HomeMy WebLinkAbout982408.tiff RESOLUTION
RE: APPROVE REVISIONS TO OPERATIONS MANUAL, SECTION 6.000, COLORADO
WORKS IN WELD COUNTY AND CHILD CARE POLICIES AND PROCEDURES
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Department of Social Services has presented revisions to the
Operations Manual, Section 6.000, Colorado Works in Weld County and Child Care Policies and
Procedures, to the Board of County Commissioners of Weld County, for consideration and
approval, and
WHEREAS, after review, the Board deems it advisable to approve said revisions, a copy
of which are attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the revisions to the Operations
Manual, Section 6.000, Colorado Works in Weld County and Child Care Policies and
Procedures for the Department of Social Services be, and hereby are, approved.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 14th day of December, A.D., 1998.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: / i./, i/. ‘,,,,: -.2.377,:;;;;;2(....-teei, >_4fc.!- j< nstance L. Harbert, Chair
Weld County Clerk tot B. rdn ,�
(r ki EXCUSED DATE OF SIGNING (AYE)
L 'St sal
W. H. Webster, Pro-Tem
BY: -! i% at e. _
Deputy Clerk to the eo=.r >� EXCUSED
�'�)(Ld y�;���.'� urge E. Baxter
ED AS RM:
a ey, . Hall /
ounty Attor ey LLL J 2 y,�� eA�
i arbara J. Kirkmeyer /✓
rp, SS 982408
SS0024
•
Kiel terSv.. , DEPARTMENT OF SOCIAL SERVICES
P.O. BOX A
'VGREELEY,COLORADO 80632
Administration and Public Assistance(970) 352-1551
Child Support(970) 352-6933
O Protective and Youth Services (970)352-1923
MEMORANDUM Food Stamps(970) 356-3850
COLORADO Fax(970) 353-5215
TO: Constance L. Harbert, Chair DATE: December 11, 1998
Board of County Commissioners //��
ort
FR: Judy A. Griego, Director, Social Services a
RE: Weld County Department of Social Services Operations Manual
for the Colorado Works in Weld County and Child Care Policies
and Procedures
Enclosed for Board approval are revisions to Section 6.000, Colorado Works in Weld County
and Child Care Policies and Procedures, of the Weld County Department of Social Services
Operations Manual.
The revisions are as follows:
6.004 Individual Responsibility Contracts - A separate Individual
Responsibility Contract was added for participants of the Weld County
Grant Diversion(State Diversion) and the Job Retention and Skills
Training Program (County Diversion Program).
6.006.21 Work Supplementation Program - In addition to the private sector, the
- public sector was added as placement sites for participants of the Work
Supplementation Program.
6.006.231 Public Sector Work Activity Agreement- To conform to the Fair Labor
Standards Act and to meet the required hours of participation under the
Colorado Works in Weld County, the total dollar amount to be used for
the computation of work hours will include cash assistance from the
Colorado Works in Weld County Program, Food Stamp assistance, and
other cash assistance (work incentives, training allowances).
6.006.33 Other Work Activities - This section expands the definition of work
activities. These work activities must be specified and approved by the
case manager and his or her supervisor in the Individual Responsibility
Contract in order for the client to meet the 24-month federal work
requirement.
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982408
MEMORANDUM
Constance L. Harbert
December 11, 1998
6.007.2 Payment Limit and Types of Payment- This section expands the
payment limit for a family unit per year from $1,600 to $3,300 under the
Weld County Grant Diversion Program (State Grant Diversion Program).
6.008.3 General Requirements for Supportive Services Needed for Job
Retention - This section expands the payment limit for a client who
requests Job Retention Support Services under the Job Retention and
Skills Training Program (County Diversion Program). This payment limit
will be from $1,600 to $3,300.
Exhibit A-1 Individual Responsibility Contract(IRC) - This exhibit will be renamed
from Exhibit A to Exhibit A-1. The IRC provided as Exhibit A-1 will be
for clients participating in non-diversion programs of the Colorado Works
in Weld County Program.
Exhibit A-2 Individual Responsibility Contract (IRC) - This exhibit is an addition.
The IRC provided as Exhibit A-2 will be for clients participating in
diversion programs of the Colorado Works in Weld County Program.
Table of The Table of Contents is revised to reflect the changes described above
Contents
Would you please indicate in the resolution, the specific sections revised or added.
If you have any questions, please telephone me at extension 6510.
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Colorado Works in Weld County and Child Care Policies and Procedures
Table of Contents
SECTION: TITLE:
6.000 Colorado Works in Weld County and Child Care Policies and Procedures
6.001 Definition and Legal Basis
6.002 Eligibility and Basic Grant Assistance
6.002.1 Eligibility
6.002.2 Domestic Violence Screening
6.002.3 Basic Grant Assistance
6.003 Client Assessment
6.003.1 Applicant
6.003.11 Department Responsibilities
6.003.12 Employment Services Responsibilities
6.003.2 Recipients
6.003.21 Department Responsibilities
6.003.22 Employment Services Responsibilities
6.003.3 Participant Assessment
6.004 Individual Responsibility Contract
6.004.1 Department Responsibilities with the IRC
6.004.2 Employment Services Responsibilities with the IRC
6.005 Temporary Good Cause Exemptions from Work Participation
6.005.1 Reasons for Temporary Good Cause Exemption from Work Participation
6.005.2 Redetermination of Temporary Good Cause Exemptions
6.005.3 Participant Appeal of Non-Exempt Status Under Temporary Good Cause
Exemptions
6.006 Work Participation Requirements and Work Activities
6.006.1 Work Participation Requirements
6.006.12 Job Ready
6.006.2 Work Activities
6.006.21 Work Supplementation Program
6.006.211 Work Participation Standard with.an Employer
6.006.212 Work Supplementation Responsibilities of an Employer
6.006.213 Work Supplementation Responsibilities of the Department
6.006.214 General Participant Screening Criteria
6.006.215 General Requirements for Training
6.006.22 Work Supplementation Program with Temporary Employment Agencies
6.006.221 Work Participation Standard with.Temporary Employment Agencies
6.006.222 Work Supplementation Responsibilities with Temporary Employment Agencies
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Colorado Works in Weld County find Child Care Policies and Procedures
6.006.223 Work Supplementation Responsibilities of the Department
6.006.224 General Participant Screening Criteria
6.006.225 - General Requirements for Training
6.006.23 Public Sector Work Activity
6.006.231 Public Sector Work Activity Agreement
6.006.232 Optional Training Under the Public Sector Work Activity Agreement
6.006.24 Private Sector Work Activity
6.006.241 Private Sector Work Activity Agreement
6.006.242 Optional Training Under the Private Sector Work Activity Agreement
6.006.25 On-the-Job Training Program
6.006.26 IRC Skill Development Seminar
6.006.27 Community Service Program
6.006.28 Vocational Education Training(not to exceed 12 months with respect to any
participant)
6.006.29 Job Skills Training
6.006.30 Education Directly Related to Employment(for a participant who has not received
a high school diploma or a certificate of high school equivalency)
6.006.31 Secondary School or Equivalent Education
6.006.32 County Designed Occupational Skills Training Program(not to exceed twelve
months with respect to any participant)
6.006.33 Other Work Activities as Approved and Authorized
6.007 Weld County Grant Diversion Program(State Grant Diversion Program)
6.007.1 Client Assessment
6.007.2 Payment Limit and Types of Payment
6.007.3 Pre-Authorization Information
6.007.4 Authorization of Payment under the Individual Responsibility Contract and
Limitations
6.007.5 Eligibility Waiver Period for Colorado Works in Weld County Assistance
6.007.6 Authorized Payee
6.007.7 Submission of Payment
6.007.8 Vendor Accepts Voucher Payment
6.007.9 Vendor Does Not Accept Voucher Payment
6.007.10 Responsibility of Department's Eligibility Technician
6.007.11 Responsibility of Department's Business Office
6.008 Job Retention and Skills Training Program(County Diversion Program)
6.008.1 Eligible Participants
6.008.2 General Requirements for Training
6.009 Participant Sanctions or Other Assistance and Separate County Division
6.010 Supportive Services (non-Child Care)
6.010.1 Transportation
6.010.2 Participation Related Services
6.010.3 Start to Work Support Services
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Colorado Works in Weld County and Child Care Policies and Procedures
6.010.4 Supportive Services Expenditure Limit
6.010.5 Participant Criteria to Receive Supportive Services
6.011 Participant Sanctions and Appeals
6.011.1 Participant Sanctions
6.011.11 Definition of Sanctions
6.011.12 Notice of Proposed Applicant or Recipient Sanction
6.011.2 Absences or Late Occurrences of Participants in Work Supplementation
Programs, On-the-Job Training Program, and the Job Retention and Skills
Training Program
6.011.3 Absences from or Late Occurrences to Other Work Activities or Scheduled
Appointments
6.011.31 Late Occurrences to Work Activities and Scheduled Appointments
6.011.32 Absences from Work Activities and Scheduled Appointments
6.011.33 Definition of Immediate Family for Purposes of Section 6.009.12
6.011.4 Participant Appeals
6.012 Organization, Flow Chart, and Budget Plan
6.012.1 General Organization
6.012.2 Joint Functions of the Department and the Employment Services
6.012.3 Functions of the Department
6.012.4 Functions of Employment Services
6.012.5 Participant Flow Chart
6.012.6 Budget Transfer from the Department to Employment Services
6.013 Performance Outcomes
6.013.1 Federal and State Participation Rates and Required Hours of Participation
6.013.2 Weld County Outcomes
6.014 Child Care
6.014.1 Client Eligibility
6.014.2 Child Care Provider Rates
6.014.3 Registration, Activity,and Transportation
6.014.31 Absences
6.014.32 Registration, Activity, and Transportation Fee
6.014.33 20% Rule
6.015 Food Stamp Interface
6.016 Medicaid Interface
6.017 Social Services Division Interface
6.017.1 Procedures
6.018 Child Support Interface
6.018.1 Individual Responsibility Contract
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Colorado Works in Weld County and Child Care Policies and Procedures
6.018.2 Child Support Payments
6.018.3 Child Support Assessment
6.019 Weld County Housing Authority Interface
6.019.1 Client Preferences for the Weld County Housing Authority Section 8 Program
6.019.2 Participation and Notification
6.019.3 Family Self-Sufficiency Program (FSS)
6.019.4 Sanctions and Appeals
6.020 Community Agency Interface
6.021 Reporting Requirements
6.022 Out of Wedlock Births Plan
6.023 Statutory Rape Plan
6.024 Contracts or Other Agreements to Purchase Services
6.025 Earned Income Tax Credit
6.026 Individual Development Accounts
6.027 County Optional Other Assistance
6.028 County Optional Diversion Grants
6.029 Any Other Services
Exhibit A-1: Weld County Individual Responsibility Contract (IRC) (For Non-Division Program)
Exhibit A-2: Weld County Individual Responsibility Contract (IRC) (For Diversion Program)
Exhibit B: Work Supplementation Agreement
Exhibit C: Work Supplementation Agreement with Temporary Employment Agencies
Exhibit D: Public Sector Work Activity Agreement
Exhibit E: Private Sector Work Activity Agreement
Exhibit F: Participant Flow Chart
Exhibit G: Client Baseline Information for Colorado Works in Weld County
Exhibit H: Notice of Proposed Sanction
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Colorado Works in Weld County and Child Care Policies and Procedures
6.004 Individual Responsibility Contracts
Effective 9/10/97
Revised 12/98 _ A. IRC for Non-Diversion Program
The Department will develop with a client and monitor the Individual
Responsibility Contact(IRC). The Individual Responsibility Contract(IRC) is
attached to this section and is set forth in Exhibit A.
The provisions and responsibilities of the IRC clearly define the expectations and
responsibilities of the Colorado Works in Weld County applicant and recipient for
assistance under the Colorado Works in Weld County Program.
If an applicant refuses to sign an IRC, the applicant shall not receive assistance
and processing of his or her application will cease.
B. IRC for Diversion Programs Only
A client who will be participating the Weld County Grant Division (State
Diversion Program)under Section 6.007 of the Job Retention and Skills Training
Program(County Division Program) under section 6.008 will complete an IRC as
set forth in Exhibit A-2.
6.004.1 Department Responsibilities with the IRC
A. Department staff will explain verbally and in writing the First Section of the IRC.
The Department staff will describe program provisions,participant
responsibilities, and participant rights under the IRC. Department staff will obtain
the necessary signatures of the applicant or recipient and Department staff on the
First Section of the IRC.
B. Department staff will use the Second Section of the IRC to identify steps the
applicants or recipients may need to take which will enhance the recipient's or
applicant's employability. These steps may include addressing mental health,
physical health, drug, and alcohol, or other issues that would limit the recipient or
applicant from participating on work participation activities. The Department
staff will obtain the necessary signatures of the applicant or recipient and
Department staff on the Second Section of the IRC.
C. Department staff will schedule an appointment and send the recipient to
Employment Services. The Department's referral to Employment Services
constitutes a referral of the recipient to employment.
D. Department staff will review all temporarily exempted recipients who are not
engaged in an authorized work activity between a one and three month period for
continued exemption from work participation.
E. Department staff will reassess recipients who are temporarily exempted from work
participation within three months of the last IRC to determine their readiness to
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Colorado Works in Weld County and Child Care Policies and Procedures
participate in an employment assessment.
6.004.2 - Employment Services Responsibilities with the IRC
A. Employment Services' staff will complete an employment assessment that will be
used as the basis of completing the work activity assignment section under the
second section of the IRC. Employment Services' staff will schedule applicants,
unless exempted after the employment assessment, to attend an IRC Skill
Development Seminar.
B. Upon the completion of the IRC Skill Development Seminar, Employment
Services' staff will reassess applicants who have not obtained employment and
have become recipients. Employment Services' staff will determine any
additional work activities and/or supportive services the applicant may need to
obtain or retain unsubsidized employment. This assessment may include
additional testing, including basic skills, academic,vocational assessments, or
employment and career exploration.
C. The Employment Services' staff, along with the applicant or recipient, will
complete the Second Section of the IRC as a result of this screening and
assessment process. Employment Services' staff will obtain the necessary
signatures of the applicant or recipient and Employment Services' staff on the
Second Section of the IRC.
D. The Employment Services' staff will update the Second Section of the IRC, as
appropriate, with the applicant or recipient.
E. If Employment Services' staff identify employment barriers of an applicant or
recipient, the Employment Services' staff, through the IRC, will direct the
applicant or recipient to the Department for the needed additional supportive
services.
Colorado Works in Weld County and Child Care Policies and Procedures
6.006 Work Participation Requirements and Work Activities
Effective 9/10/97
6.006.1 Work Participation Requirements
All caretaker relatives with the exception of those caretaker relatives having a temporary
good cause exemption from work participation will be mandatory participants in work
activities.
6.006.12 Job Ready
Job Ready is defined as any Colorado Works in Weld County applicant or recipient who
does not have temporary good cause reasons, as established in the Department's
Operations Manual, that would prevent the applicant or recipient from participating in
work, training, or educational activities.
Participants will be determined to be job ready by assessments being completed during
various stages of the application process as previously described in Section 6.003.
6.006.2 Work Activities
A. Applicants and recipients will be referred to full-time or part-time work for wages
that the employer has paid in total. Employment may occur with any public,
profit, nonprofit, or a private employer.
Revised 3/98 B. An applicant or recipient refusing to accept a referral or an actual job offer will be
sanctioned 100% of the family grant for a minimum of one month.
C. All part-time employed participants will be required to seek full-time
employment.
D. Other mandatory participants will be assessed for participation in other work
activities as described in Section 6.006.2.
6.006.21 Work Supplementation Program
Revised 12/98
An employer may participate in a Work Supplementation Program for clients of the
Colorado Works in Weld County. The Work Supplementation Program is a
private/public sector employment program specifically designed for recipients of the
Colorado Works in Weld County Program as an Employer and as an instructional training
facility.
6.006.211 Work Participation Standard with an Employer
The employer must provide a minimum of three months of unsubsidized, continuous, full
time employment. The employer will provide participants with wages and benefits that
are comparable to other employees doing comparable work and provide liability and
worker's compensation. The employer may provide an additional three months of
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Colorado Works in Weld County and Child Care Policies and Procedures
continuous, full time employment,to those participants who need additional training to
continue employment with the employer or preparation for employment with another
- employer.
6.006.212 Work Supplementation Responsibilities of an Employer
A. Provide participant screening criteria to the Department of Colorado Works in
Weld County participants for initial placement with the employer.
B. Provide a forty-hour work week for the participant that provides for a combination
of work and education.
C. Provide training to the participant in job specifics and mentoring of recipients in
work ethics and employment retention skills for either continued employment
with the employer or for employment with another employer.
D. Reinforce employer basic skills competencies with the participant through the
Department's prescribed performance evaluations and/or counseling forms.
E. Determine if the training will be provided directly by the employer or through
subcontracts with training provider(s).
F. Furnish all equipment and materials for the participant.
G. Inform the Department within 24 hours when the employer terminates the
Colorado Works in Weld County client and documents its reason(s) for its action.
H. Adhere to certain program assurances provided by the Department.
6.006.213 Work Supplementation Responsibilities of the Department
A. Provide the employer with an orientation session outlining the specific procedures
and policies that the Department requires of the employer.
B. Encourage participants to apply fir available positions with the employer and
assess participants to determine their job readiness for positions with the
employer.
C. Arrange for space for the employer to interview applicants referred to the
employer.
D. Refer, if available, the agreed upon number of participants to the employer for
employment.
E. Reimburse the employer a monthly work supplementation fee of 50% of the
participant's gross salary for the month.
F. Reimburse the employer a training allowance bonus on behalf of the participant as
follows:
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Colorado Works in Weld County and Child Care Policies and Procedures
1. A training allowance bonus of$300 for a participant who is placed in a
three-month Work Supplementation Program. The employer will be
reimbursed the total training allowance bonus at the end of the three-
month period not to exceed$300.
2. A training allowance bonus of$300 for a participant who requires an
additional three months of participation in the Work Supplementation
Program. The employer will be reimbursed the total training allowance
bonus at the end of the three-month period not to exceed$300.
3. A training allowance bonus of$500 for a participant whom the employer
has hired after a successful completion of a three month or six month
work supplementation program and retained in full time employment for
three months.
G. Assist the employer, upon the employer's request, in resolving any possible
disputes with the participant.
H. If the employer terminates a participant, the Department will determine the
eligibility and sanction status of the participant.
I. Complete a Work Supplementation Agreement with the employer. The Work
Supplementation Agreement between an employer and the Department is attached
and is set forth in Exhibit B.
J. Complete a Work Supplementation Participation Agreement with the participant.
The Work Supplementation Participation Agreement between the participant and
the Department is attached and is set forth in Exhibit B.
K. Provide the participant with the appropriate supportive services and work related
expenses.
6.006.214 General Participant Screening Criteria
A. The Department will not refer those participants whom the Department may
directly refer to employment.
B. The Department will refer those participants whom the Department has identified
as having the motivation and aptitude for the Work Supplementation Program
position, as meeting the screening criteria of the employer, and as having certain
barriers as follows:
1. limited or no work experience
2. irrelevant work history, skills, or training, i.e., truck driving training with
DUI issues.
6.006.215 General Requirements for Training
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Colorado Works in Weld County and Child Care Policies and Procedures
Under the Work Supplementation Agreement,the employer will provide job specific and
- mentoring training necessary for the participant to retain employment.
A. The Department will authorize with the employer the training plan for the
participant including training criteria,methods by which the training outcomes
will be measured, and associated costs.
B. The employer may choose to provide this training directly or to provide this
training, through subcontracts, with training providers. Training providers are
defined,but not limited to, as public schools,private non profits,private for
profit,post secondary, community colleges, and proprietary schools.
C. The Department will authorize training providers in the training areas of:
1. Job Specifics
2. Mentoring of Recipients in Work Ethics and Job Retention Skills
D. To ensure that the job specific and mentoring training meets the local demand of
employers, local private sector employers, through the Weld County Private
Industry Council, will recommend to the Department the authorization of training
plans and training providers.
6.006.22 Work Supplementation Program with Temporary Employment Agencies
A temporary employment agency, as the employer, may participate in a specially designed
Work Supplementation Program for clients of the Colorado Works in Weld County
Program. The Work Supplementation Program is a private sector employment program
specifically designed for Colorado Works in Weld County participants as an employer and
as an instructional training facility.
6.006.221 Work Participation Standard with Temporary Employment Agencies
The temporary employment agency, as an employer,must provide a minimum of three
months of unsubsidized, continuous, full time employment. The temporary employment
agency will provide participants with wages and benefits that are comparable to other
employees doing comparable work and provide liability and worker's compensation. The
temporary employment agency may provide an additional three months of continuous, full
time employment, to those participants who need additional training to continue
employment with the temporary employment agency or preparation for employment with
another employer.
6.006.222 Work Supplementation Responsibilities with Temporary Employment Agencies
A. Provide participant screening criteria to the Department of Colorado Works in
Weld County participants for initial placement with the temporary employment
agency.
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Colorado Works in Weld County and Child Care Policies and Procedures
B. Provide a forty-hour work week for the participant that provides for a combination
of work and education.
C. Provide training to the participant in job specifics and mentoring of recipients in
work ethics and employment retention skills for either continued employment
with the Employer.
D. Reinforce employer basic skills competencies with the participant through the
Department's prescribed performance evaluations and/or counseling forms.
E. Furnish all equipment and materials for the participant.
F. Inform the Department within 24 hours when the temporary employment agency
terminates the Colorado Works in Weld County client and documents its reason(s)
for its action.
G. Adhere to certain program assurances provided by the Department.
6.006.223 Work Supplementation Responsibilities of the Department
A. Provide the temporary employment agency with an orientation session outlining
the specific procedures and policies that the Department requires of the temporary
employment agency.
B. Encourage participants to apply for available positions with the temporary
employment agency and assess participants to determine their job readiness for
positions with the temporary employment agency.
C. Arrange for space for the temporary employment agency to interview applicants
referred to the temporary employment agency.
D. Refer, if available, the agreed upon number of participants to the temporary
employment agency for employment.
E. Reimburse the temporary employment agency a monthly work supplementation
fee of 25%of the participant's gross salary for the month, or$300 per month,
whichever is less.
F. Reimburse the temporary employment agency a training allowance bonus on
behalf of the participant as follows:
1) A training allowance bonus of$300 for a participant who is placed in a
three-month Work Supplementation Program. The temporary
employment agency will be reimbursed the total training allowance bonus
at the end of the three-month period not to exceed $300.
2) A training allowance bonus of$300 for a participant who requires an
additional three months of participation in the Work Supplementation
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Colorado Works in Weld County and Child Care Policies and Procedures
Program. The temporary employment agency will be reimbursed the total
training allowance bonus at the end of the three-month period not to
exceed$300.
G. Assist the temporary employment agency, upon its request, in resolving any
possible disputes with the participant.
H. If the temporary employment agency terminates a participant, the Department will
determine the eligibility and sanction status of the participant.
I. Complete a Work Supplementation Agreement with the temporary employment
agency. The Work Supplementation Agreement between a temporary
employment agency and the Department is attached and is set forth in Exhibit C.
J. Complete a Work Supplementation Participant Agreement with the participant.
The Work Supplementation Participant Agreement between the participant and
the Department is attached and is set forth in Exhibit C.
K. Provide the participant with the appropriate supportive services and work related
expenses.
6.006.224 General Participant Screening Criteria
A. The Department will not refer those participants whom the Department may
directly refer to employment.
B. The Department will refer those participants whom the Department has identified
as having the motivation and aptitude for the Work Supplementation Program
position, as meeting the screening criteria of the temporary employment agency,
and as having certain barriers as follows:
1. limited or no work experience
2. irrelevant work history, skills, or training, i.e., truck driving training with
DUI issues.
6.006.225 General Requirements for Training
Under the Work Supplementation Agreement, the temporary employment agency will
provide job specific and mentoring training necessary for the participant to retain
employment.
A. The Department will authorize with the temporary employment agency the
training plan for the participant including training criteria, methods by which the
training outcomes will be measured, and associated costs.
B. The temporary employment agency will provide this training directly to the
participant, through subcontracts, with training providers.
Colorado Works in Weld County and Child Care Policies and Procedures
C. The Department will authorize the training plan in the areas of:
1. Job Specifics
2. Mentoring of Recipients in Work Ethics and Job Retention Skills
D. To ensure that the job specific and mentoring training meets the local demand of
employers, local private sector employers,through the Weld County Private
Industry Council,will recommend to the Department the authorization of training
plans and training providers.
6.006.23 Public Sector Work Activity
Public Sector Work Activity is designed to help the near job ready to enter the world of
work,develop occupational skills and good work habits, and help the participant in
obtaining permanent unsubsidized employment. Work sites will be in the public sector.
The Department will enter into agreements with the public work site sponsor and the
participant. These agreements will outline the work activity, expectation from a work site
sponsor and participants and the length of the agreement.
6.006.231 Public Sector Work Activity Agreements
The hours outlined in Public Sector Work Activity Agreements must conform to the Fair
Labor Standards Act. The total dollar amount of the cash assistance will be composed of
basic cash assistance from the Colorado Works in Weld County Program,Food Stamp
assistance and other cash assistance (work incentives, training allowances). The total
dollar amount of cash assistance will be divided by the comparable per hour wage amount
of the client's work activity position to determine the required hours of participation.
Food Stamp recipients will be co-enrolled in the Food Stamp Work Fare Program. Work
Activity Agreements will be established for no more than three months per agreement.
Public Service Work Activity Agreement is Exhibit D.
6.006.232 Optional Training Under the Public Sector Work Activity Agreement
Under the Public Sector Work Activity Agreement, the public sector sponsor may provide
job specific training necessary for the participant to retain or obtain employment.
A. The Department will authorize with the public sector sponsor the training plan for
the participant including training criteria, methods by which the training outcomes
will be measured, duration of the training, and associated costs.
B. The public sector sponsor will provide this training directly or provide this
training, through subcontracts, with training providers.
C. The Department may authorize the job specific training plan and associated costs
not to exceed$1,500.
D. To ensure that the job specific training meets the local demand of employers, local
private sector employers, through the Weld County Private Industry Council, will
Colorado Works in Weld County and Child Care Policies and Procedures
recommend to the Department the authorization of training plans and training
providers.
6.006.24 Private Sector Work Activity
Private Sector Work Activity is designed to help the near job ready to enter the world of
work,develop occupational skills and good work habits, and help the participant in
obtaining permanent unsubsidized employment. Work sites will be in the private sector.
The Department will enter into agreements with the private sector work site sponsor and
the participant. These agreements will outline the work activity,expectation from a work
site sponsor and participants and the length of the agreement.
6.006.241 Private Sector Work Activity Agreements
The hours outlined in the Private Sector Work Activity Agreements must conform to the
Fair Labor Standards Act. The total dollar amount of the cash assistance will be divided
by the comparable wage amount of the client's work activity position. The total dollar
amount of the cash assistance will be composed of Colorado Works in Weld County
assistance and food stamp assistance. The Private Sector Work Activity Agreement is
Exhibit E.
6.006.242 Optional Training Under the Private Sector Work Activity Agreement
Under the Private Sector Work Activity Agreement, the private sector sponsor may
provide job specific training necessary for the participant to retain or obtain employment.
A. The Department will authorize with the private sector sponsor the training plan for
the participant including training criteria, methods by which the training outcomes
will be measured,duration of the training, and associated costs.
B. The private sector sponsor will provide this training directly or provide this
training, through subcontracts, with training providers.
C. The Department may authorize the job specific training plan and associated costs
not to exceed$1,500.
D. To ensure that the job specific training meets the local demand of employers, local
private sector employers, through the Weld County Private Industry Council, will
recommend to the Department the authorization of training plans and training
providers.
6.006.25 On-the-Job Training Program
The On-the-Job Training (OJT)Program is designed to teach and/or improve skills of the
participant on the job.
A. Employers must adhere to the hire first philosophy, and train the participant
during the contract period.
9S V&
Colorado Works in Weld County and Child Care Policies and Procedures
B. If an individual needs additional classroom training,beyond the employer
training,the costs of tuition and books will be included as reimbursable costs to
the employer from the Colorado Works in Weld County Program or other federal
or state resources.
C. The Department will reimburse the employer for the training costs. The costs and
duration of the OJT are calculated by determining the Dictionary of Occupational
Titles(DOT) code for the job description and the hourly wage.
6.006.26 IRC Skill Development Seminar(Job Search and Job Readiness Assistance)
Job search and job readiness assistance will be provided through the IRC Skill
Development Seminar. The IRC Skill Development Seminar is an activity that:
A. Screens and assesses an applicant's or recipient's job readiness.
B. Provides for an intensive job search activity during the participant's
application/eligibility process for the Colorado Works in Weld County Program.
C. Results in the completion of the IRC with the participant and assignment to other
authorized work activities.
D. Is up to four weeks.
E. If an applicant is successful in obtaining employment through the activity, the
applicant may not be eligible for cash assistance, or the length of time they
required public assistance may be reduced.
F. If an applicant or recipient is unsuccessful in finding unsubsidized employment,
he or she will be assigned to other authorized work activities and may return to the
IRC Skill Development Seminar later.
6.006.27 Community Service Program
The Department will not implement the Community Service Program at this time.
6.006.28 Vocational Education Training(not to exceed 12 months with respect to any
participant)
The Department will not implement Vocational Education Training at this time.
6.006.29 Job Skills Training
The job skills training gives participants specific job skills training necessary to do a
specific job or a group of jobs.
A. Participant selection for this work activity will be based on assessment,
availability of employment in the skill area, the probability of receiving a self-
sufficient wage when employed, and the participant's interest in completing
Colorado Works in Weld County and Child Care Policies and Procedures
training.
- B. Guidelines in developing or approving specific job skills training are as follows:
1. Tailored toward employer needs.
2. In line with the skills, aptitudes and interests of the participant.
3. Geared toward entry level employment, if appropriate.
4. Not exceed twelve months with respect to any participant.
5. Use labor market projects,such as the Supply/Demand Report, in
determining training areas.
C. To ensure that the job skills training areas are in demand, local employers will
help in the determination of specific training. Employers are involved initially to
ensure that training efforts result in actual jobs, and these jobs are available in the
Weld County labor market or in an area where the participant is willing to
relocate.
6.006.30 Education Directly Related to Employment(for a participant who has not received a
high school diploma or a certificate of high school equivalency)
Education will be provided for those participants who have not received a high school
diploma or a certificate of high school equivalency.
A. The participant must maintain satisfactory attendance, as defined by the
Department, at the Employment Services computer laboratory,Aims Community
College, or other accredited schools to achieve a GED or high school diploma.
B. The work activity must meet the work participation requirement.
6.006.31 Secondary School or Equivalent Education
Secondary school or equivalent education will be available to those participants who are
the head of household and have not attained twenty years of age.
A. The participant must maintain satisfactory attendance, as defined by the
Department, at a secondary school or its equivalent.
B. This work activity must meet the work participation requirement.
6.006.32 County Designed Occupational Skills Training Program(not to exceed twelve months
with respect to any participant)
Pursuant to Section 3.625.4 of the proposed rules of the Colorado Department of Human
Services, Weld County has chosen to develop another work activity that will lead the
participant to self sufficiency. The Individual Responsibility Contract will detail activity
designed to comply with the requirements of the program. Program requirements are as
follows:
A. The County Designed Occupational Skills Training Program is a short-term
Colorado Works in Weld County and Child Carelolicies and Procedures
educational activity intended to prepare an individual for employment. The
Program will not exceed twelve(12)months of continuous participation with
respect to any individual. Providers of this training include,but are not limited to,
community colleges,proprietary schools and nonprofit organizations.
B. Post secondary education will not be an allowable work activity for all new
applicants to the Colorado Works in Weld County Program effective July 1, 1997.
C. Post secondary education will be an allowable work activity for a recipient who is
already enrolled in or attending a post secondary or self-initiated education or
training at the time she or he would otherwise commence participation in the
Colorado Works in Weld County Program and meets the criteria of a recipient
who:
1. is receiving Aid to Families of Dependent Children or Aid to Families of
Unemployed Heads of Households as of June 30, 1997; and
2. is undergoing an assessment under the Colorado Works in Weld County
Program in Weld County before October 31, 1997, and
3. has a cumulative GPA of 2:.5 or above as demonstrated by transcripts; and
4. has physically attended, within the previous twelve month period, at least
two semesters out of the last three semesters of a university schedule or
three quarters out of the last four quarters of a community college
schedule as demonstrated by transcripts; and
5. is enrolled in full-time training as defined as follows:
a. Secondary school attendance(includes cooperative training
programs) of twenty-five clock hours per week or as defined by
the school; or
b. Vocational or technical school attendance of twenty-five clock
hours per week, thirty(30) in a program involving shop practice;
6. is enrolled in education that is in a demand occupational area leading to
employment upon completion of the degree as determined by the
Employment Services of Weld County; and
7. will finish a degree within a one year period from the date established in
the Individual Responsibility Contract; and
8. is not in a master or doctorate degree program.
D. Recipients enrolled in the County Designed Occupational Skills Program must
maintain an acceptable level of performance,which shall be detailed in the
Individual Responsibility Contract. To achieve an acceptable level of
performance, as measured by semester or quarter, the recipient must:
9ga7901
Colorado Works in Weld County and Child Care Policies and Procedures
1. maintain a GPA of 2.5 or above as demonstrated by transcripts; and
2. physically attend post secondary education by continuous attendance at
school with no semester or quarter interruptions in a year period; and
3. maintain full-time enrollment.
6.006.33 Other Work Activities as Approved and Authorized
Added 12/98
Individuals who are not capable, as determined by the case manager, of participating in
work activities as defined in Sections 6.006.1 through 6.006.32 of the Colorado Works in
Weld County Child Care Policies and Procedures may also be considered as engaged in
work activities and meeting the 24-month federal work requirement if they are actively
participating in one of the activities listed below which are designed to lead to self-
sufficiency. The work activity must be stated in the current IRC and be approved by the
case manager and his/her supervisor. The individual must participate in the work activity
for the number of hours identified in the IRC and demonstrate achievement in accordance
with the objectives stated in the IRC. The case manager(with authorization from the
supervisor)will not allow participants to continue in these activities longer than three
months without a re-assessment of their capabilities.
A. Receive counseling for mental health, substance abuse or domestic violence by an
approved counselor and as approved the case manager and specified in the IRC.
B. Fully participate in a medical treatment plan for a verified illness of participant or
family member and as approved by the case manager and specified in the IRC.
C. Fully participate in activities to resolve court related child welfare issues as
approved by the case manager and specified in the IRC.
D. Fully participate in activities designed to resolve family crisis as approved by the
case manager and specified in the IRC. These activities may include family
counseling mediation, etc.
E. Fully participate in self-improvement classes; i.e., self-esteem, life skills, etc., as
approved by the case manager and specified in the IRC.
F. Providing home schooling, as certified by the local school district, to a disabled
child. The Colorado Works in Weld County participant must be the caretaker
relative for the disabled child and the activity must be approved by the case
manager.
G. Other activities designed to prepare the individuals for self-sufficiency, as
approved by the case manager and that are specified in the IRC.
9S2747/08
Colorado Works in Weld County and Child Care Policies and Procedures
6.007 Weld County Grant Diversion Program(State Grant Diversion Program)
Effective 9/10/97
Revised 12/98 . The purpose of the Weld County Grant Diversion Program is to offer an alternative to
participants who are eligible for Colorado Works in Weld County Program,but could
avoid the need of such cash assistance if the Department granted the recipient assistance in
another form, in either a monthly payment or a "lump sum"payment. The Department
will comply with the general guidelines established by the Colorado Department of
Human Services and outlined in Section 3.602,Volume III, Income Maintenance
Programs.
6.007.1 Client Assessment
The Department will assess a client who requests a Grant Diversion Payment as follows:
A. Determine the client's eligibility for the Colorado Works in Weld County
Program.
B. Identify the level of monthly benefits the client is eligible to receive.
C. Identify any special conditions attached to the eligibility determination of the
client.
6.007.2 Payment Limit and Types of Payments
Revised 12/98
The client may be eligible for payments, not to exceed$3,300 for a family unit per year, as
follows:
A. Vision correction necessary for employment-related activity.
B. Tools necessary for employment-related activity.
C Cost of repair of a vehicle to enable transportation to employment-related activity.
D. Clothing/Grooming necessary for employment-related activity.
E. One-way transportation and/or moving expense assistance to relocate to site of
new employment.
6.007.3 Pre-Authorization Information
For each client, preauthorization information shall be considered by the authorizing
Department supervisor, in determining if a payment should be provided and the amount of
payment to the client. This preauthorization information must justify such cash assistance
to secure or maintain employment. The authorizing Department supervisor shall consider
the client's information as follows:
A. A potential employer must verify an employment opportunity in writing.
B. A client must demonstrate that he or she has the opportunity, willingness and
ability to participate in work-related activity. Q07/ /Og
Colorado Works in Weld County and Child Care Policies and Procedures
C. A client must demonstrate qualifications or minimum screening criteria for the
employment-related activity.
D. A client does not have major supportive service issues or bathers that would
prohibit his or her success in securing or maintaining employment and result in
long-tern dependency on Colorado Works in Weld County cash assistance.
6.007.4 Authorization of Payment under the Individual Responsibility Contract and
Limitations
The client may receive a cash assistance payment if the Department provides it under the
Individual Responsibility Contract. A payment cannot exceed$1,650 for a family unit per
year. The authorizing Department supervisor will use the Department's schedule in
calculating or authorizing payment; however,the authorizing Department supervisor may
request an exception by the Director. The Director may authorize such exception in
writing.
A. Vision Assistance- $175.00 per Client
B Tools - $200.00 per Client
C. Repair of a vehicle- $300.00 per Participant.
D. Clothing/Grooming- $150.00 per Participant.
E. Transportation/moving assistance - $800 per Participant.
6.007.5 Eligibility Waiver Period for Colorado Works in Weld County Assistance
Clients receiving Grant Diversion Assistance shall agree to waive eligibility for Colorado
Works in Weld County assistance payments for a period specified in the Individual
Responsibility Contract. The duration of the waiver is negotiable between the client's
assigned Department staff member, the authorizing Department supervisor, and the client.
The duration of the waiver should generally be calculated by dividing the grant diversion
payment by the client's monthly grant assistance amount.
6.007.6 Authorized Payee
Grant diversion payments will be made payable to the vendor providing the product or
service,not the client. The Department Director must authorize any exception to this
provision in writing. Exceptions should be considered extremely rare and will only be
authorized upon full demonstration that all other available options have been explored and
determined to be unfeasible.
6.007.7 Submission of Payment
The Department's Business Office will generate payment for the grant diversion payment
once each of the following procedural steps is completed:
9gya
Colorado Works in Weld County and Child Care Policies and Procedures
A. The Department's Eligibility Technician submits the Individual Responsibility
Contract to the authorizing Department supervisor for signature of authorization.
B. The authorizing Department supervisor reviews the Individual Responsibility
Contract for thoroughness,accuracy and reasonableness. If a contract meets
standards, the Supervisor signs contract authorizing purchase of product or
service.
C. The Business Office returns the Individual Responsibility Contract to the
Eligibility Technician who coordinates with a provider or providers to purchase
the product or service.
6.007.8 Vendor Accepts Voucher Payments
If a vendor accepts vouchers from the Department,the Eligibility Technician issues a
voucher to the client specifying:
A. The vendor from whom product or service is to be purchased,
B. The maximum dollar amount authorized for payment, and
C. The expiration date of the voucher. This date shall be a period of from one day to
one month, depending on the type of assistance being provided and the
circumstances of the case.
6.007.9 Vendor Does Not Accept Voucher Payments
If a vendor does not accept vouchers from the Department, the Eligibility Technician
requests that the vendor issue an invoice to the Department. This invoice must include the
following information:
A. The name of the client being served.
B. The specific products and/or services being provided.
C. Detailed breakdown of the price of each product and/or service being provided.
D. Total amount of payment requested.
E. Acknowledgment of the vendor that the Department is exempted from Colorado
State Sales Tax requirements.
6.007.10 Responsibility of the Department's Eligibility Technician
The Eligibility Technician submits copy of an authorized Individual Responsibility
Contract and either the Invoice from Vendor, authorized for payment, or copy of Voucher
to the Business Office for payment.
Colorado Works in Weld County and Child Care Policies and Procedures
6.007.11 Responsibility of the Department's Business Office
The Business Office will pay for grant diversion payments according to a predefined
payment time schedule,which they shall make available to the authorizing Department
supervisor. Any request for payment in advance of a payment time schedule must be
authorized in writing by the Department's Director. Exceptions should be considered
extremely rare and will only be authorized upon full demonstration that they have
explored and determined all other available options to be unfeasible.
Colorado Works in Weld County and Child Care Policies and Procedures
6.008 Job Retention and Skills Training Program (County Diversion Program)
Effective 9/10/97
The Department will conduct or implement a County Diversion Program through
the Job Retention and Skills Training Program.
6.008.1 Eligible Participants
Revised 7/1/98
Eligible participants of the Job Retention and Skills Training Program will be
those individuals who:
A. were hired by an employer in unsubsidized, continuous, and full-time
employment prior to final eligibility determination of the Colorado Works
in Weld County Program. Application for Colorado Works must have
been made within the past twelve months; or
B. were recipients who terminated their participation from the Colorado
Works in Weld County Program within the past twelve months; and
C. have a present income of below 185% of the poverty level for their
household size; and
D. request job retention supportive services within one year of termination of
financial assistance in the Colorado Works in Weld County Program and
whose termination from the Colorado Works in Weld County Program is a
result of employment.
6.008.2 General Requirements for Training
A. Under the Job Retention and Skills Development Agreement, the employer
may participate in the program as follows:
1. For an initial three month period, the employer may train his or her
employee in, but not limited to, mentoring services for purposes of
job retention,job specific training, basic skills development,
English as a Second Language, necessary for the participant to
retain or obtain employment.
2. An additional three month period may be authorized by the
Department, if the employee requires additional training in, but not
limited to, mentoring services for purposes of job retention,job
specific skills,basic skills development, English as Second
Language, necessary for the employee to retain or obtain
employment.
3. If at the end of the initial three month period or at the end of the
9807`Vol
Colorado Works in Weld County and Child Care Policies and Procedures
additional three month period, the employer is eligible for an
additional six month training period for the employee who the
employer promotes and gives a salary increase.
B. The Department will authorize with the employer the training plan for the
participant including training criteria, methods by which the training
outcomes will be measured, and associated costs.
C. The employer may choose to provide this training directly or to provide
this training, through subcontracts, with training providers. Training
providers are defined,but not limited to, as public schools,private non
profits, private for profit, post secondary, community colleges, and
proprietary schools.
D. The Department will authorize training providers in the training areas
identified by the employer.
E. To ensure that the job specific and mentoring training meets the local
demand of employers, local private sector employers, through the Weld
County Private Industry Council, will recommend to the Department the
authorization of training plans and training providers.
C. The Department may authorize the job specific training plan and
associated costs not to exceed $1,800 as follows:
1. A training allowance bonus of$300 to be reimbursed at the end of
the initial three month period.
2. A training allowance bonus of$300 to be reimbursed at the end of
the additional three month period.
3. A training allowance bonus of$500 for the employee whom the
employer promoted and successfully completed the initial three
month period and, if applicable, an additional three month period
of training. This training allowance bonus will be reimbursed at
the end of a three month period.
4. An additional training allowance bonus of$500 for the employee
whom the employer promoted and continues his or her training.
This training allowance bonus will be reimbursed at the end of a
three month period.
.7S4)1
Colorado Works in Weld County and Child Care Policies and Procedures
6.008.3 General Requirements for Supportive Services Needed for Job Retention
Added 7/1/98
The Department will assess a client who requests Job Retention Support Services as
follows:
A. Determine the client's financial eligibility for Job Retention Supportive Services.
Revised 12/98 B. Identify the level of benefit the individual is in need of and eligible for. The
benefit level cannot exceed$1,650 per family assistance unit the first six months
for Job Retention Support Services and an additional $1,650 in the second six
months of eligibility.
C. Clients receiving Job Retention Supportive Services shall agree to waive
eligibility for Colorado Works in Weld County assistance payments for a period
specified in the Individual Responsibility Contract. The duration of the waiver is
nogitiable between the client's assigned Department staff member,the authorizing
superivsor,and the client. The duration of the waiver should generally be
calculated by dividing the grant diversion payment by the client's monthly grant
assistance amount.
Exhibit A-1 (Page 1 of 2)
Effective 9/10/97
COLORADO WORKS IN WELD COUNTY Applicant 0
INDIVIDUAL RESPONSIBILITY CONTRACT(IRC) Recipient❑
FIRST SECTION
Name Household# Social Security Number Telephone Number
State ID#
1. This document is an Individual Responsibility Contract(IRC)between you,the applicant/recipient,and the Weld County
Department of Social Services(the"Department"). It governs the terms and conditions of your receipt of assistance or
application for assistance under the Colorado Works in Weld County(CWWC)Program.
2. You are not legally entitled to receive any form of assistance under the CWWC Program.
3. Your failure to comply with the terms and conditions of this IRC may result in a reduction or termination of cash
assistance or a discontinuation of the processing of your application for assistance.
4. This IRC will end if: 1)cash assistance to you is terminated for any reason,2)the processing of your application for
assistance is discontinued for any reason,or 3)if you move to another county.
RESPONSIBILITIES
As a CWWC applicant/recipient, you are required to:
• Keep all appointments designated on Page 2 of this IRC;
• Respond to any request from the Department regarding your employment status;
• Participate in assessments to determine your level of job readiness;
• Report for and participate in any employment or training activity listed on Page 2 of this IRC;
• Provide immediate documentation to your case manager of any situations which may prevent you from participating in
your scheduled activities;
• Notify your case manager of any change in your employment status; and
• Accept and maintain appropriate employment.
• Comply with all requirements of the Department's Child Support Enforcement Unit,but not limited to,the requirement
that I assign all of my rights to child support, including past due and current support, to the State of Colorado.
You have the right to participate in the development of this IRC with your case manager.
You have the right to file a grievance or complaint with the Department if: 1)you believe that you have been discriminated against on the
basis of your age,race, color, creed, sex,or national origin; 2)you disagree with your case manager's assignment or decision;or 3)you are
not satisfied with actions affecting your assistance or CWWC participation. Your case manager may assist you in filing a grievance or
complaint.
I have read or have had read to me Pages 1 and 2 of this IRC. My rights and responsibilities for participation in the CWWC Program as
detailed above have been explained. As consideration for my application for assistance and for any cash assistance I may receive, I agree to
participate in the activities and for the number of hours per week designated on Page 2 of this IRC. I also understand that if I move to another
county, this IRC will no longer be in effect and cash assistance to me will end or my application for assistance will not be processed.
Applicant/Recipient Signature Date
As the Applicant/Recipient's case manager,I have carefully explained the terms and conditions of this IRC to the Applicant/Recipient. A
signed copy of this IRC has been provided to the Applicant/Recipient.
Case Manager Signature Date
White Copy:Social Services Yellow Copy: Employment Services of Weld County Pink Copy:Applicant/Recipient
9a3
COLORADO WORKS IN WELD COUNTY DIVERSION Exhibit A-2
INDIVIDUAL RESPONSIBILITY CONTRACT(IRC)
Case Name: Household# Two Parent Household Technician#:
Yes ❑ No ❑ Technician Ext.:
Client Name: State ID# Social Security# Telephone Number
1. This document is an Individual Responsibility Contract(IRC)between you,the TANF participant and the Weld County Department of Social
Services(the Department),It governs the terms and conditions of your receipt of assistance or application for assistance under the Colorado Works in
Weld County(CWWC)Program.
2. You are not legally entitled to receive any form of assistance under the CWWC Program.
3. Your failure to comply with the terms and conditions of this IRC may result in reduction or termination of your cash assistance.
v..:/'Si' �Rtl>.T.'p :f'.:oli .nJ.:4:5':.. �i>:0�';YF:..:r. ::.6.... :,..y..d,...n.o>:S`k'o... 'oE3'. 3"3.%K:.. :..G:;'):.:S :y .n:n'.:: .:$o?i'::> � :.:6.: lca.?.oyp. ..y.Yw:q:9 !<y..: ..4.`:4)�0
N.J.:.:'bw,c...?.. .:?'fros,:h.>o<:y..w.�g�pl3opyw:<F<3.'!<S..b:,3..g..,o '$o`'�, :.r:.,?Leo?:o:333s>.'; >o.�'F>o°o4<�.?:a"i5o:�aa:..
'7Fi?,o c. .r 0.`1y,:.y o4•• !00%yF°ov.':
.>.... .. ` lou ¢ °!: »s fi o h lo_oft.. .e.:. ,� .. .;fl...3.COJ.a...a;�.J`.na:....:........o..>...:.:..
:o:.a:v..:. . . :.*,' '` ',;», �'R;o.�.,�.>,,:a $'.°�.,�`r m`�'�A. «'� a.', xa.a �?2i'o$o:3i�`
The participant has applied and been approved for a Diversionary Grant. The participant indicates that only short-term assistance is needed in order for the
family to become secure. THE PARTICIPANT WILL RECEIVE A LUMP SUM PAYMENT OF: $ ,PAID DIRECTLY TO THE
FOLLOWING VENDORS. The participant has provided proof that the sum is needed for the following expenses:
AMOUNT:$ EXPENSE _
AMOUNT: $ EXPENSE _
AMOUNT: $ EXPENSE
AMOUNT:$ EXPENSE
AMOUNT: $ EXPENSE
AMOUNT: $ EXPENSE _
AMOUNT: $ EXPENSE
The participant and all members of the household will be unable to receive financial assistance under the Colorado Works Program in Weld County or in
any other Colorado County for month and until after
You have the right to file a grievance or complaint if you believe that you have been discriminated against on the basis of your age,race,color,creed,sex,
or previous national origin;or if you disagree with your case manager's assignments or decisions. Your case manager will assist you in filing a grievance
or complaint.
You have the right to a dispute resolution conference at the county department if you are not satisfied with actions affecting your assistance or program
participation. You have the right to appeal to the state department if the dispute is not resolved. Your case manager will assist you in filing a request for a
dispute resolution conference or state appeal.
My rights and responsibilities have been explained to me and I understand that my eligibility may depend on verification of expenses,
employment, and other criteria as deemed necessary by my case manager. I also understand that if I move to another county this IRC may
affect my eligibility for Colorado Works Assistance.
TANF Participant Signature Date TANF Co-Participant Signature
As a representative of this agency, I have carefully explained the participant's rights and responsibilities and acknowledges the responsibilities
of the agency. A signed copy of this IRC has been provided to the participant..
TANF Case Manager Signature Date % ga<./v"
08/28/98 IRC-Page 2 of 2 Pages
White Copy: Social Services Pink Copy: Applicant/Recipient
Hello