MEMO: AP 00-21 Change 5 DATE: May 22, 2007 TO: FROM: SUBJECT: WIB Directors WIB Chairpersons Grant Recipients Carl Buzzelli WIA Program Manager Revision to WIA Eligibility Documentation Guide Background: During the recent federal review of the State and two local Workforce Investment Boards, a couple of eligibility documentation issues were identified by USDOL as needing to be revised to bring the State in compliance with the most recent data validation issuance. This issuance is to make those suggested changes and provide local Boards with revised source documentation requirements. Policy: Attached is a revised copy of the WIA Eligibility Documentation Guide. Pages 1 and 2 of the guide contain new revisions, as applicant statement has been removed as acceptable documentation for social security number and age. These changes are effective immediately and the CTWBS will be modified to no longer have self-certification listed as acceptable documentation for the items previously mentioned. Any questions on this determination should be directed to your area representative. Attachment
GENERAL ELIGIBILITY Social Security Number REFERENCES Workforce Investment Act of 1998 Federal Regulations REVISED 5/22/07 ACCEPTABLE DOCUMENTATION DD-214. Report of Transfer or Discharge (if SSN is listed) Employment Records IRS Form Letter 1722 Letter from Social Service Agency Drivers License (if SSN is listed) Pay Stub Social Security Benefit Documents Social Security Card/Notice of Social Security number assignment W-2 Form U.C. Records (If name and SSN is shown) Citizenship Citizen or eligible to work 188 (a) (5) Alien Registration Card Indicating Right to Work (INS Form I-151, I-551, I-94, I-688A, I-197, I-179) Baptismal certificate (If place of birth is shown) Birth Certificate DD-214, Report of Transfer or Discharge (If Place of birth is shown) Food Stamp Record (if place of birth is shown) Foreign passport (unexpired) stamped eligible to work. Hospital record of birth (if place of birth is shown) Hand gun permit Naturalization certification Public Assistance Records (if place of birth is shown) U.S. Passport (unexpired) Social Security Card (work eligible) with I.D. Native American Tribal Document One document from List A of the I-9 form or one document from list B and one document from List C of the I-9 form. a copy of the MD20 screen Selective Service: Selective Service Registrant 189 (h) Selective Service Acknowledgement Letter Copy of SSS Form 1 filled out by authorized personnel Selective Service disability verification form Selective Service Registration Record (Form 3A) DD-214, Report of Transfer or Discharge Stamped Post Office Receipt of Registration Internet Verification/Registration (http://www.sss.gov) Selective Service Telephone Verification (847-688-6888) Age: Youth: 14-21 Adult: 18+ Dislocated Worker: 18+ 101(13)(A) 101 (1) 664.200 (a) 663.110 Baptismal record (if date of birth is shown) Birth Certificate DD-214, Report of Transfer or Discharge Paper Driver's License Federal, State or Local Government Identification Card Revised 1
YOUTH ELIGIBILITY MUST BE LOW-INCOME AND ONE or MORE BARRIERS 1. LOW-INCOME INDIVIDUAL Any one of : Receives cash public assistance Family income at or below the poverty line or 70% of the lower living standard Receives food stamps or was determined eligible to receive in last six months Homeless per 103(a)&(c) of the McKinney Act Publicly supported foster child Individual with a disability and own income at or below poverty line or 70% of the Lower Living Standard CFR 663.640 Hospital Record of Birth (if Full Name is shown) Passport Public Assistance/Social Service Records School Records/Identification Card Work Permit 101(25) 664.200(b) Cash Public Assistance Copy of authorization to receive cash public assistance Copy of Public Assistance Check Medical Card Showing Cash Grant Status Public Assistance Identification Card Showing Cash Grant Status Refugee Assistance Records Telephone Verification Self-Certification Form Family/Individual Income Alimony Agreement Award Letter from Veterans Administration Bank Statement (Direct Deposit) Compensation Award Letter Court Award Letter Employer Statement/Contact Farm or Business Financial Records Housing Authority Verification Pay Stubs Capital gains Rental income Strike benefits Child Support Legal Agreement Pension Statement Public Assistance Records Quarterly Estimated Tax for self-employed persons (schedule c) Social security benefits UI documents and/or printout Applicant Statement of Family Income Family Size/Individual Status Birth certificate Hospital Record of Birth Baptismal Certificate Decree of court Disabled (see individuals with a disability) Divorce decree Landlord statement Lease Marriage certificate Most recent tax return supported by IRS documents (eg form letter 1711) Public assistance/social service agency records 2
YOUTH ELIGIBILITY 2. BARRIERS One or more of: Public housing authority (if resident of or on waiting list) Written statement from a publicly supported 24 hour care facility or institution (e.g. mental hospital, prison) Applicant Statement of Family Size Food Stamps Current authorization to obtain food stamps Current food stamp receipt Food stamp card with current date Letter form food stamp disbursing agency Postmarked food stamp mailer with applicable name and address Public assistance records/printout Homeless Written statement from an individual providing temporary residence Written statement from shelter Written statement from social service agency Foster Child Court contact Written statement from an individual providing temporary residence Verification of payments made on behalf of the child Written statement from state/local agency Individuals with Disabilities Letter from school official verifying special education status Letter from appropriate school official identifying qualifying disability Letter from drug or alcohol rehabilitation agency Medical records Observable condition (applicant statement needed) Physician's statement Psychiatrist's diagnosis Psychologist's diagnosis Rehabilitation Evaluation Sheltered workshop certification Social service records/referral Social security administration disability records Veterans administration letter/records Vocational rehabilitation letter Workers compensation record 101(13)(c) 664.200(c) Basic Skills Deficient (English reading or computing at or below the 8 th grade level) Assessed by a generally accepted standardized test School records 3
Basic Skills Deficient School Dropout Homeless, runaway, or foster child Pregnant or Parenting Youth Offender An individual (including a youth with a disability) who requires additional assistance to complete an educational program, or to secure and hold employment. School Dropout Attendance record Dropout letter Homeless, Runaway Written statement from an individual providing temporary residence Written statement from shelter Written statement from social service agency Foster Child Court contact Court documentation Verification of payment made on behalf of the child Written statement from state/local agency Pregnant or Parenting Birth certificate Baptismal Certificate Hospital record of birth Physician's note Referrals from official agencies School program for pregnant teens School records Statement from social service agency Offender Court documents Halfway house resident Letter of parole Letter from probation officer Police records Requires Additional Assistance Self-Certification form (based on definition determined by local WIB) Other supporting documentation as defined by local WIB policy 4
YOUTH ELIGIBILITY 5% EXCEPTION 5% of Youth do not have to be Low-income if they are one or more of the following: School Dropout Basic Skills Deficient - reading or computing skills at or below 8 th grade level Behind grade level Pregnant or Parenting Individual with Disabilities, including learning disabilities Homeless or runaway youth Offender Serious barrier to employment as identified by the local board and described in the local plan. 129(c)(5) 664.220 School Dropout Attendance record Dropout letter Basic Skills Deficient (English reading or computing at or below the 8 th grade level) Assessed by a generally accepted standardized test School records Behind Grade Level Report card School records Pregnant or Parenting Birth certificate Baptismal Certificate Hospital record of birth Physician's note Referrals from official agencies School program for pregnant teens School records Statement from social service agency Individuals with Disabilities Letter from school official verifying special education status Letter from appropriate school official identifying qualifying disability Letter from drug or alcohol rehabilitation agency Medical records Observable condition (applicant statement needed) Physician's statement Psychiatrist's diagnosis Psychologist's diagnosis Rehabilitation Evaluation Sheltered workshop certification Social service records/referral Social security administration disability records Veterans administration letter/records Vocational rehabilitation letter Workers compensation record 5
ADULT ELIGIBILITY A priority policy General Eligibility must be in place with the local And board. Since funds are limited, priority shall be given to recipients of public assistance and other lowincome individuals for intensive services and training services. For reference, funds allocated for Dislocated Workers are not subject to this requirement. Priority should be given to recipients of public assistance and other low-income individuals for intensive services and training services. LWIAs must establish that excess funds exist in the area to serve adults who are not low-income individuals. If excess funds exist And Meets LWIA criteria for services; List Documentation: Homeless, Runaway Written statement from an individual providing temporary residence Written statement from shelter Written statement from social service agency Offender Court documents Halfway house resident Letter of parole Letter from probation officer Police records Serious barriers to employment as identified by local board Self-Certification form (based on definition determined by local WIB) Other supporting documentation as defined by local WIB policy (Identify LWIA category) 134(d)(4)(E) 663.600 Cash Public Assistance Copy of authorization to receive cash public assistance Copy of Public Assistance Check Medical Card Showing Cash Grant Status Public Assistance Identification Card Showing Cash Grant Status Refugee Assistance Records Telephone Verification Family/Individual Income Alimony Agreement Award Letter from Veterans Administration Bank Statement (Direct Deposit) Compensation Award Letter Court Award Letter Employer Statement/Contact Farm or Business Financial Records Housing Authority Verification Pay Stubs Capital gains Rental income Strike benefits Child Support Legal Agreement Pension Statement Public Assistance Records Quarterly Estimated Tax for self-employed persons (schedule c) Social security benefits UI documents and/or printout Applicant Statement of Family Income Family Size/Individual Status 6
Birth certificate Hospital Record of Birth Baptismal Certificate Decree of court Disabled (see individuals with a disability) Divorce decree Landlord statement Lease Marriage certificate Most recent tax return supported by IRS documents (e.g form letter 1711) Public assistance/social service agency records Public housing authority (if resident of or on waiting list) Written statement from a publicly supported 24 hour care facility or institution (e.g. mental hospital, prison) Applicant Statement of Family Size Food Stamps Current authorization to obtain food stamps Current food stamp receipt Food stamp card with current date Letter form food stamp disbursing agency Postmarked food stamp mailer with applicable name and address Public assistance records/printout Homeless Written statement from an individual providing temporary residence Written statement from shelter Written statement from social service agency Individuals with Disabilities Letter from school official verifying special education status Letter from appropriate school official identifying qualifying disability Letter from drug or alcohol rehabilitation agency Medical records Observable condition (applicant statement needed) Physician's statement Psychiatrist's diagnosis Psychologist's diagnosis Rehabilitation Evaluation Sheltered workshop certification Social service records/referral Social security administration disability records Veterans administration letter/records Vocational rehabilitation letter Workers compensation record 7
DISLOCATED WORKER ELIGIBILITY Applicant must Terminated or laid off or received notice of be: termination or layoff from employment AND 101(9)(A) 663.115 Applicant s UC-61 (pink slip) Letter from employer (The individual s name must appear on the letter. For Discretionary Grants, the individual s date of separation must also appear) Letter from union (The individual s name must appear on the letter. For Discretionary Grants, the individual s date of separation must also appear) A Eligible for or exhausted entitlement to Unemployment Compensation; or has been employed for a duration sufficient to demonstrate, to the appropriate entity at a one-stop center, attachment to the workforce, but is not eligible for unemployment compensation due to insufficient earnings or having performed services for an employer that were not covered under state U.C. law AND Unlikely to return to previous industry or occupation OR Unemployment Compensation Records (Copy of MD20 or NM01 screen) Unemployment Compensation Records (For eligible for U.C., a copy of a UC58 (Monetary Determination), MD10, or NM01 screens; For exhausted U.C., a copy of the BP10 or MD20 screens) Pay Stubs indicating employment for the past six months Documented Job Search Log (Must have a minimum of 3 job contacts for the past four weeks. Log must indicate date of contact, name of employer, kind of work sought) Connecticut s Job Bank Connecticut Forecast 2006 (CT DOL Office of Research Occupation & Industry Projections) Choices Today A High Performance Workplace for Tomorrow (CT DOL Office of Research) Jobs in CT (CT DOL Office of Research) Local/Regional Business & Professional Organization Surveys/Reports OASYS Classified/On-Line Job Advertisements Doctor s note stating the individual can no longer perform his/her previous occupation for medical reasons Documenting the limited number of employers in the state in a certain industry (i.e. mass layoffs in pharmaceuticals) Newspaper articles regarding layoffs by various companies within the same industry Letters from employers stating that certain skills are required for a job and/or what skills are no longer usable Job descriptions Self-certification: This is a last resort, which should only be used if all other suggested items are unavailable or it will cause undue hardship for individuals to obtain. Using the form the client may self-certify that s/he has applied for positions, with a minimum of four employers, in a certain occupation and there were no openings. The employers should be identified on the statement and other relevant information such as position, industry, etc. 8
B C D Has been terminated or laid off, or has received notice of termination or layoff, from employment as a result of any permanent closure of, or any substantial layoff at, a plant, facility, or enterprise OR Is employed at a facility at which the employer has made a general announcement that such facility will close within 180 days OR Was self-employed (including employment as a farmer, a rancher, or a fisherman) but is unemployed as a result of general economic conditions in which the individual resides or because of natural disasters OR Is a Displaced Homemaker The term displaced homemaker means an individual who has been providing unpaid services to family members in the home and who has been dependent on the income of another family member but is no longer supported by that income; AND is unemployed or underemployed and is experiencing difficulty in obtaining or upgrading employment 101 (9)(B) WARN notice Newspaper article Letter from employer Letter from union Rapid Response Unit notice or fact sheet Job Center Employer Services Unit Records Unemployment Notice Print or electronic media announcement in which company officials state that a plant or facility is scheduled to close Rapid Response notice 101 (9)(C) Quarterly or annual tax return State tax identification number Business License/Permit IRS Documentation Business Ledgers Chapter 7 or 11 Bankruptcy published in newspaper(date must be shown) Failure of business supplier or customer Newspaper article regarding general economic conditions State/local economic development report Chamber of Commerce data Federal/State declaration of disaster 101 (9)(D) Tax returns Divorce decree/court records UI records Applicant statement noted to file Spouse Death Certificate Pay stubs or employer letter and applicant statement to file regarding full-time availability Documentation showing current annualized wage rate (in relation to family size) is not in excess of the higher of either the poverty level or 70% of the lower living standard income level 9