Project Contract Review Meeting - Excel

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					           RWB _______ 2010-2011 WIA ADULT AND DISLOCATED WORKER
                                                                                                             References                        Location of Data
                      On-Site Quality Assurance Review Tool

                                                                                                                                          AWI sample selection
        Review Period:
                                                                                                                                          AWI sample selection
        Participant Last Name:
                                                                                                                                          AWI sample selection
        Participant First Name:
                                                                                                                                          State MIS Application or Hard
        SSN (last four digits):                                                                                                           copy
                                                                                                                                          State MIS Application or Hard
        Case manager:                                                                                                                     copy

        Special Project Contractor's Name:
        Special Project Name:
        Reviewer Name:
        Dates of On-Site Review:
                                     PROGRAM ELIGIBILITY

                                                                                                                                          State MIS Application /Hard
  1     Indicate whether participant is Adult (A) or Dislocated Worker (DW)
                                                                                                                                                    Copy


        Was the adult determined low income under the priority of service rule? (Y, N, X)          20 CFR 663 and Local Workforce
  2                                                                                                                                           State MIS Application
        (Note: Not applicable if only received core services).                                              Service Plan

                                                                                                                                            Hard copy eligibility doc.,
        If a dislocated worker, did the file contain documentation of lay-off, termination,                                               State MIS Application (Note:
  3                                                                                                   WIA Sec 101(9) and/or (10)
        plant closure, or other eligible criteria? (Y, N, X).                                                                                   self-attestation is
                                                                                                                                                  acceptable)

                                                                                                 20 CFR 663.110; AWI Guidance FG -
        Was documentation in the case file of age? (Y, N) (Note: Must be 18 years of age                                                   Hard copy file (supporting
  4                                                                                               04-041; WIA Resource Guide; and
        or older).                                                                                                                             documentation)
                                                                                                       Special Project Contract

                                                                                                   AWI Resource Guide; WIA Sec.188         State MIS, Hard/electronic
        Was documentation in the case file of U.S. citizenship or authorization to work in
  5                                                                                              (a)(5); 29 USC 2938(a)(5); and Special         copy (supporting
        the U.S.? (Y, N, X).                                                                                 Project Contract                   documentation)

        If required, was documentation in the case file of Selective Service Registration or
                                                                                                  29 USC 2939(h) and Special Project         Hard copy (supporting
  6     an allowable exemption? (Y, N, X) (Note: this is a federal requirement for males
                                                                                                             Contract                           documentation)
        born on or after January 1, 1960).

                                             VETERANS

                                                                                                    TEGL 14-08; 20 CFR 1010.230,
                                                                                                                                             State MIS Application,
        If a veteran in the State's MIS, was documentation in the case file to verify that the    published at 73 Fed. Reg. 78132 on
  7                                                                                                                                           Hard/electronic copy
        participant is a veteran? (Y, N, X).                                                       December 19, 2008; and Local
                                                                                                                                          (supporting documentation)
                                                                                                        Workforce Service Plan

                                                                                                    TEGL 14-08; 20 CFR 1010.230,
                                                                                                                                             State MIS Application,
        Was documentation in the case file that the participant is a spouse of an eligible        published at 73 Fed. Reg. 78132 on
  8                                                                                                                                           Hard/electronic copy
        veteran? (Y, N, X).                                                                         December 19, 2008; and Local
                                                                                                                                          (supporting documentation)
                                                                                                        Workforce Service Plan
                                                                                                    TEGL 14-08; 20 CFR 1010.230,
        If yes to #7 or #8, was preference given to veterans and spouses of eligible              published at 73 Fed. Reg. 78132 on
  9                                                                                                                                          RWB local procedures
        veterans for WIA services? (Y, N).                                                         December 19, 2008; and Local
                                                                                                        Workforce Service Plan

                            ASSESSMENT and PROGRAM ACTIVITIES
                                            Core Services
                                                                                                                                          State MIS or Hard/Electronic
                                                                                                                                             File copy case notes,
  10    Was documentation in the case file of a core activity? (Y, N).                                   WIA Resource Guide
                                                                                                                                            Special Project Contract
                                                                                                                                               Statement of Work

                                                                                                                                          State MIS or Hard/Electronic
        If yes to #10, was documentation in the case file indicating that the core service                                                   File copy case notes,
  11                                                                                                      WIA Sec. 134(d)(2)
        provided met federal requirements? (Y, N).                                                                                          Special Project Contract
                                                                                                                                               Statement of Work




Last Updated:
                                                                                                                                         AWI sample selection
        Participant Last Name:
                                                                                                                                         AWI sample selection
        Participant First Name:
                                                                                                                                         State MIS Application or Hard
        SSN (last four digits):                                                                                                          copy
                                                                                                                                         State MIS Application or Hard
        Case manager:                                                                                                                    copy

        Special Project Contractor's Name:
        Special Project Name:
        Reviewer Name:
        Dates of On-Site Review:
                                         Intensive Services

                                                                                                                                         State MIS or Hard/Electronic
                                                                                                                                            File copy case notes,
  12    Was documentation in the case file of an intensive service? (Y, N, X).                            WIA Resource Guide
                                                                                                                                           Special Project Contract
                                                                                                                                              Statement of Work


                                                                                                                                         State MIS or Hard/Electronic
        If yes to #12, was documentation in the case file that the intensive service provided        WIA Sec. 134(d)(3) and 20 CFR          File copy case notes,
  13
        met federal requirements? (Y, N, X).                                                                 663.200, 210                  Special Project Contract
                                                                                                                                              Statement of Work


                                                                                                                                         State MIS or Hard/Electronic
        If yes to #13, was documentation in the case file that an assessment was
                                                                                                                                            File copy case notes,
  14    conducted and a Individual Employment Plan (IEP) was completed? (Y, N, X)                       20 CFR 663.200, 210. 220,
                                                                                                                                           Special Project Contract
        (Note: X = only received a core service).                                                                                             Statement of Work


                                                                                                                                         State MIS or Hard/Electronic
        If yes to #14, were the activities/services to be provided included in the participant's                                            File copy case notes,
  15                                                                                                    20 CFR 663.200, 210. 220,
        IEP? (Y,N, X).                                                                                                                     Special Project Contract
                                                                                                                                              Statement of Work


                                               Training

                                                                                                                                         State MIS or Hard/Electronic
        Was a training activity entered into the MIS? (Y, N, X) (Note: X = no training                                                      File copy case notes,
  16                                                                                                      WIA Resource Guide
        provided).                                                                                                                         Special Project Contract
                                                                                                                                              Statement of Work


                                                                                                                                         State MIS or Hard/Electronic
        If yes to #16, was documentation in the case file that an assessment and/or career
                                                                                                    Section 134(d)(4)(A)(i) and 20 CFR      File copy case notes,
  17    planning session was conducted with the participant before enrollment in training?
                                                                                                                 663.240                   Special Project Contract
        (Y, N, X).                                                                                                                            Statement of Work

                                                                                                                                         State MIS or Hard/Electronic
        Does the case file contain a determination of need for the training services                Section 134(d)(4)(A)(i) and 20 CFR      File copy case notes,
  18
        identified in the participant's IEP? (Y, N).                                                             663.240                   Special Project Contract
                                                                                                                                              Statement of Work


                                                                                                                                         State MIS or Hard/Electronic
        If Occupational Skills Training (OST) was provided, was the OST in a demand                                                         File copy case notes,
  19                                                                                                WIA Resource Guide and FG-020
        occupation? (Y, N, X).                                                                                                             Special Project Contract
                                                                                                                                              Statement of Work


        Was the training provider on the local/state approved training provider list (ETPL)?       Section 122 and 20 CFR 663 Subpart
  20                                                                                                                                              AWI website
        (Y, N, X).                                                                                                  E


                                                                                                                                          State MIS, Program Page,
                                                                                                                                           Case Notes and/or hard
  21    Was an Individual Training Account (ITA) utilized? (Y, N, X).                                    20 CFR 663 Subpart D
                                                                                                                                            copy, Special Project
                                                                                                                                         Contract Statement of Work


                                                                                                                                          State MIS, Program Page,
        If yes to #21, were ITA costs included in the Training Enrollment Cost Table in the                                                Case Notes and/or hard
  22                                                                                                      WIA Resource Guide
        MIS? (Y, N, X).                                                                                                                     copy, Special Project
                                                                                                                                         Contract Statement of Work




Last Updated:
                                                                                                                                     AWI sample selection
        Participant Last Name:
                                                                                                                                     AWI sample selection
        Participant First Name:
                                                                                                                                     State MIS Application or Hard
        SSN (last four digits):                                                                                                      copy
                                                                                                                                     State MIS Application or Hard
        Case manager:                                                                                                                copy

        Special Project Contractor's Name:
        Special Project Name:
        Reviewer Name:
        Dates of On-Site Review:
                          EMPLOYED WORKER TRAINING PROGRAM

                                                                                                                                      State MIS, Program Page,
                                                                                                                                       Case Notes and/or hard
  23    Was the participant employed at the time of registration? (Y, N).                              WIA Resource Guide
                                                                                                                                        copy, Special Project
                                                                                                                                     Contract Statement of Work

                                                                                                                                      State MIS, Program Page,
        If yes to #23, is documentation in the case file from the employer indicating the
                                                                                                                                       Case Notes and/or hard
  24    participant was in need of WIA services in order to obtain or retain employment?                 20 CFR 663.310
                                                                                                                                        copy, Special Project
        (Y, N, X) (Note: X = not referred by an employer).                                                                           Contract Statement of Work


        If yes to #23, and the participant was not referred by an employer, was                                                      Local self-sufficiency policy,
                                                                                                                                      State MIS, Program Page,
        documentation in the case file indicating the participant's employment does not
  25                                                                                                     20 CFR 663.310                Case Notes and/or hard
        meet the local self-sufficiency definition and that WIA services were needed in                                                 copy, Special Project
        order to obtain employment that leads to self-sufficiency? (Y, N, X).                                                        Contract Statement of Work


                                                                                                                                      State MIS, Program Page,
                                                                                                 20 CFR 663.715, 720; and 730,
        If customized training was provided, was it in accordance with federal guidelines?                                             Case Notes and/or hard
  26                                                                                            WPDG 00-009; and Special Project
        (Y, N, X).                                                                                                                      copy, Special Project
                                                                                                   Contract Statement of Work
                                                                                                                                     Contract Statement of Work


                                                                                                                                      State MIS, Program Page,
                                                                                                 20 CFR 663.715, 720, and 730;
        If yes to #26, did the executed customized training agreement between the                                                      Case Notes and/or hard
  27                                                                                            WPDG 00-009; and Special Project
        employer and the region include the participant's training position? (Y,N).                                                     copy, Special Project
                                                                                                   Contract Statement of Work
                                                                                                                                     Contract Statement of Work


                                                                                                                                      State MIS, Program Page,
                                                                                                20 CFR 663.700, 705, 710, and 730;
        If On-the-Job Training (OJT) was provided, was it in accordance with federal                                                   Case Notes and/or hard
  28                                                                                            WPDG 00-009; and Special Project
        guidelines? (Y, N, X).                                                                                                          copy, Special Project
                                                                                                    Contract Statement of Work
                                                                                                                                     Contract Statement of Work


                                                                                                                                      State MIS, Program Page,
                                                                                                20 CFR 663.700, 705, 710, and 730;
        If yes to #28, was an OJT agreement executed between the employer and the                                                      Case Notes and/or hard
  29                                                                                            WPDG 00-009; and Special Project
        region for the participant's training position? (Y, N, X).                                                                      copy, Special Project
                                                                                                    Contract Statement of Work
                                                                                                                                     Contract Statement of Work


                                   CREDENTIAL ATTAINMENT


                                                                                                                                      State MIS, Hard/electronic
        If a credential attainment was entered into the MIS, was documentation in the
  30                                                                                              AWI Guidance and TEGL 17-05              copy (supporting
        participant's case file? (Y, N, X).                                                                                                documentation)



                                                                                                                                      State Information System,
        If yes to #30, was the attainment date and type of credential accurately entered into
  31                                                                                              AWI Guidance and TEGL 17-05           Hard/electronic copy
        the MIS? (Y, N, X).                                                                                                          (supporting documentation)




Last Updated:
                                                                                                                                  AWI sample selection
        Participant Last Name:
                                                                                                                                  AWI sample selection
        Participant First Name:
                                                                                                                                  State MIS Application or Hard
        SSN (last four digits):                                                                                                   copy
                                                                                                                                  State MIS Application or Hard
        Case manager:                                                                                                             copy

        Special Project Contractor's Name:
        Special Project Name:
        Reviewer Name:
        Dates of On-Site Review:
                                  GRIEVANCE/COMPLAINT FORM

                                                                                                                                      Signed and Dated
        Was a signed and dated Grievance Complaint Form in the participant's hard copy
  32                                                                                             AWI FG 00-004 rev. 06/08/07         Hard/electronic copy
        case file? (Y, N, X).                                                                                                     (supporting documentation)


                  SUPPORTIVE SERVICES AND NEEDS-RELATED PAYMENTS

                                                                                                                                   State MIS, Hard/electronic
        Was documentation in the case file of any supportive services provided to the         20 CFR 664.800; TEGL 17-05; and
  33                                                                                                                                    copy (supporting
        participant? (Y, N, X).                                                                    WIA Resource Guide
                                                                                                                                        documentation)


                                                                                                                                   State MIS, Hard/electronic
        Was documentation in the case file of any needs-related payments provided to the     20 CFR 663.815, 820, 825, 830, and
  34                                                                                                                                    copy (supporting
        participant? (Y, N, X)                                                                             840
                                                                                                                                        documentation)


                                                                                                                                   State MIS ,Hard/electronic
        If yes to #34 were the needs-related payments provided in compliance with federal    20 CFR 663.815, 820, 825, 830, and
  35                                                                                                                                    copy (supporting
        and state guidelines? (Y, N, X).                                                                   840
                                                                                                                                        documentation)


        If supportive services and/or needs-related services were provided to the                                                  State Information System,
                                                                                             20 CFR 663 Subpart H; WIA Resource
  36    participant, was documentation in the case file that the services were accurately                                            Hard/electronic copy
                                                                                                 Guide; and 20 CFR 664.405
        entered in the MIS? (Y, N, X).                                                                                            (supporting documentation)

                                  EMPLOYMENT and TERMINATION

                                                                                                                                   State MIS Case Summary,
        Was the participant exited from the WIA Program? (Y, N) (Note: N = Open or WIA
  37                                                                                                WIA Resource Guide             State MIS Training Details
        case closure).                                                                                                                       page


        If the participant exited with employment, was documentation in the case file that                                         State MIS, Hard/electronic
  38    the employment start date and wage information was verified and that the                    WIA Resource Guide              copy of Job Placement
        employment information was entered accurately into the MIS? (Y, N, X).                                                      Verification, case notes

        Was follow-up contact documented at the following intervals
                                                                                                                                   State MIS, Hard/electronic
                                                                                              WIA Resource Guide; TEGL 17-05;
  39    1st Quarter After Exit ? (Y, N, X).                                                                                             copy (supporting
                                                                                             and Follow-up Memorandum 3/23/07
                                                                                                                                        documentation)

                                                                                                                                   State MIS, Hard/electronic
                                                                                              WIA Resource Guide; TEGL 17-05;
  40    2nd Quarter After Exit ? (Y, N, X).                                                                                             copy (supporting
                                                                                             and Follow-up Memorandum 3/23/07
                                                                                                                                        documentation)

                                                                                                                                   State MIS, Hard/electronic
                                                                                              WIA Resource Guide; TEGL 17-05;
  41    3rd Quarter After Exit ? (Y, N, X).                                                                                             copy (supporting
                                                                                             and Follow-up Memorandum 3/23/07
                                                                                                                                        documentation)

                                                                                                                                   State MIS, Hard/electronic
                                                                                              WIA Resource Guide; TEGL 17-05;
  42    4th Quarter After Exit ? (Y, N, X).                                                                                             copy (supporting
                                                                                             and Follow-up Memorandum 3/23/07
                                                                                                                                        documentation)




        Legend:
        Finding - Requires Corrective Action

        Systemic Deficiency - Error Rate Greater Than 20%

        Blue - Cell intentionally skipped by reviewer



Last Updated:
                                                      RWB XX     2010-2011 Adult and Dislocated Workers
                                                           On-Site Quality Assurance Review Tool
                                                         Review Period: ________________________



                                                                                              Adult       Dislocated Worker   Total
1    Indicate whether participant is Adult (A) or Dislocated Worker (DW)                        0                  0           0
                                             Percent                                          0.0%              0.0%

                                                                                              Yes                No           N/A     Total

     Was the adult determined low income under the priority of service rule? (Y, N, X)
2                                                                                              0                 0             0       0
     (Note: Not applicable if only received core services).

                                            Percent                                           0.0%              0.0%

                                                                                              Yes                No           N/A     Total
     If a dislocated worker, did the file contain documentation of lay-off, termination,
3                                                                                              0                 0             0       0
     plant closure, or other eligible criteria? (Y, N, X).
                                               Percent                                        0.0%              0.0%

                                                                                              Yes                No           Total
     Was documentation in the case file of age? (Y, N) (Note: Must be 18 years of age
4                                                                                              0                 0             0
     or older).
                                            Percent                                           0.0%              0.0%

                                                                                              Yes                No           N/A     Total
     Was documentation in the case file of U.S. citizenship or authorization to work in
5                                                                                              0                 0             0       0
     the U.S.? (Y, N, X).
                                          Percent                                             0.0%              0.0%

                                                                                              Yes                No           N/A     Total
     If required, was documentation in the case file of Selective Service Registration or
6    an allowable exemption? (Y, N, X) (Note: this is a federal requirement for males          0                 0             0       0
     born on or after January 1, 1960).
                                            Percent                                           0.0%              0.0%

                                                                                              Yes                No           N/A     Total
     If a veteran in the State's MIS, was documentation in the case file to verify that the
7                                                                                              0                 0             0       0
     participant is a veteran? (Y, N, X).
                                            Percent                                           0.0%              0.0%

                                                                                              Yes                No           N/A     Total
     Was documentation in the case file that the participant is a spouse of an eligible
8                                                                                              0                 0             0       0
     veteran? (Y, N, X).
                                            Percent                                           0.0%              0.0%

                                                                                              Yes                No           N/A     Total
     If yes to #7 or #8, was preference given to veterans and spouses of eligible
9                                                                                              0                 0             0       0
     veterans for WIA services? (Y, N).
                                           Percent                                            0.0%              0.0%

                                                                                              Yes                No           Total
10   Was documentation in the case file of a core activity? (Y, N).                            0                 0             0
                                            Percent                                           0.0%              0.0%


                                                                                              Yes                No           Total
     If yes to #10, was documentation in the case file indicating that the core service
11                                                                                             0                 0             0
     provided met federal requirements? (Y, N).
                                           Percent                                            0.0%              0.0%




                                                                                Page 5
                                                      RWB XX     2010-2011 Adult and Dislocated Workers
                                                           On-Site Quality Assurance Review Tool
                                                         Review Period: ________________________



                                                                                             Yes          No     N/A     Total

12   Was documentation in the case file of an intensive service? (Y, N, X).                   0            0      0       0

                                            Percent                                          0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     If yes to #12, was documentation in the case file that the intensive service provided
13                                                                                            0            0      0       0
     met federal requirements? (Y, N, X).
                                            Percent                                          0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     If yes to #13, was documentation in the case file that an assessment was
14   conducted and a Individual Employment Plan (IEP) was completed? (Y, N, X)                0            0      0       0
     (Note: X = only received a core service).
                                           Percent                                           0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     If yes to #14, were the activities/services to be provided included in the
15                                                                                            0            0      0       0
     participant's IEP? (Y,N, X).
                                              Percent                                        0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     Was a training activity entered into the MIS? (Y, N, X) (Note: X = no training
16                                                                                            0            0      0       0
     provided).
                                            Percent                                          0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     If yes to #16, was documentation in the case file that an assessment and/or career
17   planning session was conducted with the participant before enrollment in training?       0            0      0       0
     (Y, N, X).
                                           Percent                                           0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     Does the case file contain a determination of need for the training services
18                                                                                            0            0      0       0
     identified in the participant's IEP? (Y, N).
                                              Percent                                        0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     If Occupational Skills Training (OST) was provided, was the OST in a demand
19                                                                                            0            0      0       0
     occupation? (Y, N, X).
                                            Percent                                          0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     Was the training provider on the local/state approved training provider list (ETPL)?
20                                                                                            0            0      0       0
     (Y, N, X).
                                            Percent                                          0.0%         0.0%

                                                                                             Yes          No     N/A     Total

21   Was an Individual Training Account (ITA) utilized? (Y, N, X).                            0            0      0       0

                                            Percent                                          0.0%         0.0%

                                                                                             Yes          No     N/A     Total
     If yes to #21, were ITA costs included in the Training Enrollment Cost Table in the
22                                                                                            0            0      0       0
     MIS? (Y, N, X).
                                           Percent                                           0.0%         0.0%

                                                                                             Yes          No     Total


23   Was the participant employed at the time of registration? (Y, N).                        0            0      0


                                            Percent                                          0.0%         0.0%



                                                                                             Yes          No     N/A     Total




                                                                                  Page 6
                                                     RWB XX     2010-2011 Adult and Dislocated Workers
                                                          On-Site Quality Assurance Review Tool
                                                        Review Period: ________________________




     If yes to #23, is documentation in the case file from the employer indicating the
24   participant was in need of WIA services in order to obtain or retain employment?         0           0     0      0
     (Y, N, X) (Note: X = not referred by an employer).

                                           Percent                                           0.0%        0.0%

                                                                                             Yes         No     N/A   Total
     If yes to #23, and the participant was not referred by an employer, was
     documentation in the case file indicating the participant's employment does not
25                                                                                            0           0     0      0
     meet the local self-sufficiency definition and that WIA services were needed in
     order to obtain employment that leads to self-sufficiency? (Y, N, X).
                                           Percent                                           0.0%        0.0%

                                                                                             Yes         No     N/A   Total
     If customized training was provided, was it in accordance with federal guidelines?
26                                                                                            0           0     0      0
     (Y, N, X).
                                           Percent                                           0.0%        0.0%

                                                                                             Yes         No     N/A   Total

     If yes to #26, did the executed customized training agreement between the
27                                                                                            0           0     0      0
     employer and the region include the participant's training position? (Y,N).

                                           Percent                                           0.0%        0.0%



                                                                                             Yes         No     N/A   Total
     If On-the-Job Training (OJT) was provided, was it in accordance with federal
28                                                                                            0           0     0      0
     guidelines? (Y, N, X).
                                          Percent                                            0.0%        0.0%

                                                                                             Yes         No     N/A   Total
     If yes to #28, was an OJT agreement executed between the employer and the
29                                                                                            0           0     0      0
     region for the participant's training position? (Y, N, X).
                                              Percent                                        0.0%        0.0%



                                                                                             Yes         No     N/A   Total
     If a credential attainment was entered into the MIS, was documentation in the
30                                                                                            0           0     0      0
     participant's case file? (Y, N, X).
                                           Percent                                           0.0%        0.0%



                                                                                             Yes         No     N/A   Total
     If yes to #30, was the attainment date and type of credential accurately entered into
31                                                                                            0           0     0      0
     the MIS? (Y, N, X).
                                           Percent                                           0.0%        0.0%



                                                                                             Yes         No     N/A   Total
     Was a signed and dated Grievance Complaint Form in the participant's hard copy
32                                                                                            0           0     0      0
     case file? (Y, N, X).
                                       Percent                                               0.0%        0.0%

                                                                                             Yes         No     N/A   Total
     Was documentation in the case file of any supportive services provided to the
33                                                                                            0           0     0      0
     participant? (Y, N, X).
                                           Percent                                           0.0%        0.0%



                                                                                             Yes         No     N/A   Total

     Was documentation in the case file of any needs-related payments provided to the
34                                                                                            0           0     0      0
     participant? (Y, N, X)
                                           Percent                                           0.0%        0.0%



                                                                                             Yes         No     N/A   Total


                                                                              Page 7
                                                     RWB XX     2010-2011 Adult and Dislocated Workers
                                                          On-Site Quality Assurance Review Tool
                                                        Review Period: ________________________



     If yes to #34 were the needs-related payments provided in compliance with federal
35                                                                                           0            0      0       0
     and state guidelines? (Y, N, X).
                                           Percent                                         0.0%          0.0%


                                                                                           Yes           No     N/A     Total
     If supportive services and/or needs-related services were provided to the
36   participant, was documentation in the case file that the services were accurately       0            0      0       0
     entered in the MIS? (Y, N, X).
                                           Percent                                         0.0%          0.0%



                                                                                           Yes           No     Total

     Was the participant exited from the WIA Program? (Y, N) (Note: N = Open or WIA
37                                                                                           0            0      0
     case closure).

                                           Percent                                         0.0%          0.0%



                                                                                           Yes           No     N/A     Total
     If the participant exited with employment, was documentation in the case file that
38   the employment start date and wage information was verified and that the                0            0      0       0
     employment information was entered accurately into the MIS? (Y, N, X).
                                            Percent                                        0.0%          0.0%




                                                                             Page 8
                                             AGENCY FOR WORKFORCE INNOVATION
                                 2007-2007 ADULT- DISLOCATED WORKER PROGRAM REVIEW TOOL




             Region XX Summary

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
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                                                     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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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      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.)
  4      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.



  5      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 individuals, it is recommended that
                         local areas establish a procedure to establish these
                         requirements.




                         Any documentation of citizenship/authorization to work
                         in the United States that is accepted by the
                         Immigration and Naturalization Service can be
                         accepted by the one-stop operator




6   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




7   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
                             resource being provided, taking precedence may
                             mean:




                               (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.



8   Spouse of an eligible   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
                             has been so listed for a total of more than 90 days:



                               (i) Missing in action;


                               (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.

9    Priority of service to
     veterans and spouses of Check with the region to distinguish how priority of
     eligible veterans       service is being given to veterans and eligible spouses
                             then determine if the region is incorporating the rule.
10   Core Activity             Review participant's hard copy case file for
                               documentation of an assisted core-activity. For
                               example: WIA application.

11   Documentation of Core      Review participant's case file.
     service meeting federal
     requirements

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   Documentation of           Review participant's case file.
     Intensive service
     meeting federal
     requirements
14   Documentation of an        Review participant's case file that an assessment or
     assessment or IEP          IEP was completed. The ISS identifies the following,
                                the RWB can include one or more of the following in
                                the ISS:Such as:
                                > Employment goal (including, in appropriate
                                circumstances, non-traditional employment);
                                > Appropriate achievement objectives;
                                > Appropriate services taking into account the objective
                                assessment that was administered; and
                                > the expressed interests & desires of the participant




15   Activities and services    Review participant's IEP to ensure that the services
     provided in the IEP        that are provided where included on the participant's
                                IEP.

16   Training                   Review EFM to determine if a training activity (300
                                code) was entered.
17   Documentation of             Review participant's hard copy case file for
     assessment/career plan       documentation of an assessment or career plan. Make
                                  sure the assessment/career plan highlights the training
                                  that is to be provided. The training recorded in EFM
                                  should match the training outlined on the participant's
                                  assessment/career plan.



18   Determination of Need        Review participant's case file/EFM case notes for
                                  documentation that the participant was in need of
                                  training services.


19   Occupational Skills          Review EFM to determine the type of training provided.
     Training                     After review, check the Regional Targeted
                                  Occupational List to ensure that the training is in a
                                  demand occupation.


20   Eligible Training Provider   Review EFM activities for the training provider
     List (ETPL)                  providing the training to the participant. Next, review
                                  the Local and/or State ETPL to ensure the training
                                  provider is an approved provider.


21   ITA                          Review the participant's hard copy case for an ITA
                                  voucher.

22   ITA recorded in EFM          Click the training activity in EFM to determine if the
                                  training costs were recorded in the Training Enrollment
                                  Cost Table.


23   Employed Participant         Review participant's application to determine if the
                                  participant was employed at the time of registration.



24   Documentation of need        Review participant's case file for documentation (i.e,
     if employer referred         letter from employer) that indicated participant was in
                                  need of services to obtain or retain employment.


25   Documentation of need        Review participant's case file (hard copy or EFM case
     if not meeting local         notes) and the region's local self-sufficiency policy to
     sufficiency and not          ensure the participant's wages does not meet the local
     employer referred            self-sufficiency definition.
26   Customized Training     Check to ensure that there is a contract between the
     meeting federal         employer and the board, that there is a commitment by
     guidelines              the employer to employ an individual on successful
                             completion of the training, and that the employer pays
                             not less than 50 percent of the cost of the training. For
                             an eligible employed worker, ensure that the employee
                             is not earning a self- sufficient wage as determined by
                             Local Board policy, that the general requirements are
                             met, and that the training relates to the purposes
                             described in 663.705(c) or other appropriate purposes
                             identified by the Local Board.




27   Customized Training     Review the training agreement to ensure that the
     Agreement               agreement was executed between the region and the
                             employer and that the agreement contained the
                             participant's training position.


28   On-the-Job Training     Ensure that there is a contract with an employer in the
     (OJT) meeting federal   public, private non-profit or private sector. Ensure that
     guidelines              occupational skills training is provided for the WIA
                             participant in exchange for the reimbursement of up to
                             50 percent of the wage rate to compensate for the
                             employer's extraordinary costs. Ensure that the
                             contract is limited to the period of time required for a
                             participant to become proficient in the occupation for
                             which the training is being provided.
29   OJT Agreement           Review the training agreement to ensure that the
                             agreement was executed between the region and the
                             employer and that the agreement contained the
                             participant's training position.


30   Documentation of        If a credential was entered in the MIS for the
     Credential Attainment   participant, review the participant's hard copy case file
                             for documentation of the credential attainment
                             recorded in the MIS.


31   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.
32   Signed and dated WIA       RWBs are required to inform all WIA participants of the
     Grievance/Compliance       WIA grievance/complaint procedures. The individuals
     form                       are to complete the local grievance form attesting that
                                they were informed of the procedure and that they
                                received the completed form. Note: The form must
                                include the following: Complaints shall be sent to
                                Agency for Workforce Innovation, Office of General
                                Counsel, 107 East 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.




33   Supportive service         Review the participant case file for documentation of a
     documentation              supportive service given. 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.


34   Documentation of Needs Review the participant case file for documentation of a
     related payments       needs assessment. Refer to the region's local policy on if
                            and what type of needs assessments will be given.




35   Needs Related            Ensure that the Adult participant is unemployed, does not
     Payments in compliance   qualify or have ceased qualifying for unemployment
     with federal and state   compensation, and enrolled in a program of training
     guidelines               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).



36   Documentation of         Review EFM Program Activities to ensure that if a
     supportive service       supportive service was given, the supportive service is
     and/or needs related     recorded as an activity.
     payments in the MIS.




37   Termination from the     The case is open or the participant is still receiving
     WIA program (Case        services when at least one activity does not have a
     open or closed)          PROGRAM OUTCOME (Activity End date) in EFM.
                              Record an “Observation” if all activities have “Actual End
                              Dates” but a Program Outcome had not been completed.
 38     If employment, was it     Compare the Placement information in the State MIS to
        verified; employment      the hard copy file to determine if they match.
        start date and wage
        information correctly
        entered in EFM.


39-42   Follow-ups performed      Look at the EFM Follow-up Table for required follow-ups
        Quarters 1-4 After Exit   (usually marked "pending")

				
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