Previous Policy - 12.4 Dislocated Worker Program File Documentation

12.4.3 Required Federal Reporting

Effective date: September 1, 2020

For each Dislocated Worker Program applicant, the following data elements must be collected and documented for federal reporting purposes,¹ as outlined below. These elements do not impact program eligibility but may impact negotiated and adjusted levels of performance via the statistical adjustment model.

Consistent with the WIOA Title I Application Process Guidance, WDBs and their service providers must ensure that their WIOA Title I application forms include all the information needed to create an individual's record in ASSET. The WIOA Title I application form is considered an allowable self-attestation for these data elements.

NOTE: The list below is not exhaustive. Allowable forms of documentation for other required federal reporting elements are identified in other areas of this policy.

Data Element	Example Documentation² NOTE: This list is not intended to be all-inclusive.
Sex	Self-Attestation
Age/Date of Birth³	Driver's license Baptismal record Birth Certificate (vital record, do not copy) DD-214 Military report of Transfer or Discharge paper Federal, state, or local ID card (Do not copy state ID card) Passport Hospital record of birth Public assistance/social service records School records or ID cards Work permit Family Bible
Ethnicity: Hispanic/Latino	Self-Attestation
Race	Self-Attestation
Limited English Language Proficiency	Self-Attestation
Limited English Reading Ability (if Limited English Language Proficient)	Self-Attestation
Limited English Speaking Ability (if Limited English Language Proficient)	Self-Attestation
Primary Language (if Limited English Language Proficient)	Self-Attestation
Eligible Veteran Status⁴	Form DD-214 showing the military service member's discharge that is anything other than dishonorable Cross-match with Department of Defense records Cross-match with Veterans Service Database Letter from the Veterans Administration
Current Education Status (School Status at Program Entry)⁵	Self-Attestation OR Cross-match with Postsecondary Education Database Copy of educational institution enrollment record Applicable records from educational institution (GED certificate, diploma, attendance record, transcripts, report card, or school documentation) Electronic records Verbal Verification
Current Highest School Grade Completed	Self-Attestation OR Applicable records from education institution (GED certificate, diploma, attendance record, transcripts, drop out letter, school documentation) Signed WIOA intake application or registration form Electronic Records
Single Parent⁶	Self-Attestation OR TANF/W-2 Single Parent Eligibility Verification Needs Assessment Signed WIOA intake application or registration form Signed Individual Employment Plan Case Notes
Current Employment Status	Self-Attestation
Current Unemployment Insurance Programs (UI)⁷	Self-Attestation, only if customer is not an RESEA or WPRS participant OR Cross-match to state UI database Cross-match to state MIS database (Verification of Re-employment Services and Eligibility Assessment (RESEA)-funded services from the ASSET Manage Services tab) Referral transmittal by RESEA or WPRS
Pell Grant Recipient	Self-Attestation OR FAFSA/Financial Aid Records Award Letter
Active Duty Military Spouse	Self-Attestation
Foster Care (Foster Care Youth Status at Program Entry)⁸	Self-attestation OR Written Confirmation from Social Services Agency Foster Care Agency Referral Transmittal Signed WIOA intake application or registration form Needs Assessment Signed Individual Employment Plan Verbal Verification from cognizant agency or official (school counselor, social worker, court, etc.) Case Notes
Family Income at or Below the Current Federal Poverty Guidelines or 70% of the Lower Living Standard Income Level (LLSIL) Guidelines ⁹ Family size must be correctly determined and documented in order to correctly establish a low-income determination. NOTE: Information used to establish Family size is different from the information used to establish a household composition for the purposes of determining Economic Self-Sufficiency. NOTE: Family size is determined as of the date of eligibility determination. Family members who may have comprised part of the family during the past six months but no longer meet the definition of family should not be counted. See Income Guidance for included and excluded income types and the time span for calculating income.	Self-attestation OR Award letter from Veterans Administration Bank statements Pay stubs Compensation award letter Court award letter Pension statement Employer statement/contact Family or business financial records Housing authority verification Quarterly estimated tax for self-employed persons Social Security benefits UI claim documents Copy of authorization to receive cash public assistance Copy of public assistance check Public assistance eligibility verification Cross-match with Refugee Assistance records Cross-match with public assistance records Cross-match with UI wage records Local Income Determination Form NOTE: The career planner must document the participant's income, even if the income was $0 for the past six months.
Unemployed Greater Than or Equal to 27 Consecutive Weeks (Long-term unemployed)¹⁰	Self-Attestation OR Public assistance records Refugee assistance records Cross-match with public assistance database Cross-match to state UI database
FoodShare / (Supplemental Nutrition Assistance Program (SNAP))¹¹	FoodShare/SNAP eligibility verification Copy of Authorization to Receive Foodshare/SNAP Receipt of FoodShare/SNAP purchase showing balance from point of sale and date of purchase Referral Transmittal from Foodshare/SNAP Cross-Match with Foodshare/SNAP Public Assistance Record Verbal Verification from appropriate Human Services agency Printout from www.access.wisconsin.gov showing benefits statement NOTE: The following are not acceptable forms of documentation: A copy of the participant's FoodShare (Quest) card Screen prints from CARES
Temporary Assistance for Needy Families (TANF) / Wisconsin Works (W-2)¹²	TANF/W-2 Eligibility Verification TANF/W-2 Period of Benefit Receipt Verification Referral Transmittal from TANF/W-2 Cross-Match with TANF/W-2 Public Assistance Records Verbal Verification from appropriate Human Services agency NOTE: It is not allowable to use screen prints from CARES to document TANF/W-2.
Exhausting TANF/Wisconsin Works (W-2) within 2 years¹³	TANF/W-2 Eligibility Verification TANF/W-2 Period of Benefit Receipt Verification Referral Transmittal from TANF/W-2 Cross-Match with TANF/W-2 Public Assistance Records Verbal verification from appropriate Human Services agency NOTE: It is not allowable to use screen prints from CARES to document TANF/W-2.
Other Income-Based Public Assistance (Other Public Assistance Recipient)¹⁴	Copy of Authorization to Receive Cash Public Assistance Copy of Public Assistance Check Medical Card Showing Cash Grant Status Public Assistance Eligibility Verification Cross-Match with Refugee Assistance Records Cross-Match with Public Assistance Records Cross-Match with State MIS Database Verbal verification from appropriate social services agency NOTE: Career planners may not use screen prints from CARES to document public assistance.
Offender or Ex-Offender (Ex-Offender Status at Program Entry)¹⁵ NOTE: Does not include speeding tickets or traffic court.	Self-Attestation OR Documentation from juvenile or adult criminal justice system (https://wcca.wicourts.gov) Written Statement or Referral Document from a Court or Probation Officer Referral Transmittal from a Reintegration Agency Signed WIOA intake application or registration form Needs Assessment Signed Individual Employment Plan Federal Bonding Program Application Verbal verification with court or probation representative Case Notes
Incarcerated at Program Entry (if Offender or Ex-Offender)	Self-Attestation OR Verbal or written verification from justice system
Eligible Migrant and Seasonal Farmworker Status¹⁶	Self-attestation that participant worked in migrant farm work within last 12-months, seasonally/temporarily, with a recognized employer OR Cross-Match with Public Assistance Records NFJP Eligibility Documents Cross-Match with State MIS Cross-Match with H-1B Records Case Notes
Individual with a disability¹⁷	Self-Attestation OR School 504 records provided by student Assessment test results NOTE: Case notes and other documentation related to this element must be maintained in compliance with Section 5.7 ¹⁸ of this policy manual.
Basic Skills Deficient ¹⁹	Basic Skills Screening Tool (DETW-18156-E) OR Assessment test results Applicable records from education institution (transcripts, academic assessments, or other school documentation) Case notes
English Language Learner²⁰	Self-Attestation OR Basic Skills Screening Tool (DETW-18156-E) Assessment test results Applicable records from education institution (transcripts, or other school documentation) Signed WIOA intake application or registration form Signed Individual Employment Plan Case notes
Cultural Barriers	Self-Attestation
Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI)²¹	SSI/SSDI Receipt of Benefits Verification Referral Transmittal from Social Security Administration (SSA) SSI/SSDI Eligibility Verification Cross-Match with SSA Database Verbal Verification from Social Security Administration
Homeless(Homeless participant, Homeless Children and Youths, or Runaway Youth at Program Entry)²²	Self-attestation OR Signed WIOA intake application or registration form Written Statement or Referral Transmittal from a Shelter or Social Service Agency Needs Assessment Signed Individual Employment Plan A letter from caseworker or support provider Verbal or written verification from social service agency Case Notes
Qualifying Employer Name	Self-attestation OR Verification from employer Rapid Response list Notice of layoff (Including a WARN Notice) Public announcement of layoff UI documentation
Qualifying Dislocation Date (Actual Dislocation Date)²³	Self-attestation OR Verification from Employer Rapid Response List Notice of layoff (Including a WARN Notice) Public Announcement with Follow-Up Cross-Match with UI Database
Rapid Response Participation²⁴	Self-attestation OR Cross-match to state MIS database Rapid Response list Cross-match to Rapid Response records Case notes

¹ WIOA Reporting Advisories
² Unless otherwise noted, information on documentation sources is from OMB Control No. 1205-0521.
³ Per TEGL 23-19, Attachment II, Data Element 200 Data Element Validation is required.
⁴ Per TEGL 23-19, Attachment II, Data Element 301 Data Element Validation is required.
⁵ Per TEGL 23-19, Attachment II, Data Element 409 Data Element Validation is required.
⁶ Per TEGL 23-19, Attachment II, Data Element 806 Data Element Validation is required.
⁷ Per TEGL 23-19, Attachment II, Data Element 401 Data Element Validation is required.
⁸ Per TEGL 23-19, Attachment II, Data Element 704 Data Element Validation is required.
⁹ This criterion is not covered in TEGL 23-19, Attachment II, but is included as part of the Data Element Definition for Data Element 802. WIOA Sec. 3(36)(A)(ii) states that an individual is "low-income" if they are in a family with total family income that does not exceed the higher of (I) the poverty line; or (II) 70 percent of the lower living standard income level. Family is defined at 20 § CFR 675.300.
¹⁰ Per TEGL 23-19, Attachment II, Data Element 402 Data Element Validation is required.
¹¹ Per TEGL 23-19, Attachment II, Data Element 603 Data Element Validation is required.
¹² Per TEGL 23-19, Attachment II, Data Element 600 Data Element Validation is required.
¹³ Per TEGL 23-19, Attachment II, Data Element 601 Data Element Validation is required.
¹⁴ Per TEGL 23-19, Attachment II, Data Element 604 Data Element Validation is required.
¹⁵ Per TEGL 23-19, Attachment II, Data Element 801 Data Element Validation is required.
¹⁶ Per TEGL 23-19, Attachment II, Data Element 808 Data Element Validation is required.
¹⁷ Per TEGL 23-19, Attachment II, Data Element 202 Data Element Validation is required.
¹⁸ 29 CFR § 38.41 requires that any medical or disability-related information about a particular individual, including information that could lead to the disclosure of a disability, must be collected on separate forms. All such information, whether in hard copy, electronic, or both, must be maintained in one or more separate files, apart from other information about the individual, and treated as confidential.
¹⁹ Per TEGL 23-19, Attachment II, Data Element 804 Data Element Validation is required.
²⁰ Per TEGL 23-19, Attachment II, Data Element 803 Data Element Validation is required.
²¹ Per TEGL 23-19, Attachment II, Data Element 602 Data Element Validation is required.
²² Per TEGL 23-19, Attachment II, Data Element 800 Data Element Validation is required.
²³ Per TEGL 23-19, Attachment II, Data Element 410 Data Element Validation is required.
²⁴ Per TEGL 23-19, Attachment II, Data Element 908 Data Element Validation is required.