Forms and Letters - Master List
Last updated on November 5, 2024| HR0024 | Declaration and Undertaking for a Client Lost or Stolen Payment Form to be used when a client (payee) reports a lost or stolen unendorsed cheque or EFT payment not received. |
| HR0077 | Work Search Activities Record Form for recording work search activities and work search results. |
| HR0080A | Application for Assistance - Verbal Consent |
| HR0080B (Part 1) | Application for Assistance - Consents (Part 1) |
| HR0080 (Part 2) | Application for Assistance (Part 2) |
| HR0080R | EA/EAPWD Review |
| HR0081 | Monthly Report Form for reporting changes in circumstances and monthly income for the purposes of determining eligibility for assistance. |
| HR0095 | Release of Personal Information This form may be used for release of information purposes, but its use should be restricted to situations where a third party requires specific information regarding type, amounts of and duration on assistance. [For more information, see Related Links – Information Privacy and Security (FOIPPA) – Policy – Consent to Disclosure of Information] |
| HR0100 | Employment and Assistance Request for Reconsideration Form for clients to request a reconsideration of a ministry decision. |
| HR0150A | Facility/Residence Invoice - Daily User Rates |
| HR0150B | Facility/Residence Invoice - Monthly User Rates |
| HR2049 | Request for Replacement of Supplier Lost, Stolen or Misdirected Assistance Payment Form to be used when a service provider (payee) reports a lost or stolen unendorsed cheque or EFT payment not received. |
| HR2062 | Declaration of Administrator of E and A or E and A for PWD Form used to establish a third party as administrator of a client's assistance. |
| HR2098 | Assignment – Veterans Affairs Canada Form for assigning income received from Veterans Affairs Canada. |
| HR2100 | Assignment – WorkSafeBC Form for assigning income received from WorkSafeBC. |
| HR2138 | Medical Equipment Request and Justification Form for assessing eligibility for medical equipment. |
| HR2181A | Confirmation of Earnings Fax Form used by Prevention and Loss Management Services to confirm a client's earnings. |
| HR2181B | Confirmation of Earnings Mail Form used by Prevention and Loss Management Services to confirm a client's earnings. |
| HR2528 | Assignment of Benefit Form for issuing hardship assistance under Awaiting EI Benefits. |
| HR2567 | Request for Community Volunteer Supplement (CVS) and Eligibility Review When this form is used for review, print the second page only. |
| HR2648 | Direct Deposit Request |
| HR2663A | Repayment Agreement/Acknowledgement of Debt (Repayable) |
| HR2664 | Promise to Pay (Hardship) This form is to be used when receiving repayable hardship assistance |
| HR2684 | Repayment Agreement |
| HR2737 | Promise to Repay – Benefit while Awaiting Reconsideration/Appeal Decision Form to recover debt owed to the ministry where the client acknowledges the debt and agrees to pay at a later date. |
| HR2748 | Assignment of Maintenance Rights Form provided to client by EAW for assigning maintenance rights to the ministry. The client provides the signed and initialed HR2748 to the ministry legal representative at first appointment. |
| HR2749 | Repayment Agreement Appeal Benefit Form to recover debt owed to the ministry where the person acknowledges the debt and agrees to begin to repay the debt immediately by deduction from his or her monthly assistance cheque. |
| HR2771 | Sponsorship Obligations – Applicant Letter for informing applicants about the sponsor’s obligations. |
| HR2772 | Sponsorship Obligations – Sponsor Letter for informing sponsors of their sponsorship obligations and that they will be incurring a debt for any assistance issued to the applicant. |
| HR2782 | Promise to Pay Co-op Housing Shares Form for recording a recipient's agreement to repay a co-op housing share purchase supplement if the recipient chooses the delayed repayment option. |
| HR2786 | Verification of Sponsorship Request Form for notifying the federal government when a sponsored person applies for assistance. |
| HR2847 | Application for Monthly Nutritional Supplement Form for determining eligibility for the monthly nutritional supplement. |
| HR2864 | Child Residency Statement Form for determining whether an applicant or recipient has a dependent child. |
| HR2883 | Persons with Disabilities Designation Application Sample form for determining eligibility for the Persons with Disabilities designation. |
| HR2892 | Persons with Persistent Multiple Barriers Application Form |
| HR2892A | PPMB Checklist Form for determining if a recipient is eligible for PPMB. |
| HR2894 | Orthoses Request and Justification Form for orthotic and bracing suppliers to request preauthorization from Health Assistance. |
| HR2949 | For clients not receiving BC Family Bonus Template letter to provide clients with information on the Family Bonus Top-Up Supplement. |
| HR2988S | Simplified Monthly Self-Employment Report, (Short Form) |
| HR2988L | SEP Client Monthly Report, (Long Form ) |
| HR2998 | SEP Acceptance of Terms and Business Plan Completed by the EAW that provides both of the following: the client's signature agreeing to abide by the terms and conditions of the SEP as set out in BCEA legislation. |
| HR3010 | SEP Monthly Reporting Worksheet Worksheet that SEP clients may use as a tool to assist them in completing the SEP Client Monthly Report (HR2988). Use of the HR3010 is optional, but recommended. |
| HR3028 | Alcohol and Drug Fee Authorization Agreement Form for client authorization of deductions from monthly support allowance to pay for alcohol and drug clinic fees. |
| HR3032 | Cheque Hold Letter |
| HR3033A | Family Maintenance Questionnaire and Referral A questionnaire for the EAW to determine if the client and/or spouse is eligible for a referral for family maintenance services and this form is provided to the client to present to the ministry legal representative as proof of eligibility for services referral. |
| HR3034 | Information/Documentation Checklist |
| HR3037 | Shelter Information Form to assist applicants or clients to provide the information required to determine actual shelter costs. |
| HR3042 | Client Initiated Overpayments Letter |
| HR3043 | Ministry Initiated Overpayments Letter |
| HR3069 | Medical Report – Employability Form for clients requiring a medical report to determine if the client's condition interferes with seeking, accepting or continuing employment. |
| HR3092 | Overpayment Notification (For Open Case) Form used by staff to notify clients with open cases of an overpayment and to inform them of their right to reconsideration. |
| HR3092A | Overpayment Notification (For Closed Case or Medical Services Only Case) Form used by staff to notify persons with closed cases or medical services only cases of an overpayment and to inform them of their right to reconsideration. |
| HR3103 | Medical Report – Child Form to identify a child's physical or mental condition, which precludes a recipient from working more than 30 hours a week. |
| HR3104 | Family with a Child with Disabilities Exemption – Denial Letter A template letter to clients, who after a review of information, have been determined to be ineligible or no longer eligible for a $500 earnings exemption. |
| HR3107 | Assessment for Earnings Exemption – Questionnaire Questionnaire to be used to assess how the medical needs of the child prevents the client from working more than 30 hours a week. |
| HR3110 | Advisement that Guardian Must Sign for Release of Child's Medical Information A letter regarding the Medical Report Child (HR3103) when the recipient/caregiver is not the parent or legal guardian. |
| HR3115 | Reasonable Work Search Activities Guidelines |
| HR3116 | Work Search Review |
| HR3125 | Consent to Release Information |
| HR3138 | Diet Supplement Review |
| HR3139 | Diet Supplement Denial |
| HR3162 | Seniors Supplement – Retroactive Payments and Adjustments |
| HR3163 | Overpayment Decision Letter for PWD |
| HR3164 | Overpayment Decision Letter for Non PWD |
| HR3183 | Youth Transition Consent: Youth with Intellectual Disabilities |
| HR3184 | Child in the Home of a Relative Screening Consent |
| HR3187 | Aboriginal Self Identifier A form which requests clients to self identify if they are an Aboriginal person. |
| HR3189 | Consent to Disclosure of Information A form that gives the ministry permission to discuss a client's personal information with a third party. [For more information, see Related Links – Information Privacy and Security (FOIPPA) – Policy – Consent to Disclosure of Information]. |
| HR3189A | Consent to Disclosure of Information – Service Authorization |
| HR3196 | Request for Information |
| HR3197 | Second Request for Information PLMS letter to request that a recipient provide information that will assist with a compliance review (2nd request). |
| HR3198 | Notice of Decision Section 10 Denial PLMS letter to advise recipients of a decision to deny assistance as a result of their failure to provide information as requested. This letter also advises the recipient of their right to reconsideration or appeal. |
| HR3199 | Notice of Decision Overpayment PLMS form to notify clients with Open or Closed cases of an overpayment and to inform them of their right to reconsideration of this decision |
| HR3200 | Notice of Eligibility Decision PLMS letter to advise recipients of a decision affecting their eligibility and their right to reconsideration or appeal. |
| HR3203 | Criminal Code Conviction Letter PLMS letter advising client of sanction imposed as a result of a Criminal Code Conviction. |
| HR3209 | Denial of CIHR Assistance (not screening), Template Letter |
| HR3211 | Denial of CIHR Assistance (screening – discontinuation), Template Letter |
| HR3216 | School Start-up Confirmation of eligibility for school start-up supplement. |
| HR3217 | Incomplete HR0081 – Monthly Report Form Letter advising clients to complete the HR0081 in full and/or provide any required documentation. |
| HR3218 | Bank Profile Information Sheet Letter advising recipient to provide a copy of bank statement and bank profile. |
| HR3219 | Information to New BCEA Client Template letter which will advise new clients of some additional information about ministry services. |
| HR3220 | Information to New Persons with Disabilities Designation Letter given to new PWD designated clients advising them of additional services for which they may be eligible. |
| HR3224 | Income in Excess – Earned and Unearned Income A template letter to clients who have been determined to be ineligible for income assistance for a specific duration as the family unit’s earned income was more than the amount of assistance payable to the family unit. |
| HR3225 | Income in Excess – Family with Child with a Disability A template letter to a Family with a Disabled Child who has been determined to be ineligible for income assistance for a specific duration as the family unit’s earned income was more than the amount of assistance payable to the family unit. |
| HR3227 | Income in Excess – PWD Earned and Unearned Income A template letter to clients designated as PWD who have been determined to be ineligible for assistance for a specific duration as the family unit’s earned and/or unearned income was more than the amount of assistance payable to the family unit. |
| HR3232 | First Appointment – PPMB Review Template letter for scheduling appointments for reviewing PPMB. |
| HR3233 | First Appointment – Other Appointment Letter advising clients of a scheduled appointment time. |
| HR3236 | Second Appointment – Other Appointment Letter advising clients of a re-scheduled appointment time. |
| HR3237 | Information Required – Medical |
| HR3238 | Information Request – General A template letter advising a client of documentation required to be submitted (i.e. confirmation of employment). |
| HR3241 | PPMB Approval |
| HR3245 | PPMB Denial – New PPMB Applicant Template letter for notifying a client who is not receiving PPMB rates that he or she is not eligible for PPMB. |
| HR3249 | CPPD Information Letter When Applying for PWD Letter for informing PWD clients they are required to apply for CPPD. |
| HR3251 | Confirmation of ID for Financial Institution Letter given to clients with a copy of their ID on file to assist with opening a bank account. |
| HR3254 | Direct Deposit Template Letter |
| HR3258 | SEP Questionnaire and Terms of Acceptance |
| HR3259 | Assets in Excess Pending PWD Designation Application A template letter provided with the PWD Designation Application to clients who intend to apply for PWD designation while in receipt of income assistance with assets in excess. |
| HR3260 | Assets in Excess Pending PWD Designation Application (60 days) A template letter to request clients to submit their completed PWD Designation Application before the specific date, if they are in receipt of income assistance with assets in excess. |
| HR3261 | PWD Asset Exemption File Closure A file closure template letter to clients, who have not submitted their completed PWD Designation Application and have been determined to be no longer eligible for the asset limit exemption. |
| HR3262 | PPMB No Contact – Missed Appointment Denial letter for clients who failed to attend a second booked appointment and did not provide a medical report. |
| HR3266 | Client Identification Process |
| HR3271 | Identity Verification Checklist Checklist completed by person doing identity verification through the CIP process and third party checks. This form is to be scanned and profiled. |
| HR3311 | Statute Conviction Letter PLMS letter advising client of consequence imposed as a result of a conviction under the EA Act or EAPWD Act. |
| HR3315 | Notice of Change Due to Request for Reconsideration or Appeal PLMS letter advising clients of a change to their ongoing assistance, overpayment or repayment amount as a result of their reconsideration or appeal request. |
| HR3317 | MSO Notification Letter regarding qualification for MSO. |
| HR3317B | MSO Eligibility - PPMB Clients Letter |
| HR3319 | Facility/Residence Admittance, Discharge or Transfer |
| HR3320 | Request for Local or Non-Local Medical Transportation Assistance Form for assessing medical transportation supplement. |
| HR3322 | Life-Threatening Health Need Applicant Inquiry |
| HR3327 | Accommodation Confirmation Letter to confirm accommodation and pay hotel direct. |
| HR3331 | Eligibility Review for Income Assistance for CIHR Form for determining ongoing eligibility for child in the home of a relative assistance. |
| HR3332 | Outstanding Warrant Check Form Form used for third party check on outstanding warrant. |
| HR3334 | Notifying Client of Outstanding Warrants Denial letter due to outstanding warrant and advice to seek legal help. |
| HR3335 | Request for Client Consent to Verify Outstanding Warrant Letter to advise client of allegation on outstanding warrant and requirement to verify. |
| HR3342 | CPPD Package & Consent to Deduct and Payment Form – Second Letter |
| HR3343 | CPPD Package & Consent to Deduct and Payment Form – Initial Letter |
| HR3344 | CPPD Information Letter for Approved PWD Applicants – Initial Letter |
| HR3345 | CPPD Information Letter for Declined PWD Applicants |
| HR3470 | CPPD Request for Status of CPP Application Letter Letter requesting confirmation of the results of a client's application for CPPD. |
| HR3472 | CPP Tax Exemption Letter Letter sent to clients when issuing a one-time tax liability adjustment cheque . |
| HR3489 | CPP – Letter Enclosing ISP1613 Letter sent to clients that have applied for CPP and have not completed the ISP1613. |
| HR3500 | Bus Pass Program Consent to Disclosure form A form that gives the ministry consent to the disclosure of any personal information to a designated third party that is relevant to eligibility for the BC Bus Pass Program. |
| HR3508 | Annual Earnings Exemption Threshold Letter |
| HR3510 | PWD Youth Transition Information Application Letter Letter sent to new youth PWD applicants with Intellectual Disability and/or transitioning from the Ministry of Children and Family Development At Home Program Medical Benefits. |
| HR3533 | Third Party Administration – Advance Notice – Behavioural Letter warning clients of potential for third party administration arrangement due to behavioural issues. |
| HR3534 | Third Party Administration – Advance Notice – Financial Management Letter warning clients of potential for third party administration arrangement due to financial management issues. |
| HR3535 | Third Party Administration – Client Notification – Behavioural Letter advising of decision to third party administer the client due to behavioural issues. |
| HR3537 | Third Party Administration – Modifying Third Party Arrangement – Conditional Letter advising clients that the conditions of the third party administration arrangement have been modified. |
| HR3538 | Third Party Administration – Continuing Third Party Administration Arrangement – Behavioural Letter advising clients that after a review, their third party administration agreement will continue due to behavioural issues. |
| HR3539 | Third Party Administration – Removing Third Party Administration Arrangement Letter advising clients that after a review, their third party administration arrangement has been removed. |
| HR3557 | 1st CRV Appt (in person) |
| HR3558 | 1st CRV Appt (telephone) |
| HR3559 | 2nd CRV Appt (in person) |
| HR3560 | 2nd CRV Appt (telephone) |
| HR3561 | Notice of Decision – Denial for CRV Non-Attendance |
| HR3582 | Eligibility Review Documents: First Request Letter advising recipients to provide documents for an eligibility review |
| HR3583 | Eligibility Review Documents: Second Request Letter advising recipients of second request to provide documents for an eligibility review as documents were not provided following first request. |
| HR3584 | Eligibility Review Interview: First Request Letter advising recipient of interview time scheduled to complete an eligibility review. |
| HR3585 | Eligibility Review Interview: Second Request Letter advising recipient of second interview time schedules as recipient missed the first interview. |
| HR3586 | Eligibility Review Non-Compliance Denial Letter advising client of ineligibility for assistance due to not providing documents and/or attending an interview to complete an eligibility review. |
| HR3599 | Instructions for Service Providers This form gives instructions for service providers or suppliers on setting up direct deposit payments. |
| HR3618 | THS Notification Letter Letter regarding qualification for THS |
| HR3639 | Confirmation of Income |
| HR3642 | Persons with Disabilities Designation Application – Prescribed Class This is an application for the Persons with Disabilities Designation for member of a prescribed class. This is NOT the application for financial assistance. |
| HR3644 | AEE Exhausted to MSO Letter |
| HR3677 | Schedule A – Appendix A1 TPA of Benefits Services Referral Form |
| HR3678 | |
| HR3678B | |
| HR3680 | BC Hydro Payment Notification Letter |
| HR3727 | Breathing Device Request and Justification |
| HR4003 | Food and Sundries Voucher – Sample |