Get documents about "Final ARRA WIA Adult and Dislocated Worker Review Tool 2011-12
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American Recovery and Reinvestment Act 2011-
2012 Workforce Investment Act
References Location of Data
Adult and Dislocated Worker
RWB ____ On-Site Quality Assurance Review Tool
DEO sample selection
Review Period:
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Participant Last Name:
DEO sample selection
Participant First Name:
State MIS Application or Hard copy
SSN (last four digits):
State MIS Application or Hard copy
Case Manager:
Special Project Contractor's Name:
Special Project Name:
Reviewer Name:
Dates of On-Site Review:
PROGRAM ELIGIBILITY
State MIS or Hard/Electronic Case
1 Indicate whether participant is an Adult (A) or Dislocated Worker (DW).
File Supporting Documentation.
If an Adult, was priority of service in effect for the region at the time of 20 CFR 663.600, WIA Sec. 134 State MIS or Hard/Electronic
2 registration? (Y, X) (Note: X=priority of service was not in effect at time of (d)(4)(A), and Local Workforce Case File Supporting
registration). Service Plan Documentation
If yes to # 2, was the Adult determined low income under the priority of service
rule as described in the local plan and was there documentation in the file to
20 CFR 663.600, WIA Sec. 134 State MIS or Hard/Electronic
support the low income determination? (Y, N, X) (Note: X= Priority of service was
3 (d)(4)(A), and Local Workforce Case File Supporting
not in effect at time of registration, low-income was not applicable to the Service Plan Documentation
participant, or participant was a Dislocated Worker or Incumbent Worker) (Note:
Only applicable if received Intensive or Training services).
If a Dislocated Worker, did the case file contain documentation of lay-off, State MIS or Hard/Electronic
WIA Sec. 101(9) and (10), WIA Case File Supporting
4 termination, plant closure, or other eligible Dislocated Worker criteria? (Y, N, X)
Resource Guide Documentation (Note: self-
(Note: X=Participant was not determined eligible as a Dislocated Worker). attestation is acceptable)
Was documentation in the case file that the participant was 18 years of age or 20 CFR 663.110, WIA Sec. 101(1), Hard/Electronic Case File
5
older at registration? (Y, N). WIA Resource Guide Supporting Documentation
Was documentation in the case file of U.S. citizenship or authorization to work in 29 USC 2938(a)(5), WIA Sec.188 Hard/Electronic Case File
6
the U.S.? (Y, N). (a)(5), WIA Resource Guide, Supporting Documentation
If required, was documentation in the case file of Selective Service Registration or
29 USC 2939(h), WIA Sec.189(h),
an allowable exemption? (Y, N, X) (Note: X= exempt from selective service Hard/Electronic Case File
7 WIA Resource Guide, Local
registration) (Note: federal requirement for males born on or after January 1, Supporting Documentation
Workforce Service Plan,
1960).
Veterans
20 CFR 1010; WIA Sec. 168, TEGL State MIS or Hard/Electronic
If the participant was a veteran, did the file contain documentation to verify
8 14-08, and Local Workforce Service Case File Supporting
veteran status? (Y, N, X) (Note: X= Participant was not a veteran.). Plan Documentation
If the participant was an eligible spouse of a veteran, did the file contain 20 CFR 1010, JVA(38 U.S.C. 4215(a)) State MIS or Hard/Electronic
9 documentation to verify eligible spouse of a veteran status?(Y, N, X) (Note: X= Sec. 2(a),TEGL 14-08, Local Case File Supporting
Participant was not an eligible spouse of a veteran.). Workforce Service Plan Documentation
Last Updated:
DEO sample selection
Participant Last Name:
DEO sample selection
Participant First Name:
State MIS Application or Hard copy
SSN (last four digits):
State MIS Application or Hard copy
Case Manager:
Special Project Contractor's Name:
Special Project Name:
Reviewer Name:
Dates of On-Site Review:
ASSESSMENT and PROGRAM ACTIVITIES
Core Services
State MIS or Hard/Electronic
Was documentation in the case file of a Core service such as an initial 20 CFR 663.160(a), WIA Sec.
10 Case File Supporting
assessment or job search and placement assistance? (Y, N). 134(d)(2), WIA Resource Guide,
Documentation
Intensive Services
State MIS or Hard/Electronic
Was an Intensive service entered in the State's MIS? (Y, X) (Note: X = Participant 20 CFR 663.200(a) and 220, WIA
11 Case File Supporting
received Core services only) (If X, questions 12 and 13 will also be X). Sec. 134(d)(3), WIA Resource Guide
Documentation
If yes to #11, was documentation in the case file of an Intensive service such as a State MIS or Hard/Electronic Case
20 CFR 663.220, 240, and 245, WIA
12 jointly developed Individual Employment Plan (IEP) or Individual Counseling and File Supporting Documentation,
Sec. 134(d)(3), WIA Resource Guide
Career Plan? (Y, N, X) (Note: X = Participant received Core services only). Case Notes
If yes to #12, was documentation in the case file of a determination of need for 20 CFR 663.160(b), 220, 240(b), WIA State MIS or Hard/Electronic Case
13 Intensive services to gain/obtain employment, or retain employment leading to Sec. 134(d)(3)(ii), WIA Resource File Supporting Documentation,
"self-sufficiency"? (Y,N,X) (Note: X= Participant received Core services only). Guide Case Notes
Work Experience
Did the individual participate in Work Experience (WE)? (Y, X) (Note: X =
State MIS or Hard/Electronic Case
14 Participant did not receive a WE activity). (If X, questions 15 through 19 will also Local Workforce Service Plan
File Supporting Documentation
be X).
If yes to #14, was a WE training agreement executed between the employer and
State MIS or Hard/Electronic Case
15 the Region for the participant's training? (Y,N,X) (Note: X = Participant did not Local Workforce Service Plan
File Supporting Documentation
receive a WE activity).
Was documentation in the case file that the WE start date was on or after the
Local Workforce Service Plan and State MIS or Hard/Electronic Case
16 employer's WE training agreement effective date? (Y, N) (Note: X = Participant
WE contract agreement File Supporting Documentation
did not receive a WE activity).
Was the WE training provided as described in the WE Training Plan? (Y, N) Local Workforce Service Plan and State MIS or Hard/Electronic Case
17
(Note: X = Participant did not receive a WE activity). WE contract agreement File Supporting Documentation
CFR 20 663.200, Fair Labor
State MIS or Hard/Electronic Case
18 Was this a paid WE? (Y,X) (Note: X=Participant did not receive paid WE) Standards Act, Local Workforce
File Supporting Documentation
Service Plan
If yes to #18, was the participant paid the wage stated in the agreement and were CFR 20 663.200, Fair Labor
State MIS or Hard/Electronic Case
19 FLSA requirements met? (Y, N) (Note: X = Participant did not receive a WE Standards Act and Local Workforce
File Supporting Documentation
activity). Service Plan
Last Updated:
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Participant Last Name:
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Participant First Name:
State MIS Application or Hard copy
SSN (last four digits):
State MIS Application or Hard copy
Case Manager:
Special Project Contractor's Name:
Special Project Name:
Reviewer Name:
Dates of On-Site Review:
Occupational/Skills Upgrade Training
Was an Occupational/Skills Upgrade Training activity entered in the State's MIS? State MIS or Hard/Electronic Case
WIA Resource Guide, Special Project
20 (Y, N, X) (Note: X = Participant did not receive Occupational/Skills Upgrade File Supporting Documentation,
Contract
Training services) (If X, questions 21 through 24 will also be X). Case Notes
Was documentation in the case file of a determination of need for training
20 CFR 663.240 and 310, WIA State MIS or Hard/Electronic Case
services as identified in the IEP, comprehensive assessment, or Individual
21 Sec.134(d)(4)(A), WIA Resource File Supporting Documentation,
Counseling and Career Plan? (Y, N, X) (Note: X = Participant did not receive Guide Case Notes
Occupational/Skills Upgrade Training services).
If Occupational Skills or Skills Upgrade Training was provided, was the training in 20 CFR 663 subpart E, WIA Sec. 134
State MIS or Hard/Electronic Case
(d)(4)(G)(iii), WIA Sec. 122 (e)(4),
22 a local/state demand occupation? (Y, N, X). (Note: X = Participant did not receive File Supporting Documentation,
WIA Sec. 117(f)(1)(B)(III), WIA
Occupational/Skills Upgrade Training services). Case Notes
Resource Guide
Was the training provider on the local/state approved eligible training provider list 20 CFR 663 Subpart E; WIA Sec.122,
AWI website, Local Eligible
23 (ETPL)? (Y, N, X). (Note: X = Participant did not receive Occupational/Skills WIA Sec. 134(d)(4), WIA Sec.
Training Provider List
Upgrade Training services). 112(17)(A)(iii), WIA Resource Guide
State MIS, Program Page, or
If an Individual Training Account (ITA) was utilized, were ITA costs recorded in the AWI FG 069, 20 CFR 663 Subpart D,
Hard/Electronic Case File
24 Training Enrollment Cost table in the State's MIS? (Y, N, X). (Note: X = WIA Sec.134(d)(4)(G), WIA
Supporting Documentation, Case
Participant did not receive Occupational/Skills Upgrade Training services). Sec.122(e)(5), WIA Resource Guide
Notes
Work-Based Training
State MIS or Hard/Electronic Case
Was the participant an employed worker at the time of registration? (Y, N). (If No,
25 File Supporting Documentation,
questions 26 through 29 will also be X). Case Notes
If yes to #25, and the participant was not referred by an employer, is there
documentation in the case file indicating that the participant was not earning a self-
20 CFR 663.310, 220 and 230, WIA Local self-sufficiency policy, State
sufficient wage at the time of registration, was in need of training services to
26 134(d)(3)(ii), Sec.134(d)(4)(A)(ii), WIA MIS, Program Page, Case Notes
obtain or retain employment leading to "self-sufficiency", and was the participant Resource Guide and/or hard copy
in agreement with the training selection? (Y, N, X) (Note: X = Referred by an
employer).
If yes to #25, and the participant was referred by an employer, is there
documentation in the case file from the employer indicating the participant was in 20 CFR 663.720 and 310, WIA Local self-sufficiency policy, State
27 need of WIA training services in order to obtain or retain employment that leads to Sec.134(d)(4)(A)(ii), WIA Resource MIS, Program Page, Case Notes
self-sufficiency as described in local policy? (Y, N, X) (Note: X = Not referred by Guide and/or hard copy
an employer).
If an IWT waiver was used, was documentation in the case file that the participant AWI Memorandum dated May 31,
State MIS or Hard/Electronic Case
2011-Layoff Aversion Incumbent
28 met the waiver requirements in effect at the time of registration? (Y, N, X) (Note: X File Supporting Documentation,
Worker Training, TEGL 26-09, TEGL
= Waiver was not used). Case Notes
30-09
If yes to #28, was the correct activity code(s) entered in the State MIS indicating
AWI Memorandum dated May 31, State MIS or Hard/Electronic Case
the use of the IWT waiver? (Y, N, X) (X = Waiver was not used). (Note: IWT
29 2011-Layoff Aversion Incumbent File Supporting Documentation,
waiver codes - 190, 290 and 390 prior to October 10, 2011; IWT waiver codes Worker Training Case Notes
191, 291 and 391 after October 11, 2011).
Last Updated:
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Participant Last Name:
DEO sample selection
Participant First Name:
State MIS Application or Hard copy
SSN (last four digits):
State MIS Application or Hard copy
Case Manager:
Special Project Contractor's Name:
Special Project Name:
Reviewer Name:
Dates of On-Site Review:
On-The-Job/Customized Training
Was On-The-Job (OJT) or Customized Training (CT) provided to the participant? 20 CFR 663.700-710, WIA Sec.
State MIS or Hard/Electronic Case
30 (Y, X) (Note: X = Participant did not receive OJT or CT) (If X, questions 31 101(8), WIA Resource Guide, and
File Supporting Documentation
through 37 will also be X). Local Workforce Service Plan
20 CFR 663.700-710, WIA Sec.
State MIS or Hard/Electronic Case
31 If yes to #30, indicate the type of training provided (OJT or CT). 101(8), WIA Resource Guide, and
File Supporting Documentation
Local Workforce Service Plan
Was an OJT/CT agreement executed between the employer and the Region for 20 CFR 663.700-710, WIA Sec.
State MIS or Hard/Electronic Case
32 the participant's training position? (Y, N, X) (Note: X = Participant did not receive 101(8), WIA Resource Guide, and
File Supporting Documentation
OJT or CT). Local Workforce Service Plan
AWI FG 00-009, 20 CFR 663.700-
Is documentation in the case file of the referral to the OJT employer? (Y, N, X) 710, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
33
(Note: X = Participant did not receive OJT) (Note: Question not applicable to CT). Guide, and Local Workforce Service File Supporting Documentation
Plan
AWI FG 00-009, 20 CFR 663.700-
If the participant was provided OJT, does the job title on the referral match the
710, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
34 occupation listed in the participant's IEP or case notes? (Y, N, X) (Note: X =
Guide, and Local Workforce Service File Supporting Documentation
Participant did not receive OJT) (Note: Question not applicable to CT). Plan
Is documentation in the case file that the participant's OJT/CT start date was on 20 CFR 663.700-710, WIA Sec.
State MIS or Hard/Electronic Case
35 or after the employer's OJT/CT contract effective date? (Y, N, X) (Note: X = 101(8), WIA Resource Guide, and
File Supporting Documentation
Participant did not receive OJT or CT). Local Workforce Service Plan
Was a copy of the OJT/CT outline in the participant's case file detailing the skills AWI FG 00-009, 20 CFR 663.700-
720, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
36 to be attained, the duration of the training and the wage rate? (Y, N, X) (Note: X =
Guide, and Local Workforce Service File Supporting Documentation
Participant did not receive OJT or CT). Plan
Was the training provided as described in the OJT/CT agreement? (Y,N,X) AWI FG 00-009, 20 CFR 663.700-
720, WIA Sec.101(31), WIA Resource State MIS or Hard/Electronic Case
37 (Note: X = Participant did not receive OJT or CT). Comment: The use of
Guide, and Local Workforce Service File Supporting Documentation
waivers is covered in the OJT and Customized Training Agreement Checklist Plan
Last Updated:
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Participant Last Name:
DEO sample selection
Participant First Name:
State MIS Application or Hard copy
SSN (last four digits):
State MIS Application or Hard copy
Case Manager:
Special Project Contractor's Name:
Special Project Name:
Reviewer Name:
Dates of On-Site Review:
CREDENTIAL ATTAINMENT
If a credential attainment was entered in the MIS, was documentation in the
TEGL17-05, TEGL 14-08, TEGL15- State MIS or Hard/Electronic Case
38 participant's case file to support the credential? (Y, N, X) (Note: X = no credential
10, TEGL17-09, WIA Resource Guide, File Supporting Documentation
entered in MIS).
If yes to #38, was the credential attainment date and type match the credential TEGL17-05, TEGL 14-08, TEGL15- State MIS or Hard/Electronic Case
39
attainment information entered in the MIS? (Y, N, X). 10, TEGL17-09, WIA Resource Guide, File Supporting Documentation
GRIEVANCE/COMPLAINT FORM
Was a signed and dated Grievance/Complaint and EEO/Discrimination Form in AWI FG 00-004 rev. 06/08/07, 20 Signed and Dated Hard/electronic
40
the participant's case file? (Y, N). CFR 667.600, WIA Sec.181(c) copy (supporting documentation)
If yes to #40, did the Grievance/Complaint and EEO/Discrimination Form include
AWI FG 00-004 rev. 06/08/07, 20 Signed and Dated Hard/electronic
41 correct names and addresses for filing a grievance, appeal or EEO complaint? (Y,
CFR 667.600, WIA Sec.181(c) copy (supporting documentation)
N).
SUPPORTIVE SERVICES
Was a supportive service activity entered in EFM? (Y, N, X) (Note: X = 20 CFR 663 Subpart H, 20 CFR
State MIS or Hard/Electronic Case
42 Participant did not receive a support service). (If X, questions 43 and 44 will also 663.245, 815, 820,840, WIA Resource
File Supporting Documentation
be X). Guide
20 CFR 663 Subpart H, 20 CFR
Did the supportive services in the case file match supportive service activities State MIS or Hard/Electronic Case
43 663.245, 815, 820,840, WIA Resource
entered in EFM? (Y, N, X) (Note: X = no supportive service was provided). File Supporting Documentation
Guide
Was documentation in the case file to show that the support services were issued 20 CFR 663 Subpart H, 20 CFR
State MIS or Hard/Electronic Case
44 in accordance with local policy? (Y, N, X) (X = No supportive service was 663.245, 815, 820,840, WIA Resource
File Supporting Documentation
provided). Guide
Last Updated:
DEO sample selection
Participant Last Name:
DEO sample selection
Participant First Name:
State MIS Application or Hard copy
SSN (last four digits):
State MIS Application or Hard copy
Case Manager:
Special Project Contractor's Name:
Special Project Name:
Reviewer Name:
Dates of On-Site Review:
EXIT and FOLLOW-UP
Was the participant exited in EFM? (Y, N) (N = Case is open or there is a WIA State MIS or Hard/Electronic Case
45 WIA Resource Guide
case closure but no exit) (If No, questions 46 and 49 will also be X). File Supporting Documentation
If yes to #45, and the participant exited with employment, was documentation in State MIS or Hard/Electronic Case
the case file that the employment start date and wage information were verified WIA Resource Guide, Federal Data File Supporting Documentation,
46
and accurately entered in the State's MIS? (Y, N, X). (X = Participant did not exit Validation Requirement Job Placement Verification, case
with employment). notes
Were required follow-ups made for each of the 1st, 2nd, 3rd, and 4th quarter after
WIA Resource Guide, TEGL 17-05,
exit intervals, as applicable? (Y,N,X) (Note: X = Participant's case is currently State MIS or Hard/Electronic Case
47 and Follow-up Memorandum 3/23/07,
open, follow-up is not due, or not required if the follow-up due date is after the File Supporting Documentation
Master Cooperative Agreement
ARRA grant expiration date of 6/30/2011).
WIA Resource Guide, TEGL 17-05,
State MIS or Hard/Electronic Case
48 Were the follow-up contacts timely? (Y, N, X) and Follow-up Memorandum 3/23/07,
File Supporting Documentation
Master Cooperative Agreement
WIA Resource Guide, TEGL 17-05,
Was employment information correctly entered in the follow-up fields in EFM for State MIS or Hard/Electronic Case
49 and Follow-up Memorandum 3/23/07,
each applicable quarter and properly verified? (Y, N, X) File Supporting Documentation
Master Cooperative Agreement
Last Updated:
RWB XX 2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool Review
Period: ________________________
Adult Dislocated Worker N/A Total
1 Indicate whether participant is an Adult (A) or Dislocated Worker (DW). 0 0 0 0
Percent 0.0% 0.0%
Yes N/A Total
If an Adult, was priority of service in effect for the region at the time of registration?
2 0 0 0
(Y, X) (Note: X=priority of service was not in effect at time of registration).
Percent 0.0%
Yes No N/A Total
If yes to # 2, was the Adult determined low income under the priority of service rule
as described in the local plan and was there documentation in the file to support
the low income determination? (Y, N, X) (Note: X= Priority of service was not in
3 0 0 0 0
effect at time of registration, low-income was not applicable to the participant, or
participant was a Dislocated Worker or Incumbent Worker) (Note: Only applicable
if received Intensive or Training services).
Percent 0.0% 0.0%
Yes No N/A Total
If a Dislocated Worker, did the case file contain documentation of lay-off,
4 termination, plant closure, or other eligible Dislocated Worker criteria? (Y, N, X) 0 0 0 0
(Note: X=Participant was not determined eligible as a Dislocated Worker).
Percent 0.0% 0.0%
Yes No Total
Was documentation in the case file that the participant was 18 years of age or
5 0 0 0
older at registration? (Y, N).
Percent 0.0% 0.0%
Yes No Total
Was documentation in the case file of U.S. citizenship or authorization to work in
6 0 0
the U.S.? (Y, N).
Percent 0.0% 0.0%
Yes No N/A Total
If required, was documentation in the case file of Selective Service Registration or
7 an allowable exemption? (Y, N, X) (Note: X= exempt from selective service 0 0 0 0
registration) (Note: federal requirement for males born on or after January 1,
1960).
Percent 0.0% 0.0%
Yes No N/A Total
If the participant was a veteran, did the file contain documentation to verify veteran
8 0 0 0 0
status? (Y, N, X) (Note: X= Participant was not a veteran.).
Percent 0.0% 0.0%
Yes No N/A Total
If the participant was an eligible spouse of a veteran, did the file contain
9 documentation to verify eligible spouse of a veteran status?(Y, N, X) (Note: X= 0 0 0 0
Participant was not an eligible spouse of a veteran.).
Percent 0.0% 0.0%
Yes No Total
Was documentation in the case file of a Core service such as an initial assessment
10 0 0 0
or job search and placement assistance? (Y, N).
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RWB XX 2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool Review
Period: ________________________
Percent 0.0% 0.0%
Yes No N/A Total
Was an Intensive service entered in the State's MIS? (Y, X) (Note: X = Participant
11 0 0 0 0
received Core services only) (If X, questions 12 and 13 will also be X).
Percent 0.0% 0.0%
Yes No N/A Total
If yes to #11, was documentation in the case file of an Intensive service such as a
12 jointly developed Individual Employment Plan (IEP) or Individual Counseling and 0 0 0 0
Career Plan? (Y, N, X) (Note: X = Participant received Core services only).
Percent 0.0% 0.0%
Yes No N/A Total
If yes to #12, was documentation in the case file of a determination of need for
13 Intensive services to gain/obtain employment, or retain employment leading to "self- 0 0 0 0
sufficiency"? (Y,N,X) (Note: X= Participant received Core services only).
Percent 0.0% 0.0%
Yes No N/A Total
Did the individual participate in Work Experience (WE)? (Y, X) (Note: X =
14 Participant did not receive a WE activity). (If X, questions 15 through 19 will also be 0 0 0 0
X).
Percent 0.0% 0.0%
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RWB XX 2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool Review
Period: ________________________
Yes No N/A Total
If yes to #14, was a WE training agreement executed between the employer and
15 the Region for the participant's training? (Y,N,X) (Note: X = Participant did not 0 0 0 0
receive a WE activity).
Percent 0.0% 0.0%
Yes No N/A Total
Was documentation in the case file that the WE start date was on or after the
16 employer's WE training agreement effective date? (Y, N) (Note: X = Participant 0 0 0 0
did not receive a WE activity).
Percent 0.0% 0.0%
Yes No N/A Total
Was the WE training provided as described in the WE Training Plan? (Y, N) (Note:
17 0 0 0 0
X = Participant did not receive a WE activity).
Percent 0.0% 0.0%
Yes N/A Total
18 Was this a paid WE? (Y,X) (Note: X=Participant did not receive paid WE) 0 0 0
Percent 0.0%
Yes No N/A Total
If yes to #18, was the participant paid the wage stated in the agreement and were
19 FLSA requirements met? (Y, N) (Note: X = Participant did not receive a WE 0 0 0 0
activity).
Percent 0.0% 0.0%
Yes No N/A Total
Was an Occupational/Skills Upgrade Training activity entered in the State's MIS?
20 (Y, N, X) (Note: X = Participant did not receive Occupational/Skills Upgrade 0 0 0 0
Training services) (If X, questions 21 through 24 will also be X).
Percent 0.0% 0.0%
Yes No N/A Total
Was documentation in the case file of a determination of need for training services
as identified in the IEP, comprehensive assessment, or Individual Counseling and
21 0 0 0 0
Career Plan? (Y, N, X) (Note: X = Participant did not receive Occupational/Skills
Upgrade Training services).
Percent 0.0% 0.0%
Yes No N/A Total
If Occupational Skills or Skills Upgrade Training was provided, was the training in a
22 local/state demand occupation? (Y, N, X). (Note: X = Participant did not receive 0 0 0 0
Occupational/Skills Upgrade Training services).
Percent 0.0% 0.0%
Yes No N/A Total
Was the training provider on the local/state approved eligible training provider list
23 (ETPL)? (Y, N, X). (Note: X = Participant did not receive Occupational/Skills 0 0 0 0
Upgrade Training services).
Percent 0.0% 0.0%
Yes No N/A Total
If an Individual Training Account (ITA) was utilized, were ITA costs recorded in the
24 Training Enrollment Cost table in the State's MIS? (Y, N, X). (Note: X = Participant 0 0 0 0
did not receive Occupational/Skills Upgrade Training services).
Percent 0.0% 0.0%
Yes No N/A Total
Was the participant an employed worker at the time of registration? (Y, N). (If No,
25 0 0 0 0
questions 26 through 29 will also be X).
Percent 0.0% 0.0%
Yes No N/A Total
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RWB XX 2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool Review
Period: ________________________
If yes to #25, and the participant was not referred by an employer, is there
documentation in the case file indicating that the participant was not earning a self-
sufficient wage at the time of registration, was in need of training services to obtain
26 0 0 0 0
or retain employment leading to "self-sufficiency", and was the participant in
agreement with the training selection? (Y, N, X) (Note: X = Referred by an
employer).
Percent 0.0% 0.0%
Yes No Total
If yes to #25, and the participant was referred by an employer, is there
documentation in the case file from the employer indicating the participant was in
27 need of WIA training services in order to obtain or retain employment that leads to 0 0 0
self-sufficiency as described in local policy? (Y, N, X) (Note: X = Not referred by
an employer).
Percent 0.0% 0.0%
Yes No N/A Total
If an IWT waiver was used, was documentation in the case file that the participant
28 met the waiver requirements in effect at the time of registration? (Y, N, X) (Note: X 0 0 0 0
= Waiver was not used).
Percent 0.0% 0.0%
Yes No N/A Total
If yes to #28, was the correct activity code(s) entered in the State MIS indicating
the use of the IWT waiver? (Y, N, X) (X = Waiver was not used). (Note: IWT
29 0 0 0 0
waiver codes - 190, 290 and 390 prior to October 10, 2011; IWT waiver codes
191, 291 and 391 after October 11, 2011).
Percent 0.0% 0.0%
Yes No N/A Total
Was On-The-Job (OJT) or Customized Training (CT) provided to the participant?
30 (Y, X) (Note: X = Participant did not receive OJT or CT) (If X, questions 31 through 0 0 0 0
37 will also be X).
Percent 0.0% 0.0%
OJT CT Total
31 If yes to #30, indicate the type of training provided (OJT or CT). 0 0 0
Percent 0.0% 0.0%
Yes No N/A Total
Was an OJT/CT agreement executed between the employer and the Region for
32 the participant's training position? (Y, N, X) (Note: X = Participant did not receive 0 0 0 0
OJT or CT).
Percent 0.0% 0.0%
Yes No N/A Total
Is documentation in the case file of the referral to the OJT employer? (Y, N, X)
33 0 0 0 0
(Note: X = Participant did not receive OJT) (Note: Question not applicable to CT).
Percent 0.0% 0.0%
Yes No N/A Total
If the participant was provided OJT, does the job title on the referral match the
34 occupation listed in the participant's IEP or case notes? (Y, N, X) (Note: X = 0 0 0 0
Participant did not receive OJT) (Note: Question not applicable to CT).
Percent 0.0% 0.0%
Page 10
RWB XX 2010-2011 Adult and Dislocated Workers
On-Site Quality Assurance Review Tool Review
Period: ________________________
Yes No N/A Total
Is documentation in the case file that the participant's OJT/CT start date was on or
35 after the employer's OJT/CT contract effective date? (Y, N, X) (Note: X = 0 0 0 0
Participant did not receive OJT or CT).
Percent 0.0% 0.0%
Yes No N/A Total
Was a copy of the OJT/CT outline in the participant's case file detailing the skills to
36 be attained, the duration of the training and the wage rate? (Y, N, X) (Note: X = 0 0 0 0
Participant did not receive OJT or CT).
Percent 0.0% 0.0%
Yes No N/A Total
Was the training provided as described in the OJT/CT agreement? (Y,N,X) (Note:
37 0 0 0 0
X = Participant did not receive OJT or CT). Comment: The use of waivers is
covered in the OJT and Customized Training Agreement Checklist
Percent 0.0% 0.0%
Yes No N/A Total
If a credential attainment was entered in the MIS, was documentation in the
38 participant's case file to support the credential? (Y, N, X) (Note: X = no credential 0 0 0 0
entered in MIS).
Percent 0.0% 0.0%
Yes No N/A Total
If yes to #38, was the credential attainment date and type match the credential
39 0 0 0 0
attainment information entered in the MIS? (Y, N, X).
Percent 0.0% 0.0%
Yes No Total
Was a signed and dated Grievance/Complaint and EEO/Discrimination Form in the
40 0 0 0
participant's case file? (Y, N).
Percent 0.0% 0.0%
Yes No Total
If yes to #40, did the Grievance/Complaint and EEO/Discrimination Form include
41 correct names and addresses for filing a grievance, appeal or EEO complaint? (Y, 0 0 0
N).
Percent 0.0% 0.0%
Page 11
AGENCY FOR WORKFORCE INNOVATION
2007-2007 ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL
Region XX Summary 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
ID LAST NAME, FIRST SSN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
AGENCY FOR WORKFORCE INNOVATION
2006-2007 UNIVERSAL ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL
SSN Last Name First Name Region County One Stop Unit R/C/O/U Case Manager SP CODE Case ID
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AGENCY FOR WORKFORCE INNOVATION
2006-2007 UNIVERSAL ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL
ITEM # ELEMENT INSTRUCTIONS
Review Period: The WIA Adult and Dislocated Worker Program quality
assurance review period begin date is ________ the
end date is determined by the Quality Assurance Review
schedule
Participant last name:
This information is populated from the Sample Table.
Participant first name: This information is populated from the Sample Table.
SSN (last four digits): This information is populated from the Sample Table.
Case manager name: This information is populated from the Sample Table.
Special Project
Contractor's Name This information is populated from the Sample Table.
Special Project Name This information is populated from the Sample Table.
Reviewer Name: Enter your name once at the COLON (:)
Enter the date range for the on-site review at the COLON
Dates of on site-review: (:)
1 Program Category
This information is populated from the Sample Table.
2 Priority of service Check with the region to determine if they have the
priority of service rule in effect. If so, determine if the
participant is determined low income under this rule.
3 Priority of service
If priority of service is in effect, determine if the adult
meets the low income criteria.
4 Dislocated Worker
Review participant's hard copy case file for
documentation of lay-off, termination letter, plant closure
or other eligible criteria (i.e., UC documents, letter from
employer etc.)
5 Age Adults/Dislocated workers must have documentation in
the participant's hard copy case file that shows that they
are 18 years of age or older at the time of first service.
6 U. S. Citizen/Right to All participants must document that they are a U.S.
Work in the U.S. Citizen or have the right to work in the U.S.
According to USDOL’s issuance entitled “Q’s and A’s”
– Transition/Closeout- April 1999, citizenship must be
verified for all individuals before WIA services are
provided.
Participation in programs and activities financially
assisted in whole or in part under this Act is open to
citizens and nationals of the United States, lawfully
admitted permanent resident aliens, lawfully admitted
refugees and parolees, and other individuals
authorized by the Attorney General to work in the
United States. In order to ensure that funds are not
improperly spent on of citizenship/authorization to work
Any documentation individuals, it is recommended that
in the United States that is accepted by the
Immigration and Naturalization Service can be
accepted by the one-stop operator
7 Selective Service Proof of compliance with the Military Selective Service
Registration Act must be verified prior to enrollment or during
enrollment should the individual turn 18 during
participation. [Section 3(a) of the Military Selective
Service Act [50 U.S.C. App. § 453(a)]. Male individuals
may also register on-line at http://www.sss.gov/
Unless specifically stated otherwise, all male U.S
Citizens born after December 31, 1959, must register
while they are between the ages of 18 and 26 years.
More information on who must register is available at
http://www.sss.gov/PDFs/WhoMustRegisterChart.pdf
8 Veteran Veteran status claimed on the WIA application must be
supported with documentation. Self-attestation is not
acceptable.
Additionally, the veteran must be given priority for
services (See 20 CFR 1010.230, published at 73 Fed.
Reg. 78132 on December 19, 2008)
(a) with respect to any qualified job training program,
that a covered person shall be given priority over a non-
covered person for the receipt of employment, training,
and placement services provided under that program,
notwithstanding any other provision of the law.
(b) Priority in the context of providing priority of service
to veterans and other covered persons in qualified job
training programs covered by this regulation means the
right to take precedence over non-covered persons in
obtaining services. Depending on the type of service or
(1) The covered person receives access to the
service or resource earlier in time than the non-
covered person; or
(2) If the service or resource is limited, the covered
person receives access to the service or resource
instead of or before the non-covered person.
9 Eligible spouse of an A veteran or eligible spouse - Eligible spouse means the
veteran spouse of any of the following:
(1) Any veteran who died of a service connected
disability;
(2) Any member of the Armed Forces serving on active
duty, who at the time of application for the priority, is
listed in one or more of the following categories and
(i) Missing listed for
has been so in action; a total of more than 90 days:
(ii) Captured in the line of duty by a hostile force; or
(iii) Forcibly detained or interned in line of duty by a
foreign government power; or
(3) Any veteran who has a total disability resulting from
a service connected disability, as evaluated by the
Department of Veterans Affairs;
(4) Any veteran who died while a total disability, as
indicated in Paragraph (3) of this definition, was in
existence.
10 Core Activity Review participant's hard copy case file for
documentation of an assisted core-activity. For
example: WIA application.
11 Intensive Service Review EFM to determine if an intensive service was
entered.
12 Intensive Service Review participant's hard copy case file for
documentation of an intensive service. For example,
an individual employment plan (IEP), career plan, job
search etc.
13 Determination of need Review participant's case file for determination of
for intensive services need. For example, case notes, IEP etc.
14 Work Experience (WE) Review EFM to determine if a WE activity was entered
in EFM.
15 Work Experience (WE)- Review the training agreement to ensure that the
executed agreement agreement was executed between the region and the
employer and that the agreement contained the
participant's training position.
16 Work Experience (WE)- Review the participant's case file to ensure that the
training date participant's start date was on or after the training
agreement effective date.
17 Work Experience (WE)- Review the participant's case file to ensure that the
training training was provided as described in the agreement.
18 Work Experience (WE)- Review the participant's agreement to determine if the
pay or unpaid WE was paid or unpaid.
19 Work Experience (WE)- Review the participant's case file to ensure that the
wage rate participant was paid the wage stated in the agreement.
20 Occupational/Skills Review EFM to determine if a training activity (300
Upgrade Training code) was entered.
21 Determination of Need Review participant's case file/EFM case notes for
documentation that the participant was in need of
training services. Information should be found in the
IEP, comprehensive assessment, Individual
Counseling and Career Plan or case notes
22 Occupational/Skills Review EFM to determine the type of training provided.
Upgrade Training After review, check the Regional Targeted
Occupational List to ensure that the training is in a
demand occupation.
23 Eligible Training Provider Review EFM activities for the training provider
List (ETPL) providing the Occupational/Skills Upgrade Training to
the participant. Next, review the Local and/or State
ETPL to ensure the training provider is an approved
24 ITA cost recorded in provider. participant's hard copy case for an ITA
Review the
EFM voucher. Click the training activity in EFM to determine
if the Occupational /Skills Upgrade Training costs were
recorded in the Training Enrollment Cost Table.
25 Employed Participant at Review participant's application to determine if the
registration participant was employed at the time of registration.
26 Employed Participant not Review participant's case file (hard copy or EFM case
referred by an employer notes) and the region's local self-sufficiency policy to
ensure the participant's wages did not meet the local
self-sufficiency definition at time of registration.
27 Employed Participant Review participant's case file for documentation (i.e.,
referred by an employer letter from employer) that indicated participant was in
need of services to obtain or retain employment.
28 IWT waiver Review participant's case file to determine if an IWT
waiver was used. If a waiver was used ensure that the
waiver requirements were met based on the
requirements for the applicable time period.
29 IWT waiver-activity IWT waiver codes should be entered in EFM if an IWT
codes waiver is used. IWT waiver codes-190, 290, 390.
30 On-The- Job (OJT) or Review EFM to determine if an OJT or CT activity was
Customized Training entered in EFM.
(CT)
31 On-The- Job (OJT) or Review EFM to determine the type of training
Customized Training provided.
(CT)
32 On-The- Job (OJT) or Review the training agreement to ensure that the
Customized Training agreement was executed between the region and the
(CT) executed employer and that the agreement contained the
agreement participant's training position.
33 On-The- Job (OJT) Review the participant's case file to ensure that a
referral to the OJT referral was given to the OJT employer.
employer
34 On-the-Job Training Review the participant's case file to ensure that the job
(OJT) job title match title on the referral match the occupation listed in the
participant's IEP.
35 On-The- Job (OJT) or Review the participant's case file to ensure that the
Customized Training participant's start date was on or after the contract
(CT) start date effective date.
36 On-the-Job Training Review the participant's case file to ensure that the
(OJT) skills, duration of OJT training outline provided the skills to be attained,
training and wage rate. duration of training and the wage rate.
37 On-The- Job (OJT) or Review the participant's case file to ensure that the
Customized Training training was provided as described in the agreement.
(CT) training provided
38 Credentials entered in Review EFM to determine if a credential was entered in
EFM EFM and documentation obtained
39 Credential Attainment If a credential was obtained and entered in the MIS,
Date and Type review the participant's hard copy case file for
documentation of the credential and ensure that the
type of credential and the credential attainment date
matches the information recorded in the MIS.
40 Signed and dated WIA RWBs are required to inform all WIA participants of the
Grievance/Complaint WIA grievance/complaint procedures. The individuals
and EEO/Discrimination are to complete the local grievance form attesting that
Form they were informed of the procedure and that they
received the completed form.
41 Signed and dated WIA Review the form to ensure that it include the following:
Grievance/Complaint Complaints shall be sent to Agency for Workforce
and EEO/Discrimination Innovation, Office of General Counsel, 107 East
Form Madison Street, MSC 110, Tallahassee, Florida, 32399-
4128, or to the appropriate federal agency with a copy
of the complaint sent to AWI Office of General
Counsel.
42 Supportive service Review EFM to determine if a support service was
entered in EFM .
43 Supportive service Review the participant case file to ensure that the
documentation supportive service matches the support service
entered in EFM. Examples of supportive services are:
transportation, uniforms etc. Refer to the region's local
policy on if and what type of supportive services will be
given. If Needs Related Payments are given, ensure
that the Adult participant is unemployed, does not
qualify or have ceased qualifying for unemployment
compensation, and enrolled in a program of training
services under WIA section 134(d)(4). For a dislocated
worker, ensure that the participant is unemployed, has
ceased to qualify for unemployment compensation or
trade readjustment allowance under TAA or NAFTA-
TAA, and is enrolled in a program of training services
under WIA section 134(d)(4).
44 Support service- Review the participant case file for documentation of a
determination of need. needs assessment. Refer to the region's local policy on if
and what type of needs assessments will be given.
45 Employment and Review EFM to determine if the participant was exited
Termination in EFM.
46 Employment and If the participant exited the WIA program, check the case
Termination file for employment at exit. If the participant exited with
employment, compare the Placement information in the
State MIS to the hard copy file to determine if the start
date and wage per hour match. Note: The case is open
or the participant is still receiving services when at least
one activity does not have a PROGRAM OUTCOME
(Activity End date) in EFM.
47 Follow-ups performed Look at the EFM Follow-up Table for required follow-ups
Quarters 1-4 After Exit
48 Timely Follow-ups Review the participant's case file to ensure that the
follow-ups are conducted timely.
49 Follow-ups- Employment Review EFM to determine if employment information
information was correctly entered in the follow-up fields in EFM for
each applicable quarter and properly verified.
American Recovery and Reinvestment Act 2011-2012
Last Name First Name Last 4 SSN Case Manager
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
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0 0 0 ///
0 0 0 ///
0 0 0 ///
0 0 0 ///
0 0 0 ///
0 0 0 ///
0 0 0 ///
2011-2012 Workforce Investment Act
Issue
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
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0
0
Adult and Dislocated Worker
d Dislocated Worker RWB ____ On-Site Quality Assurance Re
e Quality Assurance Review Tool
