document titles, legacy identifiers, RFP specifications, program associations, intended audiences, and current status designations (Retain, Retire, Add, Drop, or Merge). The inventory was updated between August and October 2023 by multiple DHHR personnel including Ashley Puffenbarger, Marsha Stowers, Kimberly Vance, April Saunders, Stefanie Cyrus, and Mark Kennedy, with the final action recorded on October 17, 2023.

The document reflects significant programmatic changes requiring correspondence updates, including the retirement of documents related to discontinued programs such as P-EBT and TRIP, modifications to expungement rules for SNAP benefits (changing from variable aging clocks to a standard 274-day expungement period), and implementation of ABAWD (Able Bodied Adults without Dependents) requirements across all West Virginia counties. The inventory includes columns defining document characteristics such as static versus editable formats, data sensitivity indicators (FTI, PHI, and PII), trigger mechanisms (user action, workflow, or batch processes), file types (primarily PDF), and specification cross-references. Notable action items include updating nondiscrimination statements across multiple documents, correcting form numbers and descriptions, and identifying documents requiring retention due to eligibility and policy compliance requirements.

View the file

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DOC002_CS D043 Reports Inventory for Design Validation (2).xlsx	XLSX spreadsheet	Jun 24, 2026
DOC003_DEL046-Interface Inventory CW (2).xlsx	XLSX spreadsheet	Jun 24, 2026
DOC004_D044_D045_Correspondence_Inventory_CS.xlsx	XLSX spreadsheet	Jun 24, 2026
FederalFundsContractClauseAddendum (5).pdf	PDF	Jun 24, 2026
DOC004_D044_D045_Correspondence_Inventory_Child Welfare.xlsx	XLSX spreadsheet	Jun 24, 2026
PLEASE READ-INSTRUCTIONS TO VENDORS.pdf	PDF	Jun 24, 2026
PATH M&O RFP Appendix (3).pdf	PDF	Jun 24, 2026
DOC005_Admin_Portal_FDS.docx	DOCX document	Jun 24, 2026
CRFP HHR2600000001_Solicitation Documents.pdf	PDF	Jun 24, 2026
DOC001_WV 2022 MITA_SS-A AU Report_Final (2).pdf	PDF	Jun 24, 2026
DOC002_FA D043 Reports Inventory (3).xlsx	XLSX spreadsheet	Jun 24, 2026
Final_CRFP_0511_HHR2600000001_1_WV_CRFP_FORM.PDF	PDF	Jun 24, 2026
DOC003_IE D046 - Interface Inventory (1).xlsx	XLSX spreadsheet	Jun 24, 2026
DOC004_D044_D045_Correspondence_Inventory_CC.xlsx	XLSX spreadsheet	Jun 24, 2026
DOC002_CW D043 Reports Inventory.xlsb	XLSB spreadsheet	Jun 24, 2026
DOC003_DEL-046_Interface_Inventory_CS (1).xlsx	XLSX spreadsheet	Jun 24, 2026
Addendum 1.pdf	PDF	Jun 24, 2026
DOC002_CC D043 Reports Inventory (4).xlsx	XLSX spreadsheet	Jun 24, 2026

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Content Change Log

Content Update History
Date	Updated by	Tab Updated	Item/Row Impacted	Description of update	Reason for Update	Notes
8/21/23	Ashley Puffenbarger	Documents	31	Retire not needed	CMOB retired in 9/2021, repaced with CWN-1
8/21/23	Ashley Puffenbarger	Documents	57	Change name to SNAP closures	Food Stamps was renamed SNAP in 2008
8/21/23	Ashley Puffenbarger	Documents	68	Retire not needed	All WV counties are now ABAWD ILC
8/21/23	Ashley Puffenbarger	Documents	113	SNAP Change Reporting Form	DO NOT RETIRE
8/21/23	Ashley Puffenbarger	Documents	185	Retire not needed	NMOB retired 9/2021, replaced with NWN-1
8/21/23	Ashley Puffenbarger	Documents	211	Legacy doc description incorrect. This is the ET notification form from the case manager to DHHR	Incorrect
21-Aug	Ashley Puffenbarger	Documents	214	Retire not needed	All WV counties are now ABAWD ILC
8/21/23	Ashley Puffenbarger	Documents	272	Retire not needed	When a new SNAP policy option is taken FA Policy will create a new mailing
8/21/23	Ashley Puffenbarger	Documents	342	Retire not needed	Expungement rules have changed, there is not an option to set the aging clock back.
8/21/23	Ashley Puffenbarger	Documents	352	Retire not needed	All WV counties are now ABAWD ILC
8/21/23	Ashley Puffenbarger	Documents	380	Retire not needed	All WV counties are now ABAWD ILC
8/21/23	Ashley Puffenbarger	Documents	434	Retire not needed	Expungement rules have changed, SNAP now expunges after 274 days after issuance.
8/21/23	Ashley Puffenbarger	Documents	435	Retire not needed	Expungement rules have changed, SNAP now expunges after 274 days after issuance.
8/21/23	Ashley Puffenbarger	Documents	451	Change document description to, "The SNAP comprehensive work requirement document. Explains who must comply with each work requirement."	Incorrect
8/21/23	Ashley Puffenbarger	Documents	453	Change document description to, "The notice sent households when SNAP has been expunged 274 days after issuance."	Incorrect
8/21/23	Ashley Puffenbarger	Documents	454	Change document description to, "the notice sent to households informing them SNAP will expunge in 45 days."	Incorrect
8/21/23	Ashley Puffenbarger	Documents	457	Add document description, "notification of SNAP expungement when all household members are deceased."	No current description
8/21/23	Ashley Puffenbarger	Documents	463	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	464	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	465	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	467	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	468	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	469	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	470	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	471	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	473	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	474	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	475	Retire not needed	WV will no longer operate a P-EBT program
8/21/23	Ashley Puffenbarger	Documents	477	Retire not needed	WV will no longer issue SNAP EA Supplements eff 2/2023
8/21/23	Ashley Puffenbarger	Documents	479	Retire not needed	One-time mass mailing sent by DHHR on behalf of Workforce WV
8/21/23	Ashley Puffenbarger	Documents	485	Change description to, "worker generated version of the CWN-1"	Accuracy
8/22/23	Marsha Stowers	Documents	31	Retire	Replaced with CWN-1
8/22/23	Marsha Stowers	Documents	68	Retire	one-time only mass mailing
8/22/23	Marsha Stowers	Documents	113	Retain	SNAP Change report needs kept
8/22/23	Marsha Stowers	Documents	185	Retire	replaced with NWN-1
8/22/23	Marsha Stowers	Documents	214	Retire	All counties now AWAWD
8/22/23	Marsha Stowers	Documents	272	Retire	Policy will create when needed
8/22/23	Marsha Stowers	Documents	342	Retire	Expungement rules changed
8/22/23	Marsha Stowers	Documents	434	Retire	Expungement changed to 274	Note from Alvis Minor: the newer version of this does not appear to be on the list.
8/22/23	Marsha Stowers	Documents	435	Retire	Expungement changed to 274	Note from Alvis Minor: the newer version of this does not appear to be on the list.
8/22/23	Marsha Stowers	Documents	463-475	Retire	PEBT has ended
8/22/23	Marsha Stowers	Documents	476 and 477	Retire	EA Supplements ended
8/22/23	Marsha Stowers	Documents	479	Retire	One time only Work Force letter

8/23/23	Kimberly Vance	Documents	4	Retain
8/23/23	Kimberly Vance	Documents	10	Retain
8/23/23	Kimberly Vance	Documents	25	Retain
8/23/23	Kimberly Vance	Documents	26	Retain
8/23/23	Kimberly Vance	Documents	27	Retain
8/23/23	Kimberly Vance	Documents	29	Retain
8/23/23	Kimberly Vance	Documents	30	Retain
8/23/23	Kimberly Vance	Documents	31	Retire	Replaced with CWN-1
8/23/23	Kimberly Vance	Documents	36	Retain
8/23/23	Kimberly Vance	Documents	37	Retain
8/23/23	Kimberly Vance	Documents	38	Retain	Nondiscrimination statement needs updated to the current version.
8/23/23	Kimberly Vance	Documents	40	Retain	Nondiscrimination statement needs updated to the current version.
8/23/23	Kimberly Vance	Documents	44	Retain
8/23/23	Kimberly Vance	Documents	52	Retain
8/23/23	Kimberly Vance	Documents	54	Retain
8/23/23	Kimberly Vance	Documents	55	Retain
8/23/23	Kimberly Vance	Documents	57	Retain	Update to COLA SNAP Closures
8/23/23	Kimberly Vance	Documents	59	Retain
8/23/23	Kimberly Vance	Documents	60	Retain
8/23/23	Kimberly Vance	Documents	68	Retire	All counties now AWAWD
8/23/23	Kimberly Vance	Documents	69	Retain
8/23/23	Kimberly Vance	Documents	70	Retain
8/23/23	Kimberly Vance	Documents	76	Retain
8/23/23	Kimberly Vance	Documents	84	Retain
8/23/23	Kimberly Vance	Documents	88	Retain
8/23/23	Kimberly Vance	Documents	89	Retain
8/23/23	Kimberly Vance	Documents	93	Retain
8/23/23	Kimberly Vance	Documents	100	Retain	Until imported into PATH
8/23/23	Kimberly Vance	Documents	103	Retain
8/23/23	Kimberly Vance	Documents	104	Retain
8/23/23	Kimberly Vance	Documents	107	Retain
8/23/23	Kimberly Vance	Documents	113	Retain
8/23/23	Kimberly Vance	Documents	115	Retain
8/23/23	Kimberly Vance	Documents	117	Retain	Until imported into PATH
8/25/23	Tammy Hollandsworth	Document List	19	Changed to IG-IFM-BENPAY-1 (which needs to be retained as a form).	Revised in 3/2020. This is really a form instead of a letter. It is completed when a customer requests that benefits be removed from their EBT card & used to make a payment on the claim.
8/25/23	Tammy Hollandsworth	Document List	30	Should be a BV09 (auto-generated)	BV09 is auto-generated when a client is late on his/her payments.
8/25/23	Tammy Hollandsworth	Document List	All IFM Docs	See separate spreadsheet sent to Tiffany Mallary
8/25/23	Kimberly Vance	Documents	124	Retain
8/25/23	Kimberly Vance	Documents	130	Retain
8/25/23	Kimberly Vance	Documents	134	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	137	Retain
8/25/23	Kimberly Vance	Docuements	140	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	144	Retain
8/25/23	Kimberly Vance	Documents	150	Retain
8/25/23	Kimberly Vance	Documents	151	Retain
8/25/23	Kimberly Vance	Documents	160	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	185	Retire	Replaced with NWN-1
8/25/23	Kimberly Vance	Documents	192	Retain
8/25/23	Kimberly Vance	Documents	197	Retain
8/25/23	Kimberly Vance	Documents	198	Retain
8/25/23	Kimberly Vance	Documents	200	Retain
8/25/23	Kimberly Vance	Documents	202	Retire
8/25/23	Kimberly Vance	Documents	203	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	204	Retain
8/25/23	Kimberly Vance	Documents	214	Retire	All couties are ABAWD
8/25/23	Kimberly Vance	Documents	221	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	223	Retain	Web link needs updated to correct one within the Nondiscrimination statement.
8/25/23	Kimberly Vance	Documents	225	Retain	Web link needs updated to correct one within the Nondiscrimination statement.
8/25/23	Kimberly Vance	Documents	242	Not in list for letter type
8/25/23	Kimberly Vance	Documents	251	Retain
8/25/23	Kimberly Vance	Documents	252	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	253	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	254	Retain
8/25/23	Kimberly Vance	Documents	270	Retain
8/25/23	Kimberly Vance	Documents	272	Retire	Policy creates when needed
8/25/23	Kimberly Vance	Documents	274	Retain
8/25/23	Kimberly Vance	Documents	276	Retain
8/25/23	Kimberly Vance	Documents	280	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	282	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	289	Retain
8/25/23	Kimberly Vance	Documents	291	Retain	Nondiscrimination statement needs updated to the current version.
8/25/23	Kimberly Vance	Documents	293	Retire	Hearings officer sends a letter
8/25/23	Kimberly Vance	Documents	294	Retire	Hearings officer sends a letter
8/25/23	Kimberly Vance	Documents	300	Retire	Hearings officer sends a letter
8/25/23	Kimberly Vance	Documents	301	Retain
8/25/23	Kimberly Vance	Documents	315	Retain
8/25/23	Kimberly Vance	Documents	323	Retain
8/25/23	Kimberly Vance	Documents	326	Retain
8/25/23	Kimberly Vance	Documents	327	Retain
8/25/23	Kimberly Vance	Documents	330	Retain
8/25/23	Kimberly Vance	Documents	338	Retain
8/25/23	Kimberly Vance	Documents	339	Retain
8/25/23	Kimberly Vance	Documents	342	Retire	Expungement rules have changed, there is not an option to set the aging clock back.
8/25/23	Kimberly Vance	Documents	345	Retain
8/25/23	Kimberly Vance	Documents	347	Retain
8/25/23	Kimberly Vance	Documents	349	Retire	Provided by the Secretary of State
8/25/23	Kimberly Vance	Documents	356	Retain
8/25/23	Kimberly Vance	Documents	357	Retain
8/25/23	Kimberly Vance	Documents	358	Retire
8/25/23	Kimberly Vance	Documents	367	Retain
8/25/23	Kimberly Vance	Documents	371	Retain
8/25/23	Kimberly Vance	Documents	372	Retain
8/25/23	Kimberly Vance	Documents	373	Retain
8/25/23	Kimberly Vance	Documents	374	Retain
8/25/23	Kimberly Vance	Documents	375	Retain
8/25/23	Kimberly Vance	Documents	376	Retain
8/25/23	Kimberly Vance	Documents	377	Retain
8/25/23	Kimberly Vance	Documents	378	Retain
8/25/23	Kimberly Vance	Documents	381	Retain
8/25/23	Kimberly Vance	Documents	383	Retain
8/25/23	Kimberly Vance	Documents	388	Retain
8/25/23	Kimberly Vance	Documents	399	Retain
8/25/23	Kimberly Vance	Documents	403	Retain
8/25/23	Kimberly Vance	Documents	405	Retain
8/25/23	Kimberly Vance	Documents	410	Retain
8/25/23	Kimberly Vance	Documents	426	Retain
8/25/23	Kimberly Vance	Documents	434	Retire	Expungement rules have changed, SNAP now expunges after 274 days after issuance.
8/25/23	Kimberly Vance	Documents	435	Retire	Expungement rules have changed, SNAP now expunges after 274 days after issuance.
8/25/23	Kimberly Vance	Documents	436	Retain
8/25/23	Kimberly Vance	Documents	437	Retire
8/25/23	Kimberly Vance	Documents	438	Retain	Currently used by the field
8/25/23	Kimberly Vance	Documents	442	Retire
8/25/23	Kimberly Vance	Documents	451	Change document description to, "The SNAP comprehensive work requirement document. Explains who must comply with each work requirement."	Incorrect
8/25/23	Kimberly Vance	Documents	453	Change document description to, "The notice sent households when SNAP has been expunged 274 days after issuance."	Incorrect
8/25/23	Kimberly Vance	Documents	454	Change document description to, "the notice sent to households informing them SNAP will expunge in 45 days."	Incorrect
8/25/23	Kimberly Vance	Documents	457	Add document description, "notification of SNAP expungement when all household members are deceased."	No current discription
8/25/23	Kimberly Vance	Documents	463-475	Retire	WV will no longer operate a P-EBT program
8/25/23	Kimberly Vance	Documents	476-477	Retire	Program ended
8/25/23	Kimberly Vance	Documents	482	Retain
8/25/23	Kimberly Vance	Documents	485	Change description to, "worker generated version of the CWN-1"	Accuracy
8/28/23	April Saunders	Documents	18	Retain	Receipt is required for returned negotiables
8/28/23	April Saunders	Documents	81	Retain	DFA-EA-1 Rev 09/2023
8/28/23	April Saunders	Documents	119	Retire	Retired Program
8/28/23	April Saunders	Documents	148	Retain	DFA-SSP-1; this is an eligibility requirement to be completed
8/28/23	April Saunders	Documents	162	Retain	Shelf document active
8/28/23	April Saunders	Documents	177	Retain	Active manual process
8/28/23	April Saunders	Documents	229	Retain	Notice of pending closure must be sent
8/28/23	April Saunders	Documents	240	Retain	Case staffing documentation must be kept
8/28/23	April Saunders	Documents	257	Retire	Retired program
8/28/23	April Saunders	Documents	268	Retain	Clients must be able to clain good cause for non-cooperation
8/28/23	April Saunders	Documents	273	Retain	Used by SNAP & WV WORKSclients for reporting self-employment
8/28/23	April Saunders	Documents	285	OK to retire if correct andavailable in the system
8/28/23	April Saunders	Documents	287	retain	Active form
8/28/23	April Saunders	Documents	345	retain	Protects app date
8/28/23	April Saunders	Documents	349	ok to retire if available in the system	must offer voter registration services
8/28/23	April Saunders	Documents	354	retain	Assessment shoul be able to be completed also online
8/28/23	April Saunders	Documents	384	retain	DFA-WVW-Verif-2 is correct form #
8/28/23	April Saunders	Documents	385	retain	protects app date
8/28/23	April Saunders	Documents	437	OK to retire if correct and available in the system
8/28/23	April Saunders	Documents	439	As long as BA-67 contains EA, OK to retire
8/28/23	April Saunders	Documents	444	Retain	referral form to outside agency
8/28/23	April Saunders	Documents	446	retain	client must be notified of elig determination for SCA
8/28/23	April Saunders	Documents	450	retain	client must be notified of elig determination for all programs
9/18/23	Stefanie Cyrus	Documents	17	Retain	still needed
9/18/23	Stefanie Cyrus	Documents	268	retain	still needed
9/18/23	Stefanie Cyrus	Documents	397	Retain	still needed
9/19/23	Mark Kennedy	Document Lis	385	Retain	incorrect description/needs retained
9/19/23	Mark Kennedy	Document Lis	268	Retain	Still needed
9/19/23	Mark Kennedy	Document Lis	444	Retain	Still needed
10/17/23	Mallary Tiffany	Document List	434	Retire	This noticed was replaced by BII8

Documents -Columns Definition

Column Name	Column Definition
Unique Correspondence ID	Unique ID for each item in the D044 Correspondence Inventory
Correspondence Title	Title of correspondence
Correspondence 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
Planned Status	The proposed status of the item in the new solution (i.e. Retain, Add, Drop, Merge)
Related Program	Program using the item (i.e. SNAP, TANF, Child Welfare, etc.)
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
Language	Required languages for the item (English, Spanish, bi-lingual, other)
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
Static or Editable	Is the document static; if not, what parts are editable?
Planned File Type	PDF, JPG, etc.
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.
Sample	Optum has obtained a sample or template? If so, include link or identifier
Sample Notes	Notes regarding the sample status

Header/Footer Info For example, is the header/footer standard or does it change by county or program?

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

N/A

CMLW

AM WATER REDUCE RATE MM

F0124

AM WATER REDUCE RATE MM

Existing

Retire

20% Utility Discount

N/A

D00012

NMR3

RT-5A-GEN PHYS-CHILD

Physical information sheet to be completed by the physician.

NMR3

RT-5A-GEN PHYS-CHILD

F0120

RT-5A-GEN PHYS-CHILD

Existing

Retain

Medicaid

Client, Physician

Case Management

N/A

Worker Generated

On Demand

Yes

Editable

PDF

PG0047

N/A

D00017

NMR4

RELEASE OF CONFIDENTIAL APPLICANT AND RECIPIENT INFORMATION

Client release for Confidential information to be released by DHHR and submitted to the designated person / company as they define on the authorization sheet.

NMR4

RELEASE OF CONFIDENTIAL APPLICANT AND RECIPIENT INFORMATION

F0119

OFS-Release-1

Existing

Retain

ALL IE Programs

Client

Case Management

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

N/A

D00057

PRLA

CHIP/CME PASSIVE RENEWAL

Client renewal notice for CHIP/CME

PRLA

CHIP/CME PASSIVE RENEWAL

F0127

CHIP/CME PASSIVE RENEWAL

Existing

Retain

Medicaid

N/A

Eligibility Determination

N/A

System Generated

As Defined

N/A

D00058

PRL5

QMB/SLMB/QIA/MPW MAIL-IN

PRL5

QMB/SLMB/QIA/MPW MAIL-IN

F0128

QMB/SLMB/QIA/MPW MAIL-IN

Existing

Retain

Medicaid

N/A

Eligibility Determination

N/A

System Generated

As Defined

N/A

D00261

CNAE

MEDICAID AUTO ENROLLMENT

Medicaid Auto Enrollment notification

CNAE

MEDICAID AUTO ENROLLMENT

F0126

MEDICAID AUTO ENROLLMENT

Existing

Retain

Medicaid

N/A

Eligibility Determination

N/A

System Generated

As Defined

N/A

D00262

CNAF

MA AUTO ENROLL FOLLOW UP

Medicaid Auto Enrollment notification follow up

CNAF

MA AUTO ENROLL FOLLOW UP

F0125

MA AUTO ENROLL FOLLOW UP

Existing

Retain

Medicaid

N/A

Case Management

N/A

System Generated

As Defined

N/A

D00263

NNFR

Frail and Fragile Letter

NNFR

Frail and Fragile Letter

F0117

Frail and Fragile Letter

Existing

Retain

Medicaid

N/A

Eligibility Determination

N/A

Worker Generated

On Demand

N/A

D00265

CSLC

ELIG REV/HOME APT

Client Notification of Home Appointment for a Periodic Review

CSLC

ELIG REV/HOME APT

F0118

ELIG REV/HOME APT

Existing

Retain

SNAP, Medicaid

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0339,EE0048

N/A

D00267

EDD1

DNY INT PR MTH W,S,M

Denial of initial pro-rated month of benefits component that displays on EDAD Eligibility Notice.

EDD1

DNY INT PR MTH W,S,M

F0122

DNY INT PR MTH W,S,M

Existing

Retain

WV WORKS (TANF)

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D00272

N/A

WV RJA Non Disclosure

When an indivdual has been released from the authority removes the photo from the online wehsite but maintains a photo, form allows the BCSE worker obtain the jail photo to assist in service of process.

F0762

WVRJA-NON-DISCL

Existing

Retire

Child Support

N/A

D00278

N/A

F0768

The solution must have the ability to allow the user to print a Special Medical Card according to West Virginia business rules.

Existing

Retire

Medicaid

N/A

Case Management

N/A

D00280

N/A

F0769

The solution must provide the ability to generate a notification that an individual is no longer eligible for Special Pharmacy because they have become eligible for a full coverage Medicaid eligibility group to the MMIS.

Existing

Retire

Medicaid

N/A

Eligibility Determination

N/A

D00281

N/A

F0770

The solution must generate a denial notice for SCA applicants who have been denied SCA benefits.

Existing

Retire

WV School Clothing Allowance (SCA)

N/A

Eligibility Determination

N/A

D00282

N/A

DFA-SCA-3

SCA Payee Change Form

When the payee changes after issuance,

but before the voucher is redeemed, and the new responsible adult is not the payee on the voucher, the Worker must use the SCA Payee Change Form, DFA-SCA-3, to identify the new payee.

NOTE: This form may also be used when the primary person is unable to use the SCA voucher to purchase clothing for the upcoming school year for the child(ren) due to other circumstances such as no photo ID, medically unable to shop for the child(ren), or death of the primary person.

F0772, F1151

The solution must be able to generate the SCA Payee Change Form.

Existing

Retire

WV School Clothing Allowance (SCA)

Vendor

N/A

Case Management

N/A

Editable

PDF

N/A

D00284

N/A

F0773

The solution must be able to generate a notice explaining why an applicant is not eligible for the Special Reduced Residential Service Rate (20% Utility Discount Program).

Existing

Retain

20% Utility Discount

N/A

Eligibility Determination

N/A

D00285

N/A

DF-5

Customer Receipt

F0776

The system must have the ability to generate a Customer Receipt (DF-5) with the appropriate information of the customer and the amount(s) of the Negotiable(s) being turned in.

Existing

Retain

ALL IE Programs

Client

Case Management

N/A

Editable

PDF

GT0142

N/A

D00288

N/A

IFM-EBT-1

IG-IFM-BENPAY-1

IFM-EBT-1

IG-IFM-BENPAY-1

Should be IG-IFM-BENPAY-1 now

F0778

The system must be able to generate an EBT-IFM-1 Form for a customer to complete for any returned Electronic Benefits Transfer (EBT) Cards.

Existing

Retire

WV WORKS (TANF)

Client

Benefit Issuance

N/A

Yes

Editable

PDF

GT0142

N/A

D00293

N/A

F0779

The solution must have the ability to generate a request for additional information, according to West Virginia business rules.

Existing

Retire

ALL IE Programs

N/A

Case Management

N/A

D00294

N/A

F0780

The solution must allow for automatic generation of all Periodic Review Letters based on West Virginia business rules

Existing

Retire

Medicaid

N/A

Case Management

N/A

D00295

ED95

1095-B Medicaid and/or CHIP

End of Year tax statement to the client who received Medicaid or CHIP benefits.

ED95

None

F0781

The solution must be able to generate the 1095B Form.

Existing

Retain

Medicaid

Client

Case Management

N/A

System Generated

As Defined

Yes

Static

PDF

N/A

D00296

N/A

F0783

The solution must have the capability to distribute an education letter for excess Electronic Benefit Transfer (EBT) card replacements based on West Virginia business rules.

Existing

Retire

WV WORKS (TANF)

N/A

Benefit Issuance

N/A

D00298

CSL2

IM INIT INTRV/HOME

Client letter informing them of the Initial Interview in office appointment letter.

CSL2

IM INIT INTRV/HOME

Initial Interview in office appointment letter

F0114

IM INIT INTRV/HOME

Existing

Retain

WV WORKS (TANF)

Client

Policy Department

Policy and Communication Department

Application Intake

N/A

System Generated

As Defined

Yes

Static

PDF

EE0398

N/A

D00299

EDI3

NO CHG - WVW/SNAP

No Change of the clients SNAP benefits component that displays on EDSM Eligibility Notice.

EDI3

NO CHG - WVW/SNAP

F0784

NO CHG - WVW/SNAP

Existing

Retain

SNAP, WV WORKS (TANF)

Client

Policy Department

Policy and Communication Department

Change of Circumstance

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D00300

EDI1

INCREASE WVW/SNAP

Increase of SNAP benefits component that displays on EDSM Eligibility Notice.

EDI1

INCREASE WVW/SNAP

F0785

INCREASE WVW/SNAP

Existing

Retain

SNAP, WV WORKS (TANF)

Client

Policy Department

Policy and Communication Department

Change of Circumstance

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D00301

BII1

SUPPLEMENTAL AF/FS

Notification to client of SNAP Supplemental amount that is issued.

BII1

SUPPLEMENTAL AF/FS

SNAP Supplemental amount that is issued

F0795

SUPPLEMENTAL AF/FS

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Benefit Issuance

N/A

System Generated

As Defined

Yes

Static

PDF

N/A

D00317

PRL9

PER RPT FORM-TMA-9 MOS

Letter to client to complete and return if they want to be considered for Transitional Medicaid.

PRL9

PER RPT FORM-TMA-9 MOS

F0116

PER RPT FORM-TMA-9 MOS

Existing

Retain

Medicaid

Client

Eligibility Determination

N/A

System Generated

As Defined

Static

PDF

CM0016

N/A

D00487

EDO1

D-SNAP DECISION NOTICE

Client notice of Disaster SNAP benefits decision (Approve/Deny).

EDO1

D-SNAP DECISION NOTICE

Notice of a decision (Approve/Deny) of Disaster SNAP benefits.

F0123

D-SNAP DECISION NOTICE

Existing

Retain

D-SNAP

Client

Policy Department

Policy and Communication Department

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D00488

BVL9

LATE PAY LETTER

BVL9

BV09

LATE PAY LETTER

Should be BV09 which is automatically system generated when a client is late.

F0786

LATE PAY LETTER

Existing

Retire

BV/IFM (SNAP, WV WORKS (TANF))

N/A

Benefit Recovery

N/A

System Generated

As Defined

N/A

D00497

CMOB

WORKFORCE WV REG NOTICE

Workforce Registration notice

CMOB

WORKFORCE WV REG NOTICE

Workforce Registration notice

F0787

WORKFORCE WV REG NOTICE

Existing

Retire

SNAP

Client

Policy Department

Policy and Communication Department

Case Management

N/A

System Generated

As Defined

Static

PDF

GT0143

N/A

D00498

NVAC

IFM-1-7A

NVAC

IFM-1-7A

F1060

IFM-1-7A

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D00958

NVAL

IFM-1-7J

NVAL

IFM-1-7J

F1061

IFM-1-7J

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D00960

NVAM

IFM-1-7I

NVAM

IFM-1-7I

F1062

IFM-1-7I

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D00962

NVAN

IFM-1-7D

NVAN

IFM-1-7D

F1063

IFM-1-7D

Existing

Retire

BV/IFM (SNAP, Medicaid, WV WORKS (TANF))

N/A

Benefit Recovery

N/A

Worker Generated

On Demand

N/A

D00963

EDAB

APPRV EA

Approval of Emergency Assistance benefits component that displays on EDSM Eligibility Notice.

EDAB

APPRV EA

F0798

APPRV EA

Existing

Retain

Emergency Assistance

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D00964

BVI1

DECREASE RECOUP AMT SNAP

Client notification for decrease in recoupment amount.

BVI1

DECREASE RECOUP AMT SNAP

Notice for decrease in recoupment amount

F0826

DECREASE RECOUP AMT SNAP

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Benefit Recovery

N/A

System Generated

As Defined

Yes

Static

PDF

GT0143

N/A

D00966

NNCP

SNAP-NO CHNG-CERT PER CHN

Certification period only change eligibility remains the same.

NNCP

SNAP-NO CHNG-CERT PER CHN

Notice for no change in certification period for SNAP benefits

F0827

SNAP-NO CHNG-CERT PER CHN

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Change of Circumstance

N/A

Worker Generated

On Demand

Yes

Editable

PDF

EE0295

N/A

D00967

CML7

18 SCHOOL STATUS

Letter is sent to the client requesting school enrollment information for Children that will be turning 18 years of age in order to remain eligible for benefits.

CML7

18 SCHOOL STATUS

F0843

18 SCHOOL STATUS

Existing

Retain

WV School Clothing Allowance (SCA), WV WORKS (TANF)

Client

Application Intake

N/A

System Generated

As Defined

Static

PDF

Gap - No Spec

N/A

D00968

NA5I

SNAP RESCHEDULE PHONE REV

SNAP RESCHEDULE PHONE REVIEW

NA5I

SNAP RESCHEDULE PHONE REV

SNAP RESCHEDULE PHONE REVIEW

F0844

SNAP RESCHEDULE PHONE REV

Existing

Retain

SNAP

N/A

Policy Department

Policy and Communication Department

Change of Circumstance

N/A

Worker Generated

On Demand

N/A

D00969

NWPC

TIME SHEET REQUEST

Letter sent to client requesting missing time sheet.

NWPC

TIME SHEET REQUEST

F0828

TIME SHEET REQUEST

Existing

Retain

WV WORKS (TANF)

Client

WORKS Program

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

N/A

D00970

BVO5

CASH ASSIST OVERPAY

Notification to the client(s) that they were overpaid for Cash Assistance/School Clothing Allowance benefits or Support Service Payments. It explains that according to Federal law, a claim has been established against the household member(s) that received the overpayment and the overpayment must be paid back.

BVO5

CASH ASSIST OVERPAY

F0829

CASH ASSIST OVERPAY

Existing

Retain

BV/IFM (WV WORKS (TANF))

Client

Benefit Recovery

N/A

System Generated

As Defined

Yes

Static

PDF

GT0143

N/A

D00971

NMLG

ADULT MEDICAID REVIEW FM

NMLG

ADULT MEDICAID REVIEW FM

F0830

ADULT MEDICAID REVIEW FM

Existing

Retain

Medicaid

N/A

Eligibility Determination

N/A

Worker Generated

On Demand

N/A

D00972

AEL2

VERIFICATION REQUEST

Request to the client to provided the requested documentation that is needed to establish / continue their eligibility.

AEL2

VERIFICATION REQUEST

F0052

VERIFICATION REQUEST

Existing

Retain

ALL IE Programs

Client

Application Intake

N/A

System Generated

As Defined

Yes

Editable

PDF

GT0142

N/A

D00973

N/A

EDAE

APPROVE INIT PRO MAGI

F0053

APPROVE INIT PRO MAGI

Existing

Retire

Medicaid

Client

Eligibility Determination

N/A

Yes

Static

PDF

EE0295

N/A

D00974

NVAU

IFM-1-7H

NVAU

IFM-1-7H

F1064

IFM-1-7H

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D00976

NVAV

IFM-7K

NVAV

IFM-7K

F1065

IFM-7K

Existing

Retire

BV/IFM (SNAP, WV WORKS (TANF))

Client

Benefit Recovery

N/A

Worker Generated

On Demand

Yes

Editable

PDF

GT0142

N/A

D00977

NVIF

IFM-5B

NVIF

IFM-5B

F1066

IFM-5B

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D00979

CNPR

REPORTING CHANGE

CNPR

REPORTING CHANGE

F0990

REPORTING CHANGE

Existing

Retain

Unidentified

N/A

Application Intake, Case Level Reports, Request for Assistance

N/A

System Generated

As Defined

N/A

D00980

CNLC

CSI Reduction $25

CNLC

CSI Reduction $25

F0991

CSI Reduction $25

Existing

Retain

WV WORKS (TANF)

N/A

Case Management

N/A

System Generated

As Defined

N/A

D00981

CNLD

LIEAP SUP PAY DENIAL

CNLD

LIEAP SUP PAY DENIAL

F0992

LIEAP SUP PAY DENIAL

Existing

Retain

LIEAP

N/A

Benefit Issuance

N/A

System Generated

As Defined

N/A

D00982

CNLA

SNAP PHONE REVIEW

SNAP Phone Review

CNLA

SNAP PHONE REVIEW

SNAP Phone Review

F0993

SNAP PHONE REVIEW

Existing

Retain

SNAP

N/A

Policy Department

Policy and Communication Department

Renewal/Review

N/A

System Generated

As Defined

N/A

D00983

CNLS

CSI TRANSITION LETTER

CNLS

CSI TRANSITION LETTER

F0994

CSI TRANSITION LETTER

Existing

Retain

WV WORKS (TANF)

N/A

Case Management

N/A

System Generated

As Defined

N/A

D00984

AEO2

ASSIGN PROTECT REFERRAL

Client notification of who will be responsible for managing and distributing their benefits.

AEO2

ASSIGN PROTECT REFERRAL

F0995

ASSIGN PROTECT REFERRAL

Existing

Retain

SNAP, Medicaid, WV WORKS (TANF)

Client

Application Intake, Case Level Reports, Request for Assistance

N/A

System Generated

As Defined

Static

PDF

GT0142

N/A

D00985

AELL

CHANGE OF ADDRESS

Sent to the client after a change of address to receive updated expenses.

AELL

CHANGE OF ADDRESS

F0996

CHANGE OF ADDRESS

Existing

Retain

SNAP

Client

Case Management

N/A

System Generated

As Defined

Static

PDF

GT0142

N/A

D00986

CNMA

MA BENEFICIARY

CNMA

MA BENEFICIARY

F0997

MA BENEFICIARY

Existing

Retain

Medicaid

N/A

Benefit Issuance

N/A

System Generated

As Defined

N/A

D00987

CNLM

COLA SNAP CLOSURES

CNLM

COLA FS CLOSURES

F0998

COLA FS CLOSURES

Existing

Retain

SNAP

N/A

Policy Department

Policy and Communication Department

Case Management

N/A

System Generated

As Defined

N/A

D00988

BVOG

TOP 60-DAY

BVOG

TOP 60-DAY

F0999

TOP 60-DAY

Existing

Retain

BV/IFM

N/A

Benefit Recovery

N/A

System Generated

As Defined

N/A

D00989

CML3

HEARING WITHDRAW

Confirmation notice sent to the Client when their withdraw their Fair Hearing request.

CML3

HEARING WITHDRAW

F1001

HEARING WITHDRAW

Existing

Retain

ALL IE Programs

Client

Case Management

N/A

System Generated

As Defined

Editable

PDF

GT0142

N/A

D00991

CNBI

EARLY ISSUANCE OF FS

CNBI

EARLY ISSUANCE OF FS

F1002

EARLY ISSUANCE OF FS

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Benefit Issuance

N/A

System Generated

As Defined

N/A

PDF

EE0295

N/A

D00992

CNLR

WVEAP EXTENSION

CNLR

WVEAP EXTENSION

F1003

WVEAP EXTENSION

Existing

Retain

WV WORKS (TANF)

N/A

Case Management

N/A

System Generated

As Defined

Static

PDF

EE0295

N/A

D00993

BVLE

RECOUP END/REPAY REQUIRED

BVLE

RECOUP END/REPAY REQUIRED

F1004

RECOUP END/REPAY REQUIRED

Existing

Retire

BV/IFM

N/A

Benefit Recovery

N/A

System Generated

As Defined

N/A

D00994

CNLT

TANF REDUCTION LETTER

Client notice of TANF Reduction amount

CNLT

TANF REDUCTION LETTER

F1005

TANF REDUCTION LETTER

Existing

Retain

WV WORKS (TANF)

Client

N/A

Case Management

N/A

System Generated

As Defined

Static

PDF

N/A

D00995

AELH

TERM OF VENDOR PAYMENT

AELH

TERM OF VENDOR PAYMENT

F1006

TERM OF VENDOR PAYMENT

Existing

Retain

LIEAP

N/A

Benefit Issuance

N/A

System Generated

As Defined

Static

PDF

GT0142

N/A

D00996

CNAL

APPTMENT LETTER-COUNTIES

CNAL

APPTMENT LETTER-COUNTIES

F1007

APPTMENT LETTER-COUNTIES

Existing

Retain

ALL IE Programs

N/A

Case Management

N/A

System Generated

As Defined

N/A

D00997

CNFS

FS NR TO AD MM 0306

CNFS

FS NR TO AD MM 0306

F1008

FS NR TO AD MM 0306

Existing

Retain

SNAP

N/A

System Generated

As Defined

N/A

D00998

CNF1

PERMANENT PENALTY MM

CNF1

PERMANENT PENALTY MM

F1009

PERMANENT PENALTY MM

Existing

Retain

Medicaid

N/A

System Generated

As Defined

N/A

D00999

CNLH

ABAWD MM FOR CO 35 & 50

ABAWD Mass Mailing for County 35 & 50

CNLH

ABAWD MM FOR CO 35 & 50

ABAWD Mass Mailing for County 35 and 50

F1010

ABAWD MM FOR CO 35 & 50

Existing

Retire

SNAP

N/A

Policy Department

Policy and Communication Department

Able Bodied Adults without Dependents (ABAWD)

N/A

System Generated

As Defined

N/A

D01000

CNLI

LETTER INSERT

General cover letter to be sent with mass mailings via Service Now.

CNLI

LETTER INSERT

F1011

LETTER INSERT

Existing

Retain

ALL IE Programs

Client

Case Management

N/A

System Generated

As Defined

Static

PDF

GT0126

N/A

D01001

NFAF

DISASTER SNAP AFFIDAVIT

NFAF

DISASTER SNAP AFFIDAVIT

DFA-ID-1

F1012

DISASTER SNAP AFFIDAVIT

Existing

Retain

D-SNAP

Client

Policy Department

Policy and Communication Department

Eligibility Determination

N/A

Worker Generated

On Demand

Yes

Editable

PDF

GT0142, GT0143

N/A

D01002

NFLS

16 & 17 SCHOOL STATUS

Request for status of children between the age of 16 to 17 years. Information is required to continue assistance.

NFLS

16 & 17 SCHOOL STATUS

F1013

16 & 17 SCHOOL STATUS

Existing

Retain

WV School Clothing Allowance (SCA)

Client

Application Intake

N/A

Worker Generated

On Demand

Editable

PDF

GT0142

N/A

D01003

NKCE

KATRINA CLOSURE

NKCE

KATRINA CLOSURE

F1014

KATRINA CLOSURE

Existing

Retain

Medicaid

N/A

Worker Generated

On Demand

N/A

D01004

NMCI

IDENTITY CLOSURE

Client notification that their benefits are ending.

NMCI

IDENTITY CLOSURE

F1015

IDENTITY CLOSURE

Existing

Retain

Medicaid

Client

Case Management

N/A

Worker generated

On Demand

Editable

PDF

EE0295

N/A

D01005

NMDD

ID/CITIZENSHIP DENIAL

Client notification that their benefits are ending.

NMDD

ID/CITIZENSHIP DENIAL

F1016

ID/CITIZENSHIP DENIAL

Existing

Retain

Medicaid

Client

Eligibility Determination

N/A

Worker generated

On Demand

Editable

PDF

EE0295

N/A

D01006

NMDI

IDENTITY DENIAL

NMDI

IDENTITY DENIAL

F1017

IDENTITY DENIAL

Existing

Retain

Medicaid

N/A

Eligibility Determination

N/A

Worker Generated

On Demand

N/A

D01007

EDA1

APPRV INIT PRO WVW/SNAP

Approval of initial pro-rated month of benefits component that displays on EDAD Eligibility Notice.

EDA1

APPRV INIT PRO WVW/SNAP

F0054

APPRV INIT PRO WVW/SNAP

Existing

Retain

SNAP, WV WORKS (TANF)

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01009

NVIL

IFM-5I

NVIL

IFM-5I

F1067

IFM-5I

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01010

NVMH

IFM-5A

NVMH

IFM-5A

F1068

IFM-5A

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01013

MREV

MEDICAID REVIEW

Notification to the client that they are due for Medicaid / WV CHIP review to continue coverage.

MREV

MEDICAID REVIEW

F0055

MEDICAID REVIEW

Existing

Retain

Medicaid

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

N/A

D01014

N/A

DF-67

Authorization for Payemnt

N/A

Existing

Retire

All IE Programs, Child Welfare

N/A

Finance

N/A

D01016

N/A

Emergency Assistance Application

N/A

Existing

Retain

Emergency Assistance

N/A

Application Intake

N/A

D01017

NVMS

MNTH REPAY SUMM

Monthly Repayment Summary

NVMS

MNTH REPAY SUMM

F1069

MNTH REPAY SUMM

Existing

Retire

Investagions and Fraud Management

N/A

Benefit Recovery

N/A

Worker Generated

On Demand

N/A

D01019

NVPA

IFM-5G

NVPA

IFM-5G

F1070

IFM-5G

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

Editable

PDF

N/A

D01020

CMC1

CLOSURE - LACK OF REV

Notification to the client that their benefits are being closed because they did not complete their review.

CMC1

CLOSURE - LACK OF REV

F0056

CLOSURE - LACK OF REV

Existing

Retain

SNAP, Medicaid, WV WORKS (TANF)

Client

QMB

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01021

NVSA

IFM-5J

NVSA

IFM-5J

F1071

IFM-5J

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01022

BVOE

RECOUP END/REPAY REQUIRED

Client notification that their benefits are ending and they have an outstanding claim balance.

BVOE

RECOUP END/REPAY REQUIRED

F0805

RECOUP END/REPAY REQUIRED

Existing

Retain

BV/IFM (WV WORKS (TANF))

Client

Benefit Recovery

N/A

System Generated

As Defined

Yes

Static

PDF

GT0143

N/A

D01024

NVSC

IFM-5H

NVSC

IFM-5H

F1072

IFM-5H

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01026

EDA4

APPRV INIT MTH WVW/SNAP

Initial Month approval component that displays on EDAD Eligibility Notice.

EDA4

APPRV INIT MTH WVW/SNAP

F0057

APPRV INIT MTH WVW/SNAP

Existing

Retain

SNAP, WV WORKS (TANF)

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01028

EDR1

DECREASE WVW/SNAP

Decrease of SNAP benefits component that displays on EDSM Eligibility Notice.

EDR1

DECREASE WVW/SNAP

F0058

DECREASE WVW/SNAP

Existing

Retain

SNAP, WV WORKS (TANF)

Client

Policy Department

Policy and Communication Department

Change of Circumstance

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01070

NWD4

M-WIN REDET COMP NO CHNG

Client notification that M-WIN has been redetermined and there is no change.

NWD4

M-WIN REDET COMP NO CHNG

F0845

M-WIN REDET COMP NO CHNG

Existing

Retain

Medicaid

Client

Eligibility Determination

N/A

Worker Generated

On Demand

Yes

Static

PDF

EE0295

N/A

D01071

CNLN

LIEAP PRE-AUTHORIZATION

Pre-Authorization for LIEAP

CNLN

LIEAP PRE-AUTHORIZATION

F0059

LIEAP PRE-AUTHORIZATION

Existing

Retain

LIEAP

N/A

Eligibility Determination

N/A

System Generated

As Defined

N/A

D01072

NVVF

IFM-5E1

NVVF

IFM-5E1

F1073

IFM-5E1

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01073

CSLE

SNAP REVIEW FORM

Notification to the client that is receiving SNAP benefits their case is due for a review. They need to complete the form and return to DHHR.

CSLE

SNAP REVIEW FORM

SNAP review notice with appointment for SNAP telephone interview.

F0060

SNAP REVIEW FORM

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Renewal/Review

N/A

System Generated

As Defined

Yes

Static

PDF

N/A

D01074

NWD5

M-WIN CLOSURE NO PREMIUM

Client notification that M-WIN is being closed and there is no premium due.

NWD5

M-WIN CLOSURE NO PREMIUM

F0846

M-WIN CLOSURE NO PREMIUM

Existing

Retain

Medicaid

Client

Eligibility Determination

N/A

Worker generated

On Demand

Yes

Static

PDF

EE0295

N/A

D01075

NVVS

IFM-5E2

NVVS

IFM-5E2

F1074

IFM-5E2

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01076

N/A

F0103

inROADS Healthcare Application

Existing

Retire

Medicaid

N/A

Application Intake

N/A

D01077

NMRI

MED INFO REQUEST DFA-RT-6

Document is sent to the client's Physician requesting specified medical information.

NMRI

MED INFO REQUEST DFA-RT-6

F0104

MED INFO REQUEST DFA-RT-6

Existing

Retain

Medicaid

Client

Application Intake

N/A

Worker generated

On Demand

Yes

Editable

PDF

GT0142

N/A

D01078

NVWB

IFM-5K

NVWB

IFM-5K

F1075

IFM-5K

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01079

AEO8

CHANGE MEDICAID AG NOTICE

Medicaid change in benefit component that displays on EDSM Eligibility Notice.

AEO8

CHANGE MEDICAID AG NOTICE

F0061

CHANGE MEDICAID AG NOTICE

Existing

Retain

Medicaid

Client

Case Management

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01080

PRC2

PER RPT FORM- DFA-SNAP-12

Supplemental Nutrition Assistance Program (SNAP) - 6 or 12 month contact form

PRC2

PER RPT FORM- DFA-SNAP-12

Supplemental Nutrition Assistance Program (SNAP) - 6 or 12 month contact form

F0062

PER RPT FORM- DFA-SNAP-12

Existing

Retain

SNAP

N/A

Policy Department

Policy and Communication Department

Renewal/Review

N/A

System Generated

As Defined

N/A

D01081

CMLA

20% APPLIC

Letter and application to client stating they can apply to receive a discount on their utilities.

CMLA

20% APPLIC

F0063

20% APPLIC

Existing

Retain

20% Utility Discount

N/A

Case Management

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01082

EDA9

APPRV INIT MTH MA

Initial Month approval for Medicaid component that displays on EDAD Eligibility Notice.

EDA9

APPRV INIT MTH MA

F0064

APPRV INIT MTH MA

Existing

Retain

Medicaid

Client

Eligibility Determination

N/A

System Generated

As Defined

Yes

Static

PDF

EE0295

N/A

D01083

CSLN

NOTICE OF MISSED APPT

Client notification sent when client misses an appointment.

CSLN

NOTICE OF MISSED APPT

Notice when client misses an appointment

F0065

NOTICE OF MISSED APPT

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Application Intake

N/A

System Generated

As Defined

Static

PDF

GT0262

N/A

D01084

CSLP

SNAP/MA APPLIC APPT LTR

Client notification of Phone Interview for submitted application.

CSLP

SNAP/MA APPLIC APPT LTR

F0066

SNAP/MA APPLIC APPT LTR

Existing

Retain

SNAP, WV WORKS (TANF)

Client

Application Intake

N/A

System Generated

As Defined

Static

PDF

EE0164,EE0390,GT0271

N/A

D01085

NVWC

IFM-5F

NVWC

IFM-5F

F1076

IFM-5F

Existing

Retire

Investagions and Fraud Management

N/A

Application Intake

N/A

Worker Generated

On Demand

N/A

D01086

NWPA

SNAPE&T EMPLOY STATUS

SNAP E&T employment Status

NWPA

SNAPE&T EMPLOY STATUS

SNAP E&T employment Status

F1077

SNAPE&T EMPLOY STATUS

Existing

Retain

SNAP

N/A

Policy Department

Policy and Communication Department

N/A

Worker Generated

On Demand

N/A

D01087

NWPB

MEDICAL VERIFICATION

This is for getting Doctor's statement for being unable to work.

NWPB

MEDICAL VERIFICATION

This is for getting Doctor's statement for being unable to work.

F1078

MEDICAL VERIFICATION

Existing

Retain

SNAP

N/A

Policy Department

Policy and Communication Department

N/A

Worker Generated

On Demand

N/A

D01088

NWPE

SPONSOR TIME SHEET

Request to Sponsor for outstanding time sheets for one or more participants.

NWPE

SPONSOR TIME SHEET

F1079

SPONSOR TIME SHEET

Existing

Retain

WV WORKS (TANF)

Sponsor

Case Management

N/A

Worker Generated

On Demand

Editable

PDF

N/A

D01089

NCLS

CLOSURE 24/28 SUPPRESSION

NCLS

CLOSURE 24/28 SUPPRESSION

F0847

CLOSURE 24/28 SUPPRESSION

Existing

Retain

Medicaid

N/A

Case Management

N/A

Worker Generated

On Demand

N/A

D01090

CNLF

LIEAP APP MM

CNLF

LIEAP APP MM

F0067

LIEAP APP MM

Existing

Retain

LIEAP

N/A

Application Intake

N/A

System Generated

As Defined

N/A

D01091

PRC1

PER RPT OVERDUE

PRC1

PER RPT OVERDUE

F1080

PER RPT OVERDUE

Existing

Retain

Medicaid

N/A

System Generated

As Defined

N/A

D01092

CNL7

ADDITIONAL LIEAP PAYMENT

CNL7

ADDITIONAL LIEAP PAYMENT

N/A

Existing

Retain

LIEAP

N/A

Benefit Issuance

N/A

System Generated

As Defined

N/A

D01093

N/A

DFA-SNAP-2

SNAP Change Reporting Form

Change report form for SNAP benefits.

N/A

Existing

Retain

SNAP

Client

Policy Department

Policy and Communication Department

Change of Circumstance

N/A

Static

PDF

EE0339

N/A

D01094

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.