Adult/DW File Review - Wisconsin



Participant Name: WDA/Service Provider: Issue(s)Reviewer: Review Date: GENERAL ELIGIBILITY: FORMCHECKBOX Yes FORMCHECKBOX NoLocal application form signed & dated ___________________ FORMCHECKBOX Yes FORMCHECKBOX No Eligible to work in the USA, properly documented AND Documentation____________________Selective Service indicator in ASSET: FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Not Required FORMCHECKBOX Exempted Vet FORMCHECKBOX Waived FORMCHECKBOX Less Than 18COMMENTS: FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No Selective Service indicator is accurate FORMCHECKBOX Yes FORMCHECKBOX No Appropriate documentation is in fileFEDERAL ELIGIBILITY REQUIREMENTS: (MUST MEET ONE. ONLY ONE CAN BE IN ASSET.)1.Individual or Small Group Layoff FORMCHECKBOX Terminated/Laid Off or Received Notice of Termination/Layoff AND FORMCHECKBOX UI-Eligible or Exhausted OR Sufficient employment duration AND FORMCHECKBOX Unlikely to return to previous industry2.Permanent Closure or Mass Layoff FORMCHECKBOX Terminated/Laid off or Rec'd Notice due to Permanent Closure or Mass Layoff OR FORMCHECKBOX General Announcement of Closure within 180 days OR FORMCHECKBOX General Announcement of Closure (basic career svcs only until within 180 days)3.Separating or Separated Member of the US Armed Forces FORMCHECKBOX Discharge is anything other than Dishonorable4.Self Employed FORMCHECKBOX Unemployed due to General Economic Conditions OR Natural Disaster5.Displaced Homemaker FORMCHECKBOX Formerly dependent on income of a family member, but no longer supported OR FORMCHECKBOX Dependent spouse of active duty svc member; income reduced due to deployment, duty orders, perm change of station, svc connected death/disability6.Military Spouse FORMCHECKBOX Lost employment due to relocation of spouse's duty station FORMCHECKBOX Unemployed or underemployed and having difficulty obtaining or upgrading EmploymentQualifying Employer: __________________________________________________Qualifying Dislocation Date: ____________________________________________ FORMCHECKBOX Yes FORMCHECKBOX NoIs there allowable UI source documentation in file. Source: ______________________________________________ FORMCHECKBOX Yes FORMCHECKBOX No Eligibility Information is properly documented in the participant file & matches ASSET. VETERAN PRIORITY OF SERVICE (does not impact eligibility): FORMCHECKBOX Yes FORMCHECKBOX No Veteran or eligible individual FORMCHECKBOX If yes, DD-214 or other allowable documentation in file FORMCHECKBOX If yes, discharge is anything other than DishonorableCOMMENTS: FORMTEXT ?????LOW INCOME DETERMINATION AND DOCUMENTATION – BASED ON INCOME PREVIOUS SIX MONTHS:Per ASSET Data Field -- Family Income Previous Six Months: FORMCHECKBOX At or Below 100% FPL FORMCHECKBOX At or Below 70% of LLSIL FORMCHECKBOX Neither of the AboveFamily Income For Past Six Months Per File Documentation: __________________Individual Income For Past Six Months Per File Documentation: __________________ Annualized Income___________ FORMCHECKBOX Yes FORMCHECKBOX NoIndividual with a disability – family of 1 FORMCHECKBOX Yes FORMCHECKBOX NoIndividual and family income meet the following:Family size recorded is accurate (participant file and ASSET match)Family income is tallied for past six months and annualized properly Income is shown for each family member, is documented with allowable sources, & complies with inclusions & exclusions for the WIOA programCurrent FPL (100%) or LLSIL (70%) chart was used at the time the participant's eligibility was completedCOMMENTS: FORMTEXT ?????LOW INCOME DETERMINATION AND DOCUMENTATION – BASED ON BENEFIT(S): DOL Reporting Only. If ASSET data fields show the participant is receiving any one of the following benefits (except SSDI), they meet the low income definition. PUBLIC ASSISTANCE RECIPIENT : Food Share: FORMCHECKBOX Currently Receiving FORMCHECKBOX Received in past 6 months FORMCHECKBOX Not Receiving TANF: FORMCHECKBOX Currently Receiving FORMCHECKBOX Received in past 6 months FORMCHECKBOX Not ReceivingOther Income Based Cash Public Assistance: FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX No Response Type of Assistance: ___________________________________________SSI/SSDI: FORMCHECKBOX SSI FORMCHECKBOX SSDI FORMCHECKBOX SSI and SSDI FORMCHECKBOX No Homeless: FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX No Response FORMCHECKBOX Yes FORMCHECKBOX NoWere any of the boxes checked that benefits are/were received? FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, allowable source documentation in file. Source: ______________________________________________ FORMCHECKBOX Yes FORMCHECKBOX No Public Assistance ASSET entries matches file documentationCOMMENTS: FORMTEXT ?????ECONOMIC SELF-SUFFICIENCY CALCULATOR: FORMCHECKBOX Yes FORMCHECKBOX No Enrolled after July 1, 2017If yes: FORMCHECKBOX Yes FORMCHECKBOX No The ESS Calculator was completed per state policy at eligibility determination FORMCHECKBOX Yes FORMCHECKBOX No The ESS Calculator is documented in ASSET and the file as accurate and complete for each time it was required FORMCHECKBOX Participant is economically self-sufficient FORMCHECKBOX Participant is NOT economically self-sufficientCOMMENTS: FORMTEXT ?????ASSESSMENTS: FORMCHECKBOX Yes FORMCHECKBOX NoProvided assessments on or after participation date FORMCHECKBOX Yes FORMCHECKBOX NoAssessments are appropriately documented in ASSET and file FORMCHECKBOX Yes FORMCHECKBOX NoASSET services correspond with assessments provided; dates match Date Assessment tool ASSET ServiceCOMMENTS: FORMTEXT ?????INDIVIDUAL EMPLOYMENT PLAN (IEP): FORMCHECKBOX Yes FORMCHECKBOX NoInitial IEP is complete, signed and properly documented in ASSET and file FORMCHECKBOX Yes FORMCHECKBOX NoIEP is reviewed, updated, signed, dated, and properly documented in the participant file and ASSET as described in the Local Plan FORMCHECKBOX Yes FORMCHECKBOX No IEP is developed appropriately:jointly with the participantbased on assessmentsdelineated into clearly defined, attainable and manageable steps FORMCHECKBOX Yes FORMCHECKBOX No IEP contains appropriate information including:participant's employment goals achievement objectives determination of need for training an appropriate combination of services to achieve employment Identification of career pathwaysDoc DateASSET Open ASSET CloseInitial / Review COMMENTS: FORMTEXT ?????CAREER SERVICES: (Not IEP/Assessments) FORMCHECKBOX Provided as needed FORMCHECKBOX NOT Provided as needed FORMCHECKBOX Not needed If Other Career Services Provided: FORMCHECKBOX Yes FORMCHECKBOX NoServices provided are appropriately documented in ASSET and file FORMCHECKBOX Yes FORMCHECKBOX NoAppropriate services related to assessment, training & employment goals FORMCHECKBOX Yes FORMCHECKBOX NoCareer services provided according to local policy and procedures FORMCHECKBOX Yes FORMCHECKBOX NoASSET services correspond with career services provided; dates matchServices Provided:Career PlanningEnglish Language LearningFinancial Literacy ServicesGroup Employment CounselingIntegrated Education and Training ProgramsJob DevelopmentJob Referral/Placement AssistanceJob Search AssistanceOut of Area Job Search AssistanceOut of Area Relocation AssistanceShort-term Prevocational ServicesResume DevelopmentTransitional JobUI Claim AssistanceWork ExperienceWorkforce PreparationOther: _______________________________________________________________TRAINING SERVICES: FORMCHECKBOX Provided as needed FORMCHECKBOX NOT Provided as needed FORMCHECKBOX Not needed If Training Provided: FORMCHECKBOX Yes FORMCHECKBOX NoTraining funded by WIOA FORMCHECKBOX Yes FORMCHECKBOX NoIf yes, ESS Calculator completed prior to WIOA funding and shows participant is NOT economically self-sufficient FORMCHECKBOX Yes FORMCHECKBOX NoTraining plan is appropriate for participant:based on assessment & matches with interests, skills and qualificationsparticipant has resources to complete programparticipant applied for financial aid FORMCHECKBOX Yes FORMCHECKBOX NoTraining plan is in line with and executed within the local policyThe need for training is documented in the participant's file as described in the Local Plan response VI.G.8Training is within the dollar amount/duration of WDB's local policy FORMCHECKBOX Yes FORMCHECKBOX NoTraining start and end dates match ASSET Start Date: ____________________________________________ End Date: _____________________________________________ FORMCHECKBOX Yes FORMCHECKBOX NoThe training program is appropriate for any WIOA participant:Directly linked to employment opportunitiesOn State ITA ListApproved per local policy FORMCHECKBOX Yes FORMCHECKBOX NoThe participant's progress in training is monitored by the case managerAdult Education & LiteracyApprenticeshipCombined Workplace Skills Training & Related InstructionCustomized TrainingEnglish Language InstructionEntrepreneurial TrainingJob Readiness TrainingOccupational ClassroomOn-the-Job TrainingITA Program Name: ______________________________________________________ITA Program Provider: ____________________________________________________SemesterDirect Costs COMMENTS: FORMTEXT ?????SUPPORTIVE SERVICES: FORMCHECKBOX Provided as needed FORMCHECKBOX NOT Provided as needed FORMCHECKBOX Not needed If Supportive Services provided: FORMCHECKBOX Yes FORMCHECKBOX NoParticipant received supportive services appropriately:documented need prior to delivery of servicebased on an assessmentnecessary for participation in WIOA serviceswith coordination across dual-enrolled programs FORMCHECKBOX Yes FORMCHECKBOX NoThe Supportive Service is appropriately documented:In IEPIn ASSET Manage Services and in case file FORMCHECKBOX Yes FORMCHECKBOX NoSupportive Services provided according to local policy:AllowableWithin funding limits and durationReimbursement amounts are documented via logs, receipts, or other documentation as required by local policy FORMCHECKBOX Yes FORMCHECKBOX NoDocumentation of referrals to other resources FORMCHECKBOX Yes FORMCHECKBOX NoASSET services correspond with supportive services provided; dates matchDate Type of Support Provided Direct Costs COMMENTS: FORMTEXT ?????TRAINING PERFORMANCE OUTCOMES: (Review if training service provided) FORMCHECKBOX Yes FORMCHECKBOX No Training provided after July 1, 2016If YES: FORMCHECKBOX Yes FORMCHECKBOX NoMeasurable Skill Gains Achieved FORMCHECKBOX Yes FORMCHECKBOX No If achieved, are documented properly in ASSET and case file FORMCHECKBOX Yes FORMCHECKBOX No Training program is completed. If yes: FORMCHECKBOX Yes FORMCHECKBOX No "ITA Program Outcome" completed in ASSET service(s) FORMCHECKBOX Yes FORMCHECKBOX No "ITA Employment Outcome" completed in ASSET service(s) FORMCHECKBOX Yes FORMCHECKBOX No Credential attained. If yes: FORMCHECKBOX Yes FORMCHECKBOX No Documented properly in ASSET and fileProgram Yr Type of Gain File ASSET7/1/17-6/30/187/1/18-6/30/197/1/19-6/30/207/1/20-6/30/21COMMENTS: FORMTEXT ?????EXIT INFORMATION: FORMCHECKBOX Not Yet Exited FORMCHECKBOX Active Participant OR FORMCHECKBOX No longer receiving Services FORMCHECKBOX Services are closed – exit is pending FORMCHECKBOX Participant should be exited FORMCHECKBOX Exited FORMCHECKBOX Yes FORMCHECKBOX No Exit completed appropriately:per federal and state policy per criteria described in local plan (V1.C.10) per actual service provisionExit Reason: FORMCHECKBOX Employment FORMCHECKBOX Education FORMCHECKBOX Other_______________________ FORMCHECKBOX Exclusion ____________________________ FORMCHECKBOX Yes FORMCHECKBOX No Exclusionary exit properly documentedExit Date:_____________________COMMENTS: FORMTEXT ?????Exclusion Reason:DeceasedHealth/MedicalInstitutionalizedReserve Forces alled to Active DutyFOLLOW-UP/PERFORMANCE TRACKING: FORMCHECKBOX Not Applicable FORMCHECKBOX Yes FORMCHECKBOX NoExited to unsubsidized employment (follow-up required) Date of Employment________________ FORMCHECKBOX Yes FORMCHECKBOX NoFollow up services made available for one year Services Offered during contact FORMCHECKBOX Yes FORMCHECKBOX No Follow-up Services provided FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX NoFollow up conducted properly per state and local policy FORMCHECKBOX Yes FORMCHECKBOX NoQuarterly Follow-up surveys completed properly and entered in ASSET FORMCHECKBOX Yes FORMCHECKBOX NoSupplemental employment data requiredIf Yes – It is collected & properly documented FORMCHECKBOX Yes FORMCHECKBOX NoDate ContactedFollow-up Survey CompleteCase NotesFile DocQ1 Q2Q3 Q4 COMMENTS: FORMTEXT ?????Data Validation for Employment after exitData Validation for Wages 2nd Quarter after exitCASE NOTES: FORMCHECKBOX Yes FORMCHECKBOX NoCase notes demonstrate that the WDB's process for contacting active participants is being followed as described in the Local Plan VI.C.9 FORMCHECKBOX Yes FORMCHECKBOX NoCase notes are entered in an appropriate manner:Content and dates agree with ASSET Manage ServicesCase notes are comprehensiveCase notes contain appropriate informationCase notes entered in a timely fashionDate of last direct contact:___________________________________COMMENTS: FORMTEXT ?????EVALUATION OF SERVICE DELIVERY: FORMCHECKBOX Yes FORMCHECKBOX No Assessments were provided and evaluated appropriate needs/barriers:supportive service needs need for trainingemployment history education history good fit career options barriers to employment FORMCHECKBOX Yes FORMCHECKBOX No Assessed needs were used to develop a comprehensive IEP/ISS: FORMCHECKBOX Yes FORMCHECKBOX No IEP clearly defines a career goal, supportive service needs, related planned services, etc. in a way that can be understood by the participant. FORMCHECKBOX Yes FORMCHECKBOX No Goals include short-term and long-term, are attainable, are related to Employment/training, advance the participant's economic self- sufficiency. FORMCHECKBOX Yes FORMCHECKBOX No If training was provided, the program made sense for the participant's goals and personal circumstances. FORMCHECKBOX Yes FORMCHECKBOX No Supportive services were discussed / offered / provided in a way that makes sense to the participant's needs. FORMCHECKBOX Yes FORMCHECKBOX No Participant seemed easily able to navigate programmatic requirements / procedures; artificial barriers were not established to access services. FORMCHECKBOX Yes FORMCHECKBOX NoFile gives overall appearance that services were provided appropriately:Complete, accurate documentationRegular, timely, effective communicationCohesive, comprehensive service deliveryAssessment based and IEP driven case progressionAppropriate collaboration within One-Stop Delivery systemParticipation resulted in overall positive outcome for participantServices provided serve to advance career goalServices provided address barriers to education/employmentCareer Goal in IEP: _________________________________________ FORMCHECKBOX Yes FORMCHECKBOX No Any/all services provided served to help participant ultimately achieve career MENTS: FORMTEXT ?????FINDINGSAREAS OF CONCERNPOSITIVE PRACTICES FORMCHECKBOX EO / CRC ISSUES IDENTIFIED: ................
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