January 15, 2008 EASTERN CAROLINA LOCAL AREA ISSUANCE NO WIA Data Element Validation and Participant File Structure for Youth Programs

Transcription

1 January 5, 2008 EASTERN CAROLINA LOCAL AREA ISSUANCE NO SUBJECT: PURPOSE: WIA Data Element Validation and Participant File Structure for Youth Programs To release revised WIA Participant File Structure Policy for Data Element Validation and Rescind Eastern Carolina Local Area Issuance No BACKGROUND: Eastern Carolina Local Area Issuance No , released in November 2006, established file content and structure requirements to comply with the federal data validation mandates. This Issuance replaces Eastern Carolina Local Area Issuances Appendix D to the U.S. Department of Labor s Data Validation Handbook contains the data element validation instructions and documentation requirements. Each WIA data element that is subject to the validation requirements is listed in this appendix, along with the format used in the annual report, definition of the data element, federal sources allowed to validate each element and whether the source must provide information that matches or supports the data element being validated. Each data element listed must have at least on hard copy data source from the allowable list in the participant s file. Attachment of this Issuance contains the state approved data element validation source documents for use in North Carolina effective October, Service providers may use any of the listed documents for data element validation. Service providers are encouraged to use WorkforcePlus TM Screen printouts that contain source information to support the data elements, where allowed. In some instances, case/activity notes will be required to validate data elements. Each Service Provider must use the established file structure for all WIA participant files, with the file checklist in the front of each file. Supporting documentation within the files must be labeled with the appropriate field code and federal reference number as indicated on the file checklist. Division of Workforce Development field codes are assigned to each element according to program cohorts and data categories for all data validation elements: 34 South Glenburnie Road New Bern, North Carolina (252) voice (252) fax An Equal Opportunity/Affirmative Action Employer Page

2 Cohorts: A Adults DW Dislocated Workers OY Older Youth YY Younger Youth NEG National Emergency Grant Categories: E Eligibility/Intake/Application A Employment Activities XP Exit and Post-Program Activities Each data element also has a DOL reference number that corresponds to the Federal reporting requirements. Thus, an adult s date of birth would be coded AE2 (where A = adult, E = eligibility/intake/application, and 2 = the U.S. Department of Labor s reference number for date of birth). All data element validation field codes are indicated on the file checklist and must be indicated on the source documents in the files. If the Service Provider places a copy of a birth certificate in the file to support date of birth, the birth certificate should be labeled AE2. The following WorkforcePlus TM screen prints must be in all WIA exiters files: Complete electronic intake/application form printed out after all application data has been entered into WorkforcePlus TM and the applicant certified as WIA eligible, signed and dated by the applicant, intake staff, and parent/guardian if applicable (see note). st Employment Activity Enrollment screen ( I-Case Management for adults, dislocated workers and NEG participants; Y-Comprehensive Guidance and Counseling for youth). Case Profile screen, printed after the individual has exited WIA. Case/activity notes. st, 2 nd, and 3 rd Quarter Supplemental Data screens (if the service provider is using supplemental data for performance calculations and has allowable source documentation in the files to support the supplemental data). Leave Program and Outcomes screens. Employment Plan screen, printed after the individual has exited WIA (if name does not show on printout, it should be written on the printout). NOTE: There are two types of signed application/intake form printouts that are not acceptable sources of documentation for data element validation: Printing out a blank intake/application form, allowing the applicant to complete and sign it in pencil or ink, for the official application. Page 2

3 Printing last page of the intake/application form only (the signature lines) and, after having signatures affixed, placing the signature page in the file. ACTION: Service Providers must use the formal file structure including the file checklist to be placed in the front of each WIA participant file. All source documents used to support data element validation must have the appropriate Division field code written on them. Service Providers are required to ensure that all data validation elements and supporting documentation are included in all participants files. All new and/or exited files with an application or exit date of October, 2007 or later must have the revised checklist in the file. Service Providers will use classification folders with two (2) dividers and set-up participant files using the attached checklist and file section templates as follows: Younger and Older Youth participant files File Checklist Section One Intake/Eligibility Documentation Section Two Participant Activities and Participation Information/Exit and Outcome Information Section Three Assessment Information Section Four Worksite Information Section Five Case/Activity Notes & Supplemental Data Information/Correspondence EFFECTIVE DATE: October, 2007 EXPIRATION DATE: CONTACT: DISTRIBUTION: Indefinite Executive Director All Service Providers Tammy Childers Attachments Page 3

4 YOUNGER AND OLDER YOUTH DWD Field YYE/ OYE YYE/ OYE YYE/ OYE YYE/ OYE Ref# Data Element Federal & State Sources 2 Individual Identifier Social Security Card DD-24, Report of Transfer or Discharge Paper Passport 3 Date of Birth Baptismal Record Birth Certificate Printout of Birth Certificate From County Register of Deeds DD-24, Report of Transfer or Discharge Paper Driver s License Federal, State, Or Local Government Identification Card Hospital Record of Birth Passport Public Assistance/Social Services Records School Records/Identification Card (Copy from School) Work Permit Cross-Match With Department of Vital Statistics Tribal Records 6 Employment Status At Participation = Employed 2= Employed, but Received Notice of Termination Of Employment or Military Separation 3= Not Employed 20 Low Income = Yes 2= No Department of Motor Vehicles Case/Activity Notes Showing Information Collected From Registrant AT Registration/Enrollment Pay Stub Self Attestation (Client Statement Notarized) WF+: Printout Of Intake/Application Form, Signed And Dated By Applicant (And Parent/Guardian if applicable) AND WF+ Participation Fields Information Screen, Signed and Dated by Applicant (And Parent/Guardian If Applicable) if employment status changed between application and enrollment (if applicable) Alimony Agreement Award Letter From Veterans Administration Bank Statements Compensation Award letter Court Award Letter Pension Statement Employer Statement/Contract Farm, Family, or Business Financial Records Housing Authority Verification Pay Stubs Public Assistance Records Quarterly Estimated Tax For Self-Employed Persons Attachment Page

5 YOUNGER AND OLDER YOUTH YYE/ OYE YYE/ OYE 2 Temporary Assistance to Needy Families (TANF) = Yes 2= No 22 Other Public Assistance = Yes 2= No Social Security Benefits Statements U. I. Documents and/or printout, Including U. I. Pay Stub FICA Records Employer Notice of Direct Deposit Written Employer Statement/Contact Scholarship/Financial Aid Records (Indicating Any Cash Paid Directly to the Applicant is Counted as Incomes Self Attestation (Client Statement Notarized) Written Statement By the Applicant of No Income Written Statement By the Applicant of Cash Gifts Written Statement By the Applicant of Odd Jobs And/Or Self Employment And Income Cross-Match With TANF Database Public Assistance Records DSS TANF Printout (showing appropriate TANF coding) DSS Electronic Interface Printout Written Verification From DSS Copy of Authorization To Receive Cash Public Assistance Copy of Public Assistance Check Medical Card or Public Assistance ID Card Showing Cash Grant Status Public Assistance Records/Printout Public Assistance Refugee/Assistance Records Cross-Match With Public Assistance Database Written Verification From DSS Written Verification From Awarding Agency Letter Social Security Administration SSI Award Letter Written Documentation From Social Security Administration Attachment Page 2

6 YOUNGER AND OLDER YOUTH YYE/ OYE YYE / OYE YYE/ OYE YYE/ OYE 26 Homeless Individual And/Or Runaway = Yes 2= No 27 Offender = Yes 2= No 28 Pregnant or Parenting = Yes 2= No 29 Youth Who Needs Additional Assistance = Yes 2= Yes An applicant Who Requires Additional Assistance is One Who: Written Statement From an Individual Providing Residence Written Statement From a Shelter Written Statement Written Statement From Social Service Agency, Mental Health, Health Department or Substance Abuse Agency Written Law Enforcement Verification Self Attestation (Client Statement- Notarized) WF+: Printout Of Intake/Application Form, Signed And Dated By Applicant (And Parent/Guardian If Applicable) Documentation From juvenile Justice/Criminal Justice System Copies of Court Documents Letter Of Parole Copies of Prison Records Letter From Probation Officer Copy of Police Records NC Department of Corrections Print-Out: Self Attestation (Client Statement- Notarized) WF+: Printout Of Intake/Application Form, Signed And Dated By Applicant (And Parent/Guardian If Applicable) Birth Certificate (For Child Listing Applicant s/participant s Name As a Parent) Baptismal Record Doctor s Note Confirming Pregnancy Statement From Program for Pregnant Or Parenting Youth Statement From Social Services Agency Or Health Department Hospital Record of Live Birth (For Child Listing Applicant s/participant s Name As a Parent) Self Attestation (Client Statement- Notarized) WF+: Printout Of Intake/Application Form, Signed And Dated By Applicant (And Parent/Guardian If Applicable) Individual Service Strategy Case/Activity Notes Self-Attestation (Client Statement Notarized) WF+: Printout Of Intake/Application Form, Signed And Dated By Applicant (And Parent/Guardian If Applicable) Note: Case Managers MUST follow state policy to determine if the youth s needs additional assistance. The youth must meet all conditions outlined in previous columns: Either A, B, and C, or D E, and F. This is not up to the case manager s discretion. Attachment Page 3

7 YOUNGER AND OLDER YOUTH A. Is Currently Attending an Education Program AND B. Has Previously Dropped Out Of an Educational Program OR Has Poor Attendance Patterns In an Educational Program During the Last 2 Calendar Months AND C. Has Below Average Grades OR D. Is not Attending An Education Program AND E. Has No Vocational/Employment Goal AND F. Has a Poor Work History (To include No Work (History) OR Has been fired From a Job in the Last Six Calendar Months Case/Activity notes must include documentation that either (a), (b), AND (c) apply or That (d), (e), AND (f) apply. To do so, the case/activity notes must include (a) the Applicant s/participant s education status, (b) the applicant s/participant s prior drop-out Status or poor attendance history., AND an indication of how grades are Below average, or (d) the applicant s/participant s education status, (e) indication that there is no vocational goal AND (f) specifics of the poor/no work history or firing from employment in the prior six calendar months. Attachment Page 4

8 YOUNGER AND OLDER YOUTH YYE/ OYE 30 School Status At Participation = In-School, H.S. or less 2= In-School, Alternative School 3= In-School, Post-H.S. 4= Not attending School or H.S. Dropout 5= Not attending School; H.S. Graduate Applicable Records from Educational Institution (i.e. GED, Certificate, Diploma, Post-Secondary Enrollment, Attendance Record, Transcripts, Dropout Letter, School Documentation) Self-Attestation (Client Statement-Notarized) WF+: Printout Of Intake/Application Form, Signed And Dated By Applicant (And Parent/Guardian if applicable) AND WF+ Participation Fields Information Screen, Signed and Dated by Applicant (And Parent/Guardian If Applicable) if education status changed between application and enrollment (if applicable) YYE/ OYE 3 Basic Literacy Skills Deficient (As Defined In ξ ) = Yes 2= No Standardized Assessment Test Test Records School Records Case/Activity Notes (Test Name With Scores In School Year Month Format Front Line Staff must make sure a copy of the participant s tests and scores are kept in the case file YYXP/ OYXP 35 Date of Exit WF+: After Exit is Keyed into WF+ Printouts of WF+ Case Profile Screen and Case/Activity Notes documenting date of receipt of last service Attachment Page 5

9 YOUNGER AND OLDER YOUTH 38 Date of First Youth Service Case/Activity Notes WF+: After Exit is Keyed into WF+, Printout of WF+ Employment Screen YYXP/ OYXP 6 Other Reason for Exit (at time of exit or during 3-quarter measurement period following the quarter of Exit) = Institutionalized 2= Health/Medical 3= Deceased 4= Family Care 5= Reservists Called to Active Duty 6= Relocated to Mandated Residential Program 7= Invalid SSN 77 Enrolled in Education = Yes 2= No Case/Activity Notes Doctor s Records Hospital Records (Written) Contact With Penal System WF+: After Exit is Keyed Into WF+, Printout of Leave Program Screen (exits Prior to 7--06) or Outcomes Screen (exits 7--06) Copy of Records from Education Institution or Training Provider Certifying Enrollment Case/Activity Notes with verification from educational institute of training provider that they are enrolled in education Note: Educational status on participation date, OR enrolled in education during program participation, OR in secondary/post-secondary school at program exit. Attachment Page 6

10 YOUNGER AND OLDER YOUTH 78 Received Educational Achievement Services = Yes 2= No Y- Alternative Secondary School Offerings Y- Tutoring, Study Skills Training and Instruction Y- Academic Learning Services (prior to March 200) Case/Activity Notes Activity Sheets Sign-In Sheets Attendance Records WF+: After Exit is Keyed Into WF+, Printout of Employment Plan Screen Showing One of the indicated Y activities YYA / 79 Received Employment Services = Yes 2= No Y- Paid & Unpaid Work Experience Y- Occupational Skills Training Y- Youth Employment Y- Work Related Services Case/Activity Notes Activity Sheets Vendor Contract Attendance Roster WF+: After Exit is Keyed Into WF+, Printout of Employment Plan Screen Showing One of the indicated Y activities 80 Received Summer Employment = Yes 2= No Y- Summer Employment Opportunities Y- Summer Related Services Case/Activity Notes Activity Sheets Work Agreement Sign-In Sheets Attendance Rosters WF+: After Exit is Keyed Into WF+, Printout of Employment Plan Screen Showing One of the indicated Y activities Attachment Page 7

11 YOUNGER AND OLDER YOUTH 8 Received Additional Support for Youth Services = Yes 2= No Y- Adult Mentoring Y- Comprehensive Guidance and Counseling Case/Activity Notes Activity Sheets Pay Stub Sign-In Sheets Attendance Rosters Vendor Contractor WF+: After Exit is Keyed Into WF+, Printout of Employment Plan Screen Showing One of the indicated Y activities 82 Received Leadership Development Opportunities = Yes 2= No Y- Leadership Development Opportunities Case/Activity Notes Activity Sheets Vendor Contract Attendance Rosters WF+: After Exit is Keyed Into WF+, Printout of Employment Plan Screen Showing One of the indicated Y activities Attachment Page 8

12 YOUNGER AND OLDER YOUTH YYXP/ OYXP 83 Received Follow-up Services = Yes 2= No Y- Follow-up Services Case/Activity Notes Activity Sheets Attendance Rosters Receipt For Follow-up Supportive Services WF+: After Exit is Keyed Into WF+, Printout of Employment Plan Screen Showing One of the indicated Y activities YYXP/ OYXP 84 Employed In st Quarter After Exit = Yes 2= No 3= Information not Yet Available U. I. Wage Records WRIS Supplemental Data as Defined TEGL 7-05 Employer Statement Check Stub Copy of Notice of Direct Deposit Participant s Business/Tax-Related Records WF+: Printout of st Quarter Supplemental Data Screen YYXP 85 Type of Employment Match st Quarter After Exit Quarter YYXP/ OYXP = UI Wage Records (In-State & WRIS) 2= Federal Employment Records (OPM, USPS) 3= Military Employment Records 4= Other Administrative Wage Records 5= Supplemental through case management, Participant survey, and/or verification with the Employer 6= Information not Yet Available 9 Employed in 3 rd Quarter After Exit Quarter = Yes 2= No 3= Information Not Yet Available Case/Activity Notes Follow-up Services Record Sharing and/or Automated Matching with Other Employment and Administrative Data Base Other Out of State Wage Record Systems Employer Statement Check Stub Copy of Notice of Direct Deposit Participant s Business/Tax-Related Records WRIS WF+: Printout of st Quarter Supplemental Data Screen plus employer or statement And/or check stub/copy U. I. Wage Records WRIS Supplemental Data as Defined TEGL 7-05 Employer Statement Check Stub Copy of Notice of Direct Deposit Participant s Business/Tax-Related Records WF+: Printout of 3 rd Quarter Supplemental Data Screen Attachment Page 9

13 YOUNGER AND OLDER YOUTH YYXP/ OYXP YYXP/ OYXP YYXP/ OYXP YYXP/ OYXP YYXP/ OYXP 92 Type of Employment Match 3 rd Quarter After Exit Quarter = UI Wage Records (In-State & WRIS) 2= Federal Employment Records (OPM, USPS) 3= Military Employment Records 4= Other Administrative Wage Records 5= Supplemental through case management, Participant survey, and/or verification with the Employer 6= Information not Yet Available 98 Wages st Quarter After Exit U. I. Wages WRIS Other State Wage Records Federal Wage Databases 00 Wages 3 rd Quarter After Exit U. I. Wages WRIS Other State Wage Records Federal Wage Databases 5 Attained Diploma, GED, Certificate - Individual Attained a Secondary School (high school) Diploma 2- Individual Attained a GED or High School Equivalency Diploma 3- Individual Attained a Certificate in Recognition of Attainment of Technical or Occupational Skills 4- Individual Did Not Attain a Diploma, GED, or Certificate Case/Activity Notes Follow-up Services Record Sharing and/or Automated Matching with Other Employment and Administrative Data Base Other Out of State Wage Record Systems Employer Statement Check Stub Copy of Notice of Direct Deposit Participant s Business/Tax-Related Records WRIS WF+: Printout of 3 rd Quarter Supplemental Data Screen plus employer or statement And/or check stub/copy Copy of School Transcript Indicating Requirements for Credential/Certificate Completed Copy of Credential//Certificates Copy of Diploma/License/Degree School Records/Statement 52 Date Attained Diploma, GED, or Certificate Copy of School Transcript Indicating Date for Credential/Certificate Completed Copy of Credential//Certificates Copy of Diploma/License/Degree Test Results Indicating Date Requirements For Diploma/GED Completed Attachment Page 0

14 YOUNGER AND OLDER YOUTH School Records/Statement YYXP/ OYXP YYXP/ OYXP YYXP/ OYXP 53 School Status at Exit = In-School, H.S. or less 2= In-School, Alternative School 3= In-School, Post H.S. 4= Not attending school or H.S. Dropout 5= Not attending school; H.S. Graduate 54 Youth Placement Information = Entered Post-Secondary 2= Entered Advanced Training 3= Entered Military Service 4= Entered a Qualified Apprenticeship 55 Youth Retention Information = In Post-Secondary 2= In Advanced Training 3= In Military Service 4= In a Qualified Apprenticeship Note: Date on source document used for 5 should match the date entered into WF+ Case/Activity Notes Letter From School System (secondary or post-secondary Applicable Records From Educational Institute (I.E.) GED, Post-Secondary Enrollment, Attendance Record, Dropout Letter, School Documentation Copy of Transcripts Copy of Credentials/Certificated Copy of Diploma/GED/Degree Case/Activity Notes Cross-Match With Appropriate Agencies -Apprenticeship Verification - Military Service Records - Advance Training Institutes - Post-Secondary Education Institutions Transcripts Registration Forms Community College and/or University Records U.I. Wage Records WRIS Employer Statement Check Stub Copy of Notice of Direct Deposit Participant s Business/Tax-Related Records Signed Statements From Appropriate Agencies (Apprenticeship, Advanced Training Institutions, Post-Secondary Institutions) Federal and Department of Defense Wage Records Case/Activity Notes Cross-Match With Appropriate Agencies -Apprenticeship Verification - Military Service Records - Advance Training Institutes - Post-Secondary Education Institutions Transcripts Registration Forms Community College and/or University Records U.I. Wage Records WRIS Employer Statement Check Stub Attachment Page

15 YOUNGER AND OLDER YOUTH 56 Category of Assessment 57/7/ 85 58/72/ 86 59/73/ 87 60/74/ 88 = ABE 2= ESL Type of Assessment Test #/2/3 = TABE 2= CASAS (Life Skills) 3= ABLE 4= WorkKeys 5= SPL 6= Oral 7= BEST 8= BEST Plus Functional Area #/2/3 = Reading 2= Writing 3= Language 4= Mathematics 5= Speaking 6= Oral 7= Listening Test #/2/3 Pre-Test Score #/2/3 Copy of Notice of Direct Deposit Participant s Business/Tax-Related Records Signed Statements From Appropriate Agencies (Apprenticeship, Advanced Training Institutions, Post-Secondary Institutions) Federal and Department of Defense Wage Records Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Attachment Page 2

16 YOUNGER AND OLDER YOUTH 6/75/ 89 Educational Functioning Level #/2/3 = Beginning ABE/ESL Literacy 2= Beginning ABE/ESL Basic Education 3= Low Intermediate ABE/ESL Education 4= High Intermediate ABE/ESL Education 5= Low Adult Secondary Education/Advanced ESL 6= High Adult Secondary Education/Advanced ESL Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file 62/76/ 90 63/77/ 9 64/78/ 92 Post-Test #/2/3 (Year ) Post-Test #/2/3 Score (Year ) Post-Educational Functioning Level #/2/3 (Year ) Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Attachment Page 3

17 YOUNGER AND OLDER YOUTH 65/79/ 93 Post-Test #/2/3 (Year 2) 66/80/ / 95 68/82/ 96 69/83/ 97 70/84/ 98 Post-Test Score #/2/3 (Year 2) Post-Educational Functioning Level #/2/3 (Year 2) Post-Test #/2/3 (Year 3) Post-Test #/2/3 (Year 3) Post-Test Educational Functioning Level #/2/3 (Year 3) Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Test Records Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the Participant s test and scores are kept in the Case file. Case notes must detail the participant s progress Copies of test results and case notes must be included in the file Attachment Page 4

18 PROGRAM SPECIFIC YOUNGER YOUTH DWD Field Ref# Data Element Federal & State Sources YYE 32 Foster Care Youth = Yes 2=No Written confirmation from Social Services Agency Case/Activity Notes YYA 03/07/ /5/ 9/23/ 27/3/ 35/39/ 43/47 NOTE: Record if the participant is a person who is currently in Foster Care or has been in the foster care system at any Point during his/her lifetime. Record 2 if the participant does not meet the condition Described above Goal #-2 Type = Basic Skills 2= Occupational Skills 3= Work Readiness Skills Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the participant s test scores are kept in the case file WF+: After exit is keyed into WF+, Printout of case profile screen Attachment 2 Page

19 PROGRAM SPECIFIC YOUNGER YOUTH YYA 04/08/ 2/6/ 20/24/ 28/32/ 36/40/ 44/48 YYA 05/0 9/ 3/ 7/ 2/2 5/ 29/3 3/ 37/4 / 45/4 9 YYA 06/ 0/ 4/ 8/ 22/2 6/ 30/3 4/ 38/4 2/ 46/5 0 Date Goal #-2 was set Attainment of Goal #-2 = Attained 2= Set, not attained 3= Set, Attainment pending Date Attained Goal #-2 Case Activity notes WF+: After exit is keyed into WF+, Printout of case profile screen Case/Activity Notes documenting the necessary details for each element of testing Front Line Staff should make sure a copy of the participant s test scores are kept in the case file Transcripts School/Employer Notification WF+: After exit is keyed into WF+, Printout of case profile screen Case/Activity Notes WF+: After exit is keyed into WF+, Printout of case profile screen Attachment 2 Page

20 PROGRAM SPECIFIC OLDER YOUTH OYE 2 Eligible Veteran Status = Yes 80 Days 2= Yes, Eligible Veteran 3= Yes, Other Eligible Person 4= No DD-24, Report of Transfer or Discharge Paper Cross-Match with Veterans Data Veteran s Service Officer Statement/Printout OYXP 95 Wages 3 rd Quarter Prior to Participation Quarter U. I. Wages WRIS Other State Wage Records Federal Wage Databases OYXP 96 Wages 2 nd Quarter Prior to Participation Quarter U. I. Wages WRIS Other State Wage Records Federal Wage Databases OYXP 99 Wages 2 nd Quarter After Exit U. I. Wages WRIS Other State Wage Records Federal Wage Databases OYXP 02 Type of Recognized Credential = High School Diploma/Equivalency/GED 2= AA or AS Diploma 3= BA or BS Diploma/Degree 4= Occupational Skills License 5= Occupational Skills Certificate or Credential 6= Other Recognized Educational or Occupational Skills Credential/Certificate 0= Individual receiving training, but no recognized credential received Copy of School Transcript Indicating Requirements for Credential/Certificate Completed Copy of Credential//Certificates Copy of Diploma/License/Degree School Records/Statement Note: Master s Degree or higher, use code 6 Attachment 2 Page 2

21 Eastern Carolina Workforce Development Board, Inc. Younger Youth File Checklist Participant Name: Case Manager: Data Element File Code Check Source(s) Used Section Verification of Residency Verification of Citizenship Number in Family or Family of One Verification Verification of Selective Service Registration for Males born on or after January, 960 Individual with a Disability Eastern Carolina Workforce Development Board Disclosure Release Form Equal Opportunity is the Law Participant Orientation Form Printed Copy of WorkforcePlus Intake/Assessment Information (Signed) Assessment Tools 3 Individual Identifier Social Security Card YYE2 DD-24, Discharge Paper Birth Certificate Date of Birth DD-24, Discharge Paper YYE3 Driver s License DMV ID Card Employment Status At Participation (Application) YYE6 WF+ Printed Application signed & dated by applicant Low Income (not food stamps) YYE20 Employer Verification of Income Pay Stubs UI Documents and/or Printout Attachment 2 Page

22 Eastern Carolina Workforce Development Board, Inc. Younger Youth File Checklist TANF Other Public Assistance Homeless Individual And/ Or Runaway Offender Pregnant Or Parenting Youth Who Needs Additional Assistance School Status at Participation Basic Literacy Skills Deficiency Foster Care Youth Date of Exit Date of First Youth Service Other Reason for Exit YYE2 YYE22 YYE26 YYE27 YYE28 YYE29 YYE30 YYE3 2 5 YYE32 YYXP35 YYA38 YYXP6 Enrolled in Education 5 YYA77 Applicant Statement (Notarized) Written Verification from DSS DSS TANF Printout SSI Award Letter Letter from Social Security Administration WF+ Printed Application signed & dated by applicant Applicant Statement (Notarized) Written Statement from a Shelter Written Statement from Social Service Agency WF+ Printed Application signed & dated by applicant Documentation from Criminal Justice System Applicant Statement (Notarized) Copy of Child s Birth Certificate WF+ Printed Application signed & dated by applicant Doctor s Note Confirming Pregnancy WF+ Printed Application signed & dated by applicant Case/Activity Notes WF+ Printed Application signed & dated by applicant School Records Standardized Assessment Test Test Records School Records Written Documentation from DSS WF+: After Exit is Keyed into WF+, Printout of WF+ Case Profile and Case/Activity Notes documenting date of receipt of last service WF+ Printout of WF+ Employment Plan Doctor s Note/Records Written Contact with the Justice System School or Training Provider Record Case notes with verification from educational institution Attachment 2 Page 2

23 Eastern Carolina Workforce Development Board, Inc. Younger Youth File Checklist Received Education Achievement Services Received Employment Service Received Summer Employment Opportunities Received Additional Support for Youth Services Received Leadership Development Opportunities Received Follow-up Services Employed in st Quarter After Exit Quarter Type of Employment Match st Qtr After Exit 2/4/5 2/4/5 2 2 YYA78 YYA79 YYA80 YYA8 YYA82 YYA83 YYXP84 YYXP85 Activity Sheets Attendance Record WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attendance Rosters WF+: After Exit is Keyed into WF+, Printout of Employment Plan Worksite Agreement Timesheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attendance Rosters Sign-In Sheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Activity Sheets Attendance Rosters Sign-In Sheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attendance Rosters Sign-In Sheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Employment Verification Completed by Employer Check Stub within st Quarter after exit WF+ Printout of st Qtr Supplemental data with supporting documentation Employment Verification Completed by Employer Check Stub within st Quarter after exit WF+ Printout of st Qtr Supplemental data with supporting documentation Attachment 2 Page 3

24 Eastern Carolina Workforce Development Board, Inc. Younger Youth File Checklist Employed 3 rd Qtr After Exit Type of Employment Match 3 rd Qtr After Exit Goal #-2 Type Basic Skills Work Readiness Occupational Skills Date Goal # -2 Was Set Attainment of Goal #- 2 Date Attained Goal #-2 Attained Diploma, GED, or Certificate YYXP9 YYXP92 YYA03/07/ /5/9/ 23/27/3/ 35/39/43/ 47 YYA04/08/ 2/6/20/ 24/28/32/ 36/40/44/ 48 YYA05/09/ 3/7/2/ 25/29/33/ 37/4/45/ 49 YYA06/0/ 4/8/22/ 26/30/34/ 38/42/46/ 50 YYXP5 Employment Verification Completed by Employer Check Stub within 3rd Quarter after exit WF+ Printout of 3rd Qtr Supplemental data with supporting documentation Employment Verification Completed by Employer Check Stub within 3 rd Quarter after exit WF+ Printout of 3 rd Qtr Supplemental data with supporting documentation WF+: After Exit is Keyed Into WF+, Printout of Case Profile Screen WF+: After Exit is Keyed Into WF+, Printout of Case Profile Screen Test Records WF+: After Exit is Keyed Into WF+, Printout of Case Profile Screen Test Records WF+: After Exit is Keyed Into WF+, Printout of Case Profile Screen Copy of School Transcript Indicating Credential/Certificate Received Copy of Certificate/Diploma/License/Degree Attachment 2 Page 4

25 Eastern Carolina Workforce Development Board, Inc. Younger Youth File Checklist Date Attained Diploma, GED, or Certificate School Status at Exit Youth Placement Information 2 YYXP52 YYXP53 YYXP54 Youth Retention Information YYXP55 Category of Assessment Type of Assessment Test #/2/3 Functional Area #/2/3 Date of Administered Pre- Test #/2/3 Pre-Test Score#/2/3 Pre-Test Educational Functioning Level #/2/3 Post-Test #/2/3 (Year ) Post-Test Score #/2/3 (Year ) YYA56 YYA57/ 7/85 YYA58/ 72/86 YYA59/ 73/87 YYA60/ 74/88 YYA6/ 75/89 YYA62/ 76/90 YYA63/ 77/9 Copy of School Transcript Indicating Credential/Certificate Received and Date Received Copy of Certificate/Diploma/License/Degree and Date Received Copy of School Transcript Indicating Credential/Certificate Received and Date Received Copy of Certificate/Diploma/License/Degree and Date Received Military Records Transcripts Check Stub Employer Statement Military Records Transcripts Check Stub Employer Statement Test Records with copy of test and scores Test Records with copy of test and scores Test Records with copy of test and scores Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Post-Test Educational YYA64/ Test Records including Attachment 2 Page 5

26 Eastern Carolina Workforce Development Board, Inc. Younger Youth File Checklist Functioning Level #/2/3 (Year ) Date-Administered Post- Test #/2/3 (Year 2) Post-Test Score #/2/3 (Year 2) Post-Test Education Functioning Level #/2/3 (Year 2) Post-Test #/2/3 (Year 3) Post-Test Score #/2/3 (Year 3) Post-Test Educational Functioning Level #/2/3 (Year 3) 78/92 with copy of test and scores and Test Records including YYA65/ with copy of test and scores and 79/93 YYA66/ 80/94 YYA67/ 8/95 YYA68/ 82/96 YYA69/ 83/97 YYA70/ 84/98 Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Review Completed By: Date Completed: Attachment 2 Page 6

27 Eastern Carolina Workforce Development Board, Inc. Older Youth File Checklist Participant Name: Case Manager: Data Element File Code Check Source(s) Used/File Documents Section Verification of Residency Verification of Citizenship Number in Family or Family of One Verification Verification of Selective Service Registration for Males born on or after January, 960 Individual with a Disability Eastern Carolina Workforce Development Board Disclosure Release Form Equal Opportunity is the Law Participant Orientation Form Printed Copy of WorkforcePlus Intake/Assessment Information (Signed) Assessment Tools 3 Individual Identifier Social Security Card OYE2 DD-24, Discharge Paper Birth Certificate Date of Birth DD-24, Discharge Paper OYE3 Driver s License DMV ID Card Veteran Status OYE2 DD-24, Discharge Paper Employment Status At WF+ Printed Application signed & dated by OYE6 Participation (Application) applicant Employer Verification of Income Low Income (not food Pay Stubs OYE20 stamps) UI Documents and/or Printout Applicant Statement (Notarized) TANF Written Verification from DSS OYE2 DSS TANF Printout Other Public Assistance SSI Award Letter OYE22 Letter from Social Security Administration Attachment 3 Page

28 Eastern Carolina Workforce Development Board, Inc. Older Youth File Checklist Homeless Individual And/ Or Runaway Offender Pregnant Or Parenting Youth Who Needs Additional Assistance School Status at Participation Basic Literacy Skills Deficiency OYE26 OYE27 OYE28 OYE29 OYE30 OYE3 Date of Exit OYXP35 Date of First Youth Service 2 38 Other Reason for Exit 5 OYXP6 Enrolled in Education 5 77 Received Education Achievement Services Received Employment Service 78 2/4/5 79 WF+ Printed Application signed & dated by applicant Applicant Statement (Notarized) Written Statement from a Shelter Written Statement from Social Service Agency WF+ Printed Application signed & dated by applicant Documentation from Criminal Justice System Applicant Statement (Notarized) Copy of Child s Birth Certificate WF+ Printed Application signed & dated by applicant Doctor s Note Confirming Pregnancy WF+ Printed Application signed & dated by applicant Case/Activity Notes WF+ Printed Application signed & dated by applicant School Records Standardized Assessment Test Test Records School Records WF+: After Exit is Keyed into WF+, Printout of WF+ Case Profile and Case/Activity Notes documenting date of receipt of last service WF+ Printout of WF+ Employment Plan Doctor s Note/Records Written Contact with the Justice System School or Training Provider Record Case notes with verification from educational institution Activity Sheets Attendance Record WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attendance Rosters WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attachment 3 Page 2

29 Eastern Carolina Workforce Development Board, Inc. Older Youth File Checklist Received Summer Employment Opportunities Received Additional Support for Youth Services Received Leadership Development Opportunities Received Follow-up Services Employed in st Quarter After Exit Quarter Type of Employment Match st Qtr After Exit 2/4/ OYXP84 OYXP85 Employed 3 rd Qtr After Exit 2 OYXP9 Type of Employment Match 3 rd Qtr After Exit Type of Recognized Credential 2 2 OYXP92 OYXP02 Worksite Agreement Timesheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attendance Rosters Sign-In Sheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Activity Sheets Attendance Rosters Sign-In Sheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Attendance Rosters Sign-In Sheets WF+: After Exit is Keyed into WF+, Printout of Employment Plan Employment Verification Completed by Employer Check Stub within st Quarter after exit WF+ Printout of st Qtr Supplemental data with supporting documentation Employment Verification Completed by Employer Check Stub within st Quarter after exit WF+ Printout of st Qtr Supplemental data with supporting documentation Employment Verification Completed by Employer Check Stub within 3rd Quarter after exit WF+ Printout of 3rd Qtr Supplemental data with supporting documentation Employment Verification Completed by Employer Check Stub within 3 rd Quarter after exit WF+ Printout of 3 rd Qtr Supplemental data with supporting documentation Copy of School Transcript Indicating Credential/Certificate Received Copy of Certificate/Diploma/License/Degree Attained Diploma, GED, or Certificate 2 OYXP5 Copy of School Transcript Indicating Credential/Certificate Received Copy of Certificate/Diploma/License/Degree Attachment 3 Page 3

30 Eastern Carolina Workforce Development Board, Inc. Older Youth File Checklist Date Attained Diploma, GED, Or Certificate School Status at Exit Youth Placement Information Youth Retention Information 2 OYXP52 Category of Assessment Type of Assessment Test #/2/3 Functional Area #/2/3 Date of Administered Pre- Test #/2/3 OYXP53 OYXP54 OYXP55 Pre-Test Score#/2/3 Pre-Test Educational Functioning Level #/2/3 Post- Test #/2/3 (Year ) Post-Test Score #/2/3 (Year ) Post-Test Educational Functioning Level #/2/3 (Year ) 56 57/ 7/85 58/ 72/86 59/ 73/87 60/ 74/88 6/ 75/89 62/ 76/90 63/ 77/9 64/ 78/92 Copy of School Transcript Indicating Credential/Certificate Received and Date Received Copy of Certificate/Diploma/License/Degree and Date Received Copy of School Transcript Indicating Credential/Certificate Received and Date Received Copy of Certificate/Diploma/License/Degree and Date Received Military Records Transcripts Check Stub Employer Statement Military Records Transcripts Check Stub Employer Statement Test Records with copy of test and scores Test Records with copy of test and scores Test Records with copy of test and scores Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Attachment 3 Page 4

31 Eastern Carolina Workforce Development Board, Inc. Older Youth File Checklist Date-Administered Post- Test #/2/3 (Year 2) Post-Test Score #/2/3 (Year 2) Post-Test Education Functioning Level #/2/3 (Year 2) Post- Test #/2/3 (Year 3) Post-Test Score #/2/3 (Year 3) Post-Test Educational Functioning Level #/2/3 (Year 3) 65/ 79/93 66/ 80/94 67/ 8/95 68/ 82/96 69/ 83/97 70/ 84/98 Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Test Records including with copy of test and scores and Review Completed By: Date Completed: Attachment 3 Page 5

32 Eastern Carolina Workforce Development Board, Inc. Section Checklist Section One Intake/Eligibility Check the appropriate box and ensure all applicable forms and documentation are filed in this section. Printed Copy of WIA WorkforcePlus Intake/Assessment Information {Signed) Eastern Carolina Workforce Development Board Disclosure/Release Form Equal Opportunity is the Law Participant Orientation Form Verification of Social Security Number Verification of Residency Verification of Date of Birth Verification of Citizenship Verification of Selective Service Registration for Males born after January, 960 Age 4 to 2 Public Assistance {TANF, SSI} Food Stamps Person with a Disability Individual/Family Income Number in Family Verification Deficient in basic literacy skills A school dropout Homeless, a runaway, or a foster child Pregnant or parenting An offender An individual who requires additional assistance to complete an educational program, or to secure and hold employment. Is currently attending an educational program AND has previously dropped out of an educational program OR has poor attendance patterns in an educational program during the last 2 months, AND has below average grades. OR Is not attending an educational program AND has no vocational/employment goal AND has a poor work history (to include no work history) OR has been fired from a job in the last six calendar months. Attachment 4 Page

33 Eastern Carolina Workforce Development Board, Inc. Section Checklist Section Two Participant Activities Check the appropriate box and ensure all applicable forms and documentation are filed in this section. Workforce Investment Act Youth Individual Service Strategy Printed Copy of WorkforcePlus Case Profile Printed Copy of WorkforcePlus Y-Comprehensive Guidance and Counseling Printed Copy of Youth Employment Plan Screen After Exit (including goals 4-8 attach copy of pre and post-assessments) Printed Copy of Younger Youth Goals Screen (Attach copies of pre and post-assessments) Printed Copy of Literacy and Numeracy Goals Screen (Attach copies of pre and post-assessments) Printed Copy of WorkforcePlus Employment Plan Printed Copy of WorkforcePlus Leave Program Printed Copy of Youth Outcomes Printed Copy of st Quarter Supplemental Data (if applicable) Printed Copy of 3 rd Quarter Supplemental Data (if applicable) Printed Copy of WIA WorkforcePlus Exit WIA Printed Copy of WIA WorkforcePlus Post Program Activity(ies) Upon Completion of the program, please place the following items in this section; Leave, Exit, and Outcomes (hard copy), Supporting documentation for Outcomes and placement (Copies of transcripts, diplomas, certificates). Include supplemental data (if applicable) such as pay stubs or employer statements. Attachment 4 Page 2

34 Eastern Carolina Workforce Development Board, Inc. Section Checklist Section Three Assessments Ensure all assessment results to include pre-assessments and post-assessments are filed in this section Assessment Instruments (TABE, CASAS, COPS,CAPS, INEGRATOR, Computer Learning Works Employability and Work Maturity Skills and Eastern Carolina Workforce Development Board s Work Readiness and Occupational Skills Benchmarking System s pre and post-assessments). Attachment 4 Page 3

35 Eastern Carolina Workforce Development Board, Inc. Section Checklist Section Four Worksite Forms Check the appropriate box and ensure all applicable forms and documentation are filed in this section. Copy of Child Labor Laws (if applicable) Worksite Agreement/I-9 Forms Job Description List of Participants at Worksite Worksite Supervisor Orientation WIA Worksite Checklist Worksite Supervisor Progress Evaluation Copies of Participant Timesheets Copy of On-the-Job Training Contract (if applicable) Case/Activity notes should be updated at least every 30 days. If no WIA or partner services are provided for over a 90 day period, the participant should be exited as of the date of the last service provided. Follow-up should also be documented in case/activity notes. Attachment 4 Page 4

36 Eastern Carolina Workforce Development Board, Inc. Section Checklist Section Five Case/Counseling Notes/Correspondence Check the appropriate box and ensure all applicable forms and documentation are filed in the section. Case Notes/Activity Notes (notes should in program entry, participation, support, exit and follow-up information) Attendance/Sign-In Sheets/Grades Correspondence Pertaining to Participant Financial Award Analysis (if applicable) Supportive Services Back-up Documentation Follow-up Information Attachment 4 Page 5