WV DHHS DFA-UH-5 2009 free printable template
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Attach additional sheets if necessary. Please attach all supporting documentation to support your claim of undue hardship. I affirm that the foregoing information and any attachments are true and accurate to the best of my knowledge. Signature of Applicant or Representative Submit completed form and all supporting documentation to WV DHHR Attn County Office Date Signed.
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How to fill out WV DHHS DFA-UH-5
How to fill out WV DHHS DFA-UH-5
01
Begin by obtaining the WV DHHS DFA-UH-5 form from the official WV Department of Health and Human Resources website or your local office.
02
Fill out the date at the top of the form.
03
Provide your full name, address, and contact information in the designated fields.
04
Indicate the reason for completing the form, ensuring to select the appropriate category.
05
Fill in your household information, including names and relationships of all members living with you.
06
Include details regarding your income sources, including any wages, benefits, or assistance you receive.
07
Provide information about any expenses you incur, such as rent or utility costs.
08
Review the completed form for accuracy and completeness.
09
Sign and date the form at the bottom where indicated.
10
Submit the form to your local WV DHHS office, either in person or by mail.
Who needs WV DHHS DFA-UH-5?
01
Individuals or families applying for assistance programs through the West Virginia Department of Health and Human Resources.
02
People who wish to report changes in their income, household composition, or other relevant information that impacts eligibility for services.
03
Those who need to update their information for existing assistance benefits.
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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 Services (DHHS) to collect specific information related to public assistance programs.
Who is required to file WV DHHS DFA-UH-5?
Individuals or households applying for or receiving certain public assistance benefits in West Virginia are required to file WV DHHS DFA-UH-5.
How to fill out WV DHHS DFA-UH-5?
To fill out WV DHHS DFA-UH-5, individuals must provide personal information, income details, family composition, and any other relevant information as specified in the form instructions.
What is the purpose of WV DHHS DFA-UH-5?
The purpose of WV DHHS DFA-UH-5 is to gather necessary information to determine eligibility for public assistance programs and to ensure accurate program administration.
What information must be reported on WV DHHS DFA-UH-5?
Information that must be reported on WV DHHS DFA-UH-5 includes personal identification details, income sources, household members, and any other data required to assess eligibility for assistance.
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