Www.wvdhhr.org Sample Contracts

WV WORKS PERSONAL RESPONSIBILITY CONTRACT (PRC)
Health and Human Resources • April 24th, 2008

• I understand that I am required to attend any meetings or appointments related to my eligibility for cash assistance and my self-sufficiency goals. These meetings or appointments include, but are not limited to, home visits, periodic review of my eligibility for benefits, assessment of my skills and progress in meeting my goals and becoming self-sufficient, employment interviews scheduled by or for me, etc. or I may be sanctioned.

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LIEAP FUEL SUPPLIER AGREEMENT
Fuel Supplier Agreement • August 13th, 2004

In consideration for timely payments and authorization that will be provided by the OFFICE for households found eligible for assistance through the Low Income Energy Assistance Program (LIEAP), SUPPLIER agrees that:

Interagency Agreement Between
Interagency Agreement • February 19th, 2013
GROUP RESIDENTIAL PROVIDER AGREEMENT
Group Residential Provider Agreement • August 30th, 2006

The West Virginia Department of Health and Human Resources, Bureau for Children and Families , Office of Finance and Administration, hereinafter DHHR, and Agency Name, hereinafter Provider, mutually covenant and agree that for and in consideration of the Provider’s delivery of group residential services, the Department will make payment in accordance with terms and conditions set forth in this Agreement.

WV WORKS - PERSONAL RESPONSIBILITY CONTRACT (PRC) PART 1 OF 2
March 17th, 2004
  • Filed
    March 17th, 2004

• I understand that if I am a parent age 20 or above, I will have to get a job or be in a job activity, or both. I further understand that if I quit or refuse a job or job activity without good cause, I will be sanctioned.

Contract
July 9th, 2008
  • Filed
    July 9th, 2008
AT EQUIPMENT LOAN AGREEMENT
Equipment Loan Agreement • September 22nd, 2020

The family or professional borrowing the equipment will take responsibility for the equipment loaned to them. In signing this form, the family or professional is agreeing to return the equipment by the expiration date of the loan period. The family or professional will return the equipment in its original condition. If, during the loan period, the equipment is broken or in need of repair, the family or professional will contact the WV Birth to Three system and determine the best process for getting the equipment repaired, to be covered by WV Birth to Three. In some instances (such as purposeful breakage or negligence), the family or professional (borrower) will be responsible for the cost of repair.

VFC Storage Agreement PIN#
January 18th, 2006
  • Filed
    January 18th, 2006

Providers who wish to receive Vaccines for Children vaccine must agree to provide the appropriate storage units as well as adhere to the Immunization Program’s handling requirements. Failure to comply may result in a suspension of vaccine provided.

180-DAY WASTE EVALUATION AGREEMENT
August 16th, 2011
  • Filed
    August 16th, 2011

 I hereby acknowledge that the above facility is currently generating in excess of fifty pounds of infectious medical waste per month.

FORM Conditional Employee or Food Employee Reporting Agreement 1-B Preventing Transmission of Diseases through Food by Infected Conditional Employees or
Reporting Agreement • April 28th, 2008

Food Employees with Emphasis on illness due to Norovirus, Salmonella Typhi, Shigella spp., Enterohemorrhagic (EHEC) or Shiga toxin-producing Escherichia coli (STEC), or hepatitis A Virus

JOINT OPPORTUNITIES FOR INDEPENDENCE (JOIN) CONTRACT BETWEEN WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES AND Addendum/Renewal
November 3rd, 2003
  • Filed
    November 3rd, 2003

This addendum shall be incorporated as part of the original Contract. All other aspects of original Contract shall remain in effect.

COMMUNITY WORK EXPERIENCE PROGRAM (CWEP) CONTRACT BETWEEN
October 20th, 2003
  • Filed
    October 20th, 2003

This addendum shall be incorporated as part of the original Contract. All other aspects of the original Contract shall remain in effect.

PREPAREDNESS AND RESPONSE COOPERATIVE AGREEMENT
CDC Bioterrorism • May 23rd, 2002

This cooperative agreement is a clear opportunity to strengthen preparedness and response capacity of West Virginia’s public health system and to develop a Public Health Threat Response Plan with our many partners. Threat Preparedness and Response is not a new topic to public health in WV. The Bureau for Public Health (BPH), in conjunction with the Department of Military Affairs and Public Safety, Office of Emergency Services, regularly responds to natural disasters (primarily floods) affecting much of our population. However, many factors need to be considered in addressing these issues. West Virginia is the only state entirely within Appalachia and communities are widely disparate both geographically and culturally across the state. West Virginia encompasses 24,282.45 square miles and has a population of approximately 1.8 million people living within its 55 counties. Both county size and rurality of locales vary widely.

AT EQUIPMENT LOAN AGREEMENT
At Equipment Loan Agreement • September 14th, 2020

The family or professional borrowing the equipment will take responsibility for the equipment loaned to them. In signing this form, the family or professional is agreeing to return the equipment by the expiration date of the loan period. The family or professional will return the equipment in its original condition. If, during the loan period, the equipment is broken or in need of repair, the family or professional will contact the WV Birth to Three system and determine the best process for getting the equipment repaired, to be covered by WV Birth to Three. In some instances (such as purposeful breakage or negligence), the family or professional (borrower) will be responsible for the cost of repair.

WEST VIRGINIA WISEWOMAN
West Virginia Wisewoman • June 27th, 2019
INTERAGENCY AGREEMENT
Interagency Agreement • November 14th, 2000

Note: This file copy of the Interagency Agreement is unsigned. A signed copy of the agreement will replace this file in the near future.

Establish a claim against the party most likely to repay first.
January 30th, 2008
  • Filed
    January 30th, 2008

However, if a claim is established against the sponsor first and the sponsor fails to respond to the repayment letter within 30 days of receipt, a claim must then be established against the alien's AG.

AT Equipment Loan Agreement
September 22nd, 2020
  • Filed
    September 22nd, 2020

The family or professional borrowing the equipment will take responsibility for the equipment loaned to them. In signing this form, the family or professional is agreeing to return the equipment by the expiration date of the loan period. The family or professional will return the equipment in its original condition. If, during the loan period, the equipment is broken or in need of repair, the family or professional will contact the WV Birth to Three system and determine the best process for getting the equipment repaired, to be covered by WV Birth to Three. In some instances (such as purposeful breakage or negligence), the family or professional (borrower) will be responsible for the cost of repair.

WEST VIRGINIA WISEWOMAN
August 3rd, 2017
  • Filed
    August 3rd, 2017
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COMMUNITY WORK EXPERIENCE PROGRAM (CWEP) CONTRACT BETWEEN
October 20th, 2003
  • Filed
    October 20th, 2003

This addendum shall be incorporated as part of the original Contract. All other aspects of the original Contract shall remain in effect.

COMMUNITY WORK EXPERIENCE PROGRAM (CWEP) CONTRACT BETWEEN
Health and Human Resources And • February 20th, 2004 • West Virginia

THIS CONTRACT is made this day of , 20 , by and between the West Virginia Department of Health and Human Resources, Division of Family Assistance and/or County Office (hereinafter referred to as the “Department”) and (hereinafter referred to as “Contractor”).

WV WORKS Diversionary Cash Assistance Agreement
September 8th, 2006
  • Filed
    September 8th, 2006

- To provide verification that I am employed, have a verified offer of employment or will have another verified source of income within two months of this application.

JOINT OPPORTUNITIES FOR INDEPENDENCE (JOIN) CONTRACT BETWEEN
November 3rd, 2003
  • Filed
    November 3rd, 2003

This JOIN Contract between the West Virginia Department of Health and Human Resources, Division of Family Assistance and/or County Office, referred to as the “Department” and referred to as the “Contractor” is hereby revised effective as of to continue through June 30, .

WEST VIRGINIA WISEWOMAN
August 3rd, 2017
  • Filed
    August 3rd, 2017
AGREEMENT TO SELL PROPERTY
February 2nd, 2007
  • Filed
    February 2nd, 2007

Description of EACH Asset (If Real Property, show the address and location) Name of Owners Nature and Percentage of Ownership of each Estimated Current Market Value Amount still Owed if any Estimated Net Proceeds of Sale (after sales expenses and any amount owed) 1. 2. 3. My assets exceed the amount to qualify for cash assistance payments from the WV WORKS Program. I request that conditional payments be made to my family, for a period not to exceed six months, until I am able to sell the asset(s) described above for the current market value or highest price I am able to obtain. After the Department of Health and Human Resources notifies me of the approval of this agreement, I agree to the following:< To take all necessary actions to sell the asset(s) for the current market value within six months of the notice of this agreement’s approval; and< To notify DHHR within five business days of the sale’s completion; and< To repay DHHR all payments received with

Contract
October 22nd, 2008
  • Filed
    October 22nd, 2008

The Worker and the client agree on the amount needed for the family for overnight lodging, rent, utility deposits and food. These items are not verifiable, since the client does not yet have a place to live in the new state and does not know where he will stay overnight on the drive. It is reasonable to assume that these costs will be incurred in moving to another state, and the amount is negotiated.

PAYMENT AGREEMENT
Payment Agreement • October 11th, 2005

, - - has been approved for Adult Family (client name) (social security #) Care in the home of at (provider name) (provider address) effective . The rate of payment is established at $ for a full month or $ per day for a partial month placement. The client currently receives SSI benefits in the amount of $ per month. Other resources to be applied toward the cost of care are: $ from . The client shall retain

Establish a claim against the party most likely to repay first.
March 8th, 2010
  • Filed
    March 8th, 2010

However, if a claim is established against the sponsor first and the sponsor fails to respond to the repayment letter within 30 days of receipt, a claim must then be established against the alien's AG.

AT EQUIPMENT LOAN AGREEMENT
Equipment Loan Agreement • September 22nd, 2020

The family or professional borrowing the equipment will take responsibility for the equipment loaned to them. In signing this form, the family or professional is agreeing to return the equipment by the expiration date of the loan period. The family or professional will return the equipment in its original condition. If, during the loan period, the equipment is broken or in need of repair, the family or professional will contact the WV Birth to Three system and determine the best process for getting the equipment repaired, to be covered by WV Birth to Three. In some instances (such as purposeful breakage or negligence), the family or professional (borrower) will be responsible for the cost of repair.

STATE OF WEST VIRGINIA
August 25th, 2006
  • Filed
    August 25th, 2006
MEMORANDUM OF UNDERSTANDING BETWEEN
March 29th, 2007
  • Filed
    March 29th, 2007

The West Virginia Department of Agriculture (WVDA) under West Virginia Code §19-10a et seq. has authority to regulate the production, processing, sale and distribution of eggs. The Bureau of Public Health (BPH) is charged under the West Virginia Code with inspecting food service establishments and retail food stores where eggs are sold and served.

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