SR 97-37 Dated 10/97

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases activity and component codes for the JOBS tracking system, and revises Form 213, Interagency Referral/Work Registration and Form 213(i), Instructions for Form 213. It also revises Form 214, Return Results Form, and Form 214(i), Instructions for Form 214. Changes to both forms are discussed in the "Forms Revisions" section below.

POLICY

Release of Activity and Component Codes for Use in the JOBS Tracking System

Several activity and component codes have been added to the JOBS tracking system to reflect additional activities available to New Hampshire Employment Program (NHEP) participants and to identify the component which applies to the participant. These codes must be entered on revised Form 214, Return Results Form, in accordance with revised Form 214(i), Instructions for Form 214.

Activity codes Q and Z require that wages per hour and the occupational code be entered in order for the case to be processed on the JOBS Tracking System. The system also has been reprogrammed to allow the amount of AWEP earnings to be entered as $00.00.

Form 213, Interagency Referral/Work Registration

Form 213, Interagency Referral/Work Registration, is now a four part NCR form (formerly a six part NCR form) used by NHEP Teams, the Division of Transitional Assistance (DTA) District Offices and employment agencies to refer individuals between agencies. DTA District Offices use Form 213 to refer an individual to another agency, to enroll Temporary Assistance for Needy Families (TANF) financial assistance recipients in NHEP and make a subsequent referral, and to work register food stamp clients and make a subsequent referral. Forms 213 completed for NHEP individuals are keyed by the Bureau of Data Management for federal reporting purposes.

Form 214, Return Results Form

Form 214, Return Results Form, is a four-part NCR form used to report the results of a referral made on Form 213, Interagency Referral/Work Registration, back to the referring agency when results are requested. Forms 214 completed for NHEP clients are keyed by the Bureau of Data Management (BDM) for tracking and reporting information.

FORMS REVISIONS

Form 213, Interagency Referral/Work Registration

The following changes have been made to side 1 of Form 213:

 The Department of Health and Human Services has been added to the upper left hand heading;

 Keying blocks have been added to the area for client name and this section has been expanded for legibility at the request of the Bureau of Data Management;

 The SSN (social security number) field has been converted to blocks for legibility;

 The section on "referred to" information has been reformatted and now contains check off boxes for each of the NHEP teams;

 Several changes have been made to the section entitled, "NHEP AND/OR FS INFORMATION," (previously "DHS JOBS AND/OR FS INFORMATION,").

 - This section now refers to NHEP single parent and two parent requirements and to

  requirements for Able Bodied Adults Without Dependents (ABAWD);

 - Under # 6, "Program," the program designation A (AFDC-AP) has been changed to NHEP

  and B (MA Only) has been changed to FS;

 - Under # 6, Program, the program designations of C (MA and FS) and E (other) have

  been deleted;

 - Section 8, "JOBS," has been deleted in its entirety; and

 The bottom section on activity information has been deleted since this information is contained on the revised Form 214.

The listing of activity codes on side 2 of Form 213 has been removed and replaced with a listing of NHEP Team codes.

Form 213 (i), Instructions for Form 213

The following changes have been made to Form 213 (i):

 In the heading, "Division of Human Services" has been replaced by "Department of Health and Human Services"; and "Office of Economic Services" has been replaced with "Division of Transitional Assistance;"

 References to AFDC have been changed to TANF, and references to JOBS have been changed to NHEP throughout the text;

 The referral section has been revised to reference the listing of NHEP Team codes on the back of Form 213; and

 The section entitled, "NHEP AND/OR FS INFORMATION," (previously "DHS JOBS AND/OR FS INFORMATION,") has been expanded to refer to NHEP single parent and two parent requirements and to ABAWD requirements.

Form 214, Return Results Form

The following changes have been made to side 1 of Form 214:

 In the upper left hand heading, "Division of Human Services" has been replaced by "Department of Health and Human Services;"

 A Work Program box has been added to identify the type of work program applicable to the participant (NHEP or Other);

 A new check off section, "NHEP Team," has been added to identify each NHEP Team by a 3 letter code;

 A new check off section, "Other Program," has been added for referral of food stamp clients; (e.g., Division of Vocational Rehabilitation - DVR; or Job Training Council - JTC);

 The "Begin/Update Activity Information" heading is now referred to as "Begin/Update Activity/Component Information;"

 The "Begin/Update for Concurrent Activity" heading is now referred to as "Begin/Update for Concurrent Activity/Component Information;"

 The heading "For OJT Only" block under the "Begin/Update Activity/Component Information;" and under "Begin/Update for Concurrent Activity/Component" has been expanded to read," For OJT, AWEP and Employment Only;"

 The "End Activity Information," heading has been revised to read, "End Activity/Component Information;"

 Code I, TANF case closed/denied, has been added to the list of reasons that a participant does not successfully complete an activity or component; and

 The distribution section has been revised to indicate that the white copy of Form 214 goes to BDM and that the canary copy goes to DTA.

The following changes have been made to side 2 of Form 214:

 Activity codes P, R, S ,T, U and Z have been added;

 The term "CWEP" (Community Work Experience Program), formerly identified as activity code Q, has been changed to "AWEP" (Alternative Work Experience Program); and

 The occupational code 00/01 (architecture, engineering, and surveying) has been changed to 01.

Form 214(i), Instructions for Form 214

The changes below have been made to Form 214(i), Instructions for Form 214.

 All references to "Division of Human Services" have been changed to "Department of Health and Human Services" or "Division of Transitional Assistance;"

 References to "JOBS" have been changed to "NHEP;"

 The "Agency Identification" section has been modified to reflect usage of the 3 letter designation for each NHEP team and to include instructions for entering referrals for food stamps and other programs;

 Instructions for completion of the "Begin/Update Activity/Component Information" section and the "End Activity/Component Information" section are now provided in table format to be more user friendly;

 The "Begin Activity/Component Information" section requires that the hourly wages and occupational code be entered for code Z, employment activity, and code Q, AWEP activity;

 A table has been added to show grade level codes which are required for completion of the "End Activity/Component Information" section;" and

 The distribution section has been revised to reflect current distribution procedures for NHEP participants and other individuals for whom Form 214 is completed.

IMPLEMENTATION

An initial supply of revised Forms 213 and 214 will be distributed to District Offices and NHEP Teams and available for use on October 1, 1997. Current Forms 213 and 214, dated 10/92, SR 92-55 must be destroyed effective October 1, 1997.

CLIENT NOTIFICATION

No client notification is planned.

TRAINING

No training is planned.

POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed after its contents have been noted and its posting instructions have been carried out.

DISTRIBUTION

This SR only will be distributed according to the distribution list for the Forms Manual. Printed copies of the forms will be distributed to all holders of the Forms Manual.

DTA/SJC/s

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CERTIFICATE OF DESTRUCTION

I hereby certify that all copies of Forms 213 and 214, SR 92-55/October 1992, have been destroyed.

Office Manager: ________________________ District Office: ________________________

NOTE: Return this certificate to Stock Control at State Office after the instructions in this SR have been carried out.