№ lp_1_2_61889
File format: docx
Character count: 3555
File size: 37 KB
Year:
2023
Region / City:
United States
Theme:
Employment, Workforce Development
Document Type:
Eligibility Form
Agency / Organization:
WIOA
Author:
WIOA Career Planner
Target Audience:
Individuals applying for the Dislocated Worker Program
Validity Period:
Ongoing
Approval Date:
N/A
Date of Changes:
N/A
Context:
A form used by individuals to self-attest their eligibility for the Dislocated Worker Program under WIOA based on specific categories of dislocation, including layoffs, military service, and other factors.
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2020
Region / City:
United States
Subject:
Eligibility Documentation for WIOA Title I-B Programs
Document Type:
Policy Change
Agency / Institution:
Department of Labor (DOL)
Author:
Not specified
Target Audience:
Case Managers, LWDBs, Service Providers
Effective Date:
March 23, 2020
Expiration Date:
June 30, 2024
Date of Approval:
Not specified
Date of Amendments:
December 3, 2021
Effective Date:
March 23, 2020
Expiration Date:
June 30, 2024
Note:
Minimum Requirements for Documenting Eligibility for WIOA Title I-B Programs
Period of Effectiveness:
March 23, 2020 – June 30, 2024
Year:
N/A
Region / City:
N/A
Subject:
Employment / Healthcare / Social Work
Document Type:
Self-attestation form
Organization:
N/A
Author:
N/A
Target Audience:
Healthcare professionals, social workers, and other regulated professionals
Validity Period:
N/A
Approval Date:
N/A
Amendment Date:
N/A
Document Type:
Self-attestation form
Subject:
Fit and Proper Person Test declaration
Jurisdiction:
England
Applicable Legislation:
Fit and Proper Person Test requirements
Related Checks:
DBS check
Relevant Sectors:
Healthcare and social care
Declarations Included:
Character, qualifications, professional registration status, health capability, criminal convictions, bankruptcy status, barred list status, misconduct and mismanagement
Obligation to Notify:
Duty to inform the chair of any change in circumstances affecting compliance
Signatories:
Applicant and Chair of the organisation
Fields Included:
Name, job title/role, professional registrations, DBS check date, appraisal date, signatures and dates
Intended Audience:
New starters applying for a role within a regulated organisation
Note:
Year
Topic:
Data Privacy, Federal Agencies, Data Security
Document Type:
Questionnaire, Data Management Plan
Target Audience:
Federal Agencies
Purpose:
This form is for federal agencies requesting research data through the CMS Data Use Agreement (DUA) process.
Security Requirements:
Data Custodian responsible for compliance with CMS data security requirements.
Evidence Required:
Authority to Operate (ATO) Letter(s) with official details.
Year:
2026
Region / City:
United Kingdom
Subject:
Employment Compliance and Professional Standards
Document Type:
Self-Attestation Form
Organization / Institution:
Healthcare or Social Care Provider
Author:
Employee / New Starter
Target Audience:
New hires in regulated roles
Applicable Regulations:
Fit and Proper Person Test requirements, professional registration obligations
Required Registrations:
Relevant professional body registration if applicable
Background Checks:
DBS check, professional qualifications verification
Signature Dates:
Employee and Chair acknowledgment
Program:
Data Privacy Safeguard Program
Document Type:
Self-Attestation Questionnaire
Subject:
Data Security and Privacy Controls for CMS Data
Organization / Authority:
Centers for Medicare & Medicaid Services (CMS)
Reference Standard:
CMS Acceptable Risk Safeguards (ARS) 3.1
Reference Framework:
NIST SP 800-53 Revision 4 Security and Privacy Controls
Purpose:
Attestation of organizational compliance with CMS security and privacy safeguard requirements
Primary Topic:
Information Security and Privacy Governance
Scope:
Access Controls, Security Controls, and Privacy Controls for CMS Data Environments
Applicable Environment Types:
Cloud Service Provider (CSP), Onsite, Hybrid Computing Environments
Responsible Role:
Data Custodian
Additional Contact Role:
Secondary Point of Contact (POC)
Related Document:
Data Management Plan (DMP)
Information Type Covered:
CMS data including PII/PHI
Intended Respondent:
Organizations requesting access to CMS data
Note:
Year
Organization / Institution:
Minnesota Department of Employment and Economic Development (DEED)
Year:
2018
Region / Jurisdiction:
Minnesota
Subject:
Workforce development and incumbent worker training
Document type:
Policy
Governing law:
Workforce Innovation and Opportunity Act (WIOA)
Regulatory references:
20 CFR Part 680; 20 CFR Part 682
Issuing agency:
Minnesota Department of Employment and Economic Development
Programs covered:
WIOA Adult Program; WIOA Dislocated Worker Program; State Dislocated Worker Program; National Dislocated Worker Grants
Effective date:
July 1, 2018
Last updated:
April 18, 2025
Policy requirement:
Local policy required
Target population:
Employed incumbent workers
Employer eligibility criteria:
Financial viability; minimum one year in operation; tax compliance
Cost sharing requirements:
Employer contribution based on employer size
Training delivery modes:
In-person; online; hybrid
Contact information:
[email protected]
Note:
; 651-259-7503
Year:
2018
Region / City:
Minnesota
Subject:
Dislocated Worker Programs, Supportive Services, Follow-Up Services
Document Type:
Policy
Agency:
Minnesota Department of Employment and Economic Development (DEED)
Author:
DEED
Target Audience:
Local providers, program participants, and case managers
Period of Validity:
Ongoing
Approval Date:
4/18/2018
Last Update Date:
4/26/2025
Year:
2023
Country:
United States
State:
Minnesota
Program:
Workforce Innovation and Opportunity Act (WIOA); State Dislocated Worker Program
Document type:
Eligibility documentation guidelines
Reference:
TEGL 23-19, Change 2
Effective date:
May 12, 2023
Issuing authority:
U.S. Department of Labor
Intended use:
Program eligibility determination
Subject areas:
Identity verification; employment status; public assistance; income status; special populations
Tabular structure:
Data elements; requirements; source documentation
Regulated populations:
Dislocated workers; veterans; foster care youth; homeless individuals; ex-offenders; low-income individuals; English language learners
Federal programs referenced:
TANF; MFIP; SSI; SSDI; SNAP; UI
Administrative systems referenced:
State UI Database; State MIS Database; WF1; SSA Database
Year:
2024
Region / City:
Minnesota
Theme:
Dislocated Worker Program
Document Type:
Policy
Organization / Institution:
Minnesota Department of Employment and Economic Development (DEED)
Author:
Minnesota Department of Employment and Economic Development (DEED)
Target Audience:
Local providers, dislocated workers
Effective Period:
From 7/1/2024
Approval Date:
12/9/2024
Last Updated:
12/9/2024
Year:
2023
Region / City:
United States
Topic:
Workforce Development
Document Type:
Guidelines
Organization:
U.S. Department of Labor
Author:
U.S. Department of Labor
Target Audience:
Workforce program administrators and staff
Effective Period:
Ongoing
Approval Date:
N/A
Date of Changes:
N/A
Year:
2017
Region / City:
Massachusetts
Theme:
Disaster Response, Workforce Development
Document Type:
Master Agreement
Organization / Institution:
Regional Employment Board of Hampden County
Author:
Massachusetts Executive Office of Labor and Workforce Development
Target Audience:
Refugees impacted by Hurricanes Irma and Maria, local workforce centers
Period of Validity:
December 1, 2017 - November 30, 2019
Approval Date:
Not specified
Date of Amendments:
Not specified
Note:
Context description
Agreement #:
COVID NDWG - xxx
Organization Name:
DTC Enterprises Inc, d/b/a Snapchef
Address:
420 Washington Street, Dorchester, MA 02124
Phone Number:
844-424-3343
Email:
[email protected]
Signatory Name:
Meagan Greene, Area Manager
Employer of Record’s Federal ID#:
[not specified in document]
Workers Compensation Carrier & Policy #:
Ace Group / Policy #6S62UB-4500P91-1-16
Worksite Employer Type:
Private for Profit
Project Name:
[Project Name not specified]
Worksite Name/Location:
[Worksite Name/Location not specified]
Authority:
Workforce Innovation and Opportunity Act, 29 USC 3101, WIOA Final Regulation
Term of Agreement:
From June 22, 2020, maximum 12 months or 2,080 hours
Employee Role:
Participant temporarily hired for disaster recovery and clean-up
Document Type:
Worksite Agreement
Target Audience:
Worksite Employers and Employees
Year:
2026
Region / City:
United States
Subject:
Workforce Innovation and Opportunity Act (WIOA) Program Eligibility
Document Type:
Program Guidelines / Eligibility Checklist
Agency / Institution:
Employment Security Department (ESD)
Author:
Washington State Workforce System (WSS)
Target Audience:
Program participants, case managers, employment service staff
Effective Period:
Ongoing
Date of Issue:
2026
Related Legislation:
WIOA Sections 3(2) and 129(a), RCW 50.20.050, WAC 192-150
Eligibility Criteria:
Age, legal work status, income level, program-specific requirements
Documentation Required:
Identification, I-9 forms, self-attestation, employment records
Program Categories:
Adult, Dislocated Worker, ISY Youth, OSY Youth
Verification Methods:
MIS recording, cross-validation, policy references
Year:
2021
Program:
WIOA Adult, Dislocated Worker, and Youth Programs
Region:
United States
Type of Document:
Policy/Guidance
Agency:
U.S. Department of Labor, Employment and Training Administration
Target Audience:
Program staff and participants
Duration of Services:
Minimum 12 months after program exit
Purpose:
Employment retention, wage increase, career advancement, and support for post-secondary transition
Documentation Requirements:
Statewide electronic case management system
Contact Attempts:
Minimum of five, using multiple methods
Reporting Periods:
2nd and 4th quarters after exit for adults, 2nd quarter for youth
Follow-Up Service Components:
Career counseling, work-related problem assistance, peer support, educational information, supportive service referrals
Youth Specific Requirements:
Alignment with Individual Service Strategy (ISS), proactive and reactive interventions, quarterly contact, opportunity to opt out
Year:
2015
Region / City:
United States
Theme:
Income Eligibility, Welfare Programs
Document Type:
Policy
Organization / Institution:
U.S. Department of Labor
Author:
Not specified
Target Audience:
Workforce Development Agencies, Eligibility Specialists
Period of Action:
Ongoing
Approval Date:
07/01/15
Last Updated:
11/04/25
Program:
Workforce Innovation and Opportunity Act (WIOA) Title I
Jurisdiction:
Virginia Workforce Connection (VaWC)
Document type:
Administrative guidelines
Subject:
Document naming and tagging standards
Intended users:
Service providers and program staff
Application context:
WIOA Title I pre-application and participant file management
Scope:
Eligibility, enrollment, training, supportive services, outcomes, and exit documentation
Governing references:
USCIS, Selective Service, LWDB policies
Coverage:
Adult, Dislocated Worker, and Youth programs
Administrative level:
Local Workforce Development Areas
Source classification:
Program administration documentation