WV DHHS DFA-UH-5 2012-2025 free printable template
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APPLICATION FOR UNDUE HARDSHIP WAIVER A Applicant Information Name: LAST FIRST MI Address: Route and Box or Number and Street Apt. Number City / Town State Date of Birth: County of Residence: Zip
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How to fill out WV DHHS DFA-UH-5
01
Obtain a copy of the WV DHHS DFA-UH-5 form from the official website or local office.
02
Gather required information, including personal identification details, income information, and household size.
03
Fill in the applicant's name and address at the top of the form.
04
Provide details about all household members including their names, dates of birth, and relationships to the applicant.
05
Complete the income section by listing all sources of income, amount received, and frequency of payment.
06
Disclose any assets or resources that are relevant to the application.
07
Sign and date the form certifying that all information is accurate and complete.
08
Submit the completed form either online, by mail, or in person to the appropriate DHHS office.
Who needs WV DHHS DFA-UH-5?
01
Individuals or families seeking financial assistance or benefits from the West Virginia Department of Health and Human Resources.
02
Those applying for programs such as Medicaid, food assistance, or temporary assistance for needy families.
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What is WV DHHS DFA-UH-5?
WV DHHS DFA-UH-5 is a form used by the West Virginia Department of Health and Human Resources, specifically within the Division of Family Assistance, for reporting and managing various assistance-related information.
Who is required to file WV DHHS DFA-UH-5?
Individuals or families applying for or receiving assistance benefits through the West Virginia DHHS are required to file the WV DHHS DFA-UH-5 form.
How to fill out WV DHHS DFA-UH-5?
To fill out the WV DHHS DFA-UH-5 form, provide accurate personal information, details about your household, income, expenses, and any other relevant data as instructed on the form.
What is the purpose of WV DHHS DFA-UH-5?
The purpose of WV DHHS DFA-UH-5 is to collect necessary information to assess eligibility for assistance programs and to ensure that applicants receive the appropriate benefits.
What information must be reported on WV DHHS DFA-UH-5?
The information that must be reported on WV DHHS DFA-UH-5 includes personal identification, household composition, income details, living expenses, and any other specific data requested on the form.
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