12.4 Dislocated Worker Program File Documentation

12.4.1 General Eligibility

Effective date: October 1, 2024

All Dislocated Worker Program participants are required to meet general eligibility requirements, including Selective Service registration, when applicable.

These criteria must be documented as outlined below:

Eligibility Criterion (All are required)	Acceptable Documentation¹ Only one per eligibility criterion is required Documents must be unexpired at enrollment unless otherwise noted.
Selective Service Registration²	For individuals born male 18 years of age or older who did register: Selective Service registration acknowledgment letter Selective Service registration acknowledgment card Screen printout from www.sss.gov showing online verification Letter of verification from Selective Service Selective Service Status Information Letter For individuals born male over age 26 who did not register: Documentation from the local WDB or service provider that supports the individual's failure to register was not knowing and willful. (Record as Waived in ASSET) OR Documentation that the individual entered the country legally for the first time after their 26^th birthday. Acceptable forms of supporting documentation include:³ Date of entry on his passport I-94 with date of entry stamp on it Letter from the U.S. Citizenship and Immigration Services (USCIS) indicating the date the man entered the United States presented in conjunction with documentation establishing the individual's age OR Documentation that the individual entered the country illegally for the first time after their 26^th birthday. Acceptable forms of supporting documentation include:⁴ Proof that he was not living in the U.S. from age 18 through 25 OR Copy of a valid, non-immigrant visa Individuals born male who are over the age of 18 at the time of application, but have not yet turned 26, and have not yet registered for Selective Service, must complete Selective Service registration before they can be determined eligible for the Adult Program. See the Selective Service Guidance, which gives information about who is and is not required to register, and steps to take if someone was required to register but failed to do so. This list is not intended to be exhaustive. Please visit the Selective Service website for more information about the registration requirements at www.sss.gov. Refer to the Selective Service System's Documentation List for a complete list of acceptable documentation.

Eligibility Criterion
(All are required)

Acceptable Documentation¹

Only one per eligibility criterion is required
Documents must be unexpired at enrollment unless otherwise noted.

Selective Service Registration²

For individuals born male 18 years of age or older who did register:

Selective Service registration acknowledgment letter
Selective Service registration acknowledgment card
Screen printout from www.sss.gov showing online verification
Letter of verification from Selective Service
Selective Service Status Information Letter

For individuals born male over age 26 who did not register:

Documentation from the local WDB or service provider that supports the individual's failure to register was not knowing and willful. (Record as Waived in ASSET)
OR
Documentation that the individual entered the country legally for the first time after their 26^th birthday. Acceptable forms of supporting documentation include:³
- Date of entry on his passport
- I-94 with date of entry stamp on it
- Letter from the U.S. Citizenship and Immigration Services (USCIS) indicating the date the man entered the United States presented in conjunction with documentation establishing the individual's age
OR
Documentation that the individual entered the country illegally for the first time after their 26^th birthday. Acceptable forms of supporting documentation include:⁴
- Proof that he was not living in the U.S. from age 18 through 25
OR
Copy of a valid, non-immigrant visa

Individuals born male who are over the age of 18 at the time of application, but have not yet turned 26, and have not yet registered for Selective Service, must complete Selective Service registration before they can be determined eligible for the Adult Program.

See the Selective Service Guidance, which gives information about who is and is not required to register, and steps to take if someone was required to register but failed to do so.

This list is not intended to be exhaustive. Please visit the Selective Service website for more information about the registration requirements at www.sss.gov. Refer to the Selective Service System's Documentation List for a complete list of acceptable documentation.

¹ In addition to the acceptable documentation outlined below, Career Planners may use the WIOA Title I Dislocated Worker Program Eligibility Self-Attestation Form.
² WIOA Sec. 188(a)(5) requires that all individuals participating in WIOA Title I programs comply with Selective Service requirements, if applicable.
³ TEGL 11-11, Change 2, p. 2
⁴ TEGL 11-11, Change 2, p. 2

12.4.2 Federal Dislocated Worker Eligibility Criteria

Effective date: August 14, 2023

In order to be determined eligible for the WIOA Dislocated Worker Program each applicant must provide evidence of at least one of the Dislocated Worker Eligibility Categories identified in this section in addition to the criteria in Section 12.4.1.

Dislocated Worker Eligibility Categories (Must meet one of the six)	Acceptable Documentation¹
1. Individual or Small Group Layoff Has been terminated or laid off or has received a notice of termination or layoff AND Is Unlikely to Return to a Previous Industry or Occupation AND Is eligible for or has exhausted Unemployment Insurance (UI) benefits OR Has been employed for a duration sufficient to demonstrate attachment to the workforce, but is not eligible for UI due to insufficient earnings or having performed services for an employer not covered under a State UI law	Demonstration that the individual has been terminated or laid off or has received a notice of termination or layoff through one of the following: Self-attestation Verification from employment Notice of layoff (Including a WARN Notice) Public announcement AND Self-attestation that the individual is Unlikely to Return to a Previous Industry or Occupation AND If referred by RESEA, demonstration that the individual is eligible for or has exhausted unemployment insurance (UI) payments, or is ineligible for UI payments (because of insufficient earnings or was in a job not covered by state UI law) through one of the following: UI records (includes letters from UI) Verbal verification from UI representative Verification of Re-employment Services and Eligibility Assessment (RESEA)-funded services from the ASSET Manage Services tab OR Self-attestation that the individual has been employed for a duration sufficient to demonstrate attachment to the workforce, but is not eligible for UI due to insufficient earnings or having performed services for an employer not covered under a State UI law
2. Permanent Closure or Mass Layoff	Self-attestation OR Verification from employer Rapid Response list Notice of layoff (Including a WARN Notice) Public announcement of layoff UI documentation
3. Separating or Separated Members of the U.S. Armed Forces	DD-214 or other documentation showing separation or imminent separation with a discharge status that is anything other than dishonorable
4. Self-employed	Self-attestation that individual was self-employed and is now unemployed as the result of general economic conditions or natural disaster
5. Displaced Homemaker ²	Self-attestation OR Signed WIOA intake application or registration form Cross-Match with Public Assistance Records Copy of Spouse's Layoff Notice Copy of Spouse's Death Record Copy of Spouse's Permanent Change of Station (PCS) Orders for a military move or assignment) Copy of Divorce Records Copy of Applicable Court Records Copy of Bank Records (showing financial dependence on spouse, no separate individual income support, or no employment income earned) Needs Assessment Signed Individual Employment Plan
6. Military Spouse	Self-attestation that the individual is the spouse of an active member of the U.S. Armed Forces and has experienced the loss of employment because of the service member's permanent change in military duty station OR Self-attestation that the individual is the spouse of an active member of the U.S. Armed Forces and is unemployed or underemployed and having trouble obtaining or upgrading employment

¹ Unless otherwise noted, information on documentation sources is from OMB Control No. 1205-0521.
² Per TEGL 23-19, Change 2, Attachment II, Data Element 807 Data Element Validation is required.

12.4.3 Required Federal Reporting

Effective date: August 14, 2023

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	Self-Attestation OR 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 Cross-match with state agency records Justice system records Selective Service registration Signed letter from a parent or guardian Medical records
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	Source documentation beyond Self-Attestation for this element is only required at the point in which a decision is made to enroll a covered person over a non-covered person and commit financial resources, which does not include staff time. Self-attestation OR 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 NGB-22 documenting Title 10 federal active-duty service
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 Case notes
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 Case notes
Single Parent⁶	Self-Attestation OR TANF Single Parent Eligibility Verification Needs Assessment Intake Application or Enrollment Form Individual Service Strategy or Employment Plan Case notes
Current Employment Status	Self-Attestation
Current Unemployment Insurance Programs (UI)⁷	Self-attestation, only if customer was not referred by RESEA 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 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 OR Cross-Match with Public Assistance Records Cross-Match with State MIS Employment records Case notes
Individual with a disability¹⁷	Self-Attestation OR School 504 records provided by student Assessment test results School Individualized Education Program (IEP) record 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 Rapid Response list 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, Change 2, Attachment II, Data Element 200 Data Element Validation is required.
⁴ Per TEGL 23-19, Change 2, Attachment II, Data Element 301 Data Element Validation is required.
⁵ Per TEGL 23-19, Change 2, Attachment II, Data Element 409 Data Element Validation is required.
⁶ Per TEGL 23-19, Change 2, Attachment II, Data Element 806 Data Element Validation is required.
⁷ Per TEGL 23-19, Change 2, Attachment II, Data Element 401 Data Element Validation is required.
⁸ Per TEGL 23-19, Change 2, Attachment II, Data Element 704 Data Element Validation is required.
⁹ This criterion is not covered in TEGL 23-19, Change 2, 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, Change 2, Attachment II, Data Element 402 Data Element Validation is required.
¹¹ Per TEGL 23-19, Change 2, Attachment II, Data Element 603 Data Element Validation is required.
¹² Per TEGL 23-19, Change 2, Attachment II, Data Element 600 Data Element Validation is required.
¹³ Per TEGL 23-19, Change 2, Attachment II, Data Element 601 Data Element Validation is required.
¹⁴ Per TEGL 23-19, Change 2, Attachment II, Data Element 604 Data Element Validation is required.
¹⁵ Per TEGL 23-19, Change 2, Attachment II, Data Element 801 Data Element Validation is required.
¹⁶ Per TEGL 23-19, Change 2, Attachment II, Data Element 808 Data Element Validation is required.
¹⁷ Per TEGL 23-19, Change 2, 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, Change 2, Attachment II, Data Element 804 Data Element Validation is required.
²⁰ Per TEGL 23-19, Change 2, Attachment II, Data Element 803 Data Element Validation is required.
²¹ Per TEGL 23-19, Change 2, Attachment II, Data Element 602 Data Element Validation is required.
²² Per TEGL 23-19, Change 2, Attachment II, Data Element 800 Data Element Validation is required.
²³ Per TEGL 23-19, Change 2, Attachment II, Data Element 410 Data Element Validation is required.
²⁴ Per TEGL 23-19, Change 2, Attachment II, Data Element 908 Data Element Validation is required.
²⁵ Per TEGL 23-19, Change 2, Attachment II, Data Element 807 Data Element Validation is required.

Content being developed.

12.4.6 Supportive Services Documentation¹

Effective date: August 14, 2023

In addition to following the requirements outlined in Chapter 8.6.4 of this policy manual, career planners must document all supportive services, including needs-related payments, that a participant receives in one of the following ways:

Evidence of what WIOA activity is being enabled

AND

Case notes;
Activity sheets;
Sign-in sheets;
Attendance record;
Vendor contract;
Electronic records;

¹ Per TEGL 23-19, Change 2, Attachment II, Data Element 1500 Data Element Validation is required.
² Per TEGL 23-19, Change 2, Attachment II, Data Element 1409 Data Element Validation is required.

12.4.7 Exit and Follow-up Documentation

Effective date: August 14, 2023

In addition to following the requirements outlined in Chapter 8.7 and Chapter 11.6.1 of this policy manual, career planners must document exit dates and, if applicable, exclusion exit reasons for each data element in the following ways:

Data Element	Acceptable Documentation
Date of Program Exit ³	A copy of the letter sent to the individual indicating that the case was closed WIOA status/exit forms Electronic Records Attendance records Review of service records identifying the last qualifying service (and lack of a planned gap)
Exclusion reasons for Exit ⁴	Information from partner services WIOA or program status/exit forms Electronic Records Withdrawal form with explanation Information from institution or facility Case notes
Date Enrolled in Post Exit Education or Training Program Leading to a Recognized Postsecondary Credential ⁵	Copy of enrollment record Case notes School records Transcript or report card Cross-Match

As required in Chapter 8.8.3 of this manual, career planners must record the results of follow-up attempts separately in ASSET Customer Notes and if any information is obtained, enter the details in ASSET Follow-up Status. Career planners also must adhere to the data collection requirements of Chapter 11.21 of this manual, when collecting supplemental data during the follow-up period.

¹ Per TEGL 23-19, Change 2, Attachment II, Data Element 1409 Data Element Validation is required.
² Per TEGL 23-19, Change 2, Attachment II, Data Element 1500 Data Element Validation is required.
³ Per TEGL 23-19, Change 2, Attachment II, Data Element 901 Data Element Validation is required.
⁴ Per TEGL 23-19, Change 2, Attachment II, Data Element 923 Data Element Validation is required.
⁵ Per TEGL 23-19, Change 2, Attachment II, Data Element 1406 Data Element Validation is required.

12.4 Dislocated Worker Program File Documentation

Chapter 12.4.1 Resources

Chapter 12.4.2 Resources

Chapter 12.4.3 Resources

Chapter 12.4.4 Resources

Chapter 12.4.5 Resources

Chapter 12.4.6 Resources

Chapter 12.4.7 Resources

12.4.1 General Eligibility

12.4.2 Federal Dislocated Worker Eligibility Criteria

12.4.3 Required Federal Reporting

12.4.6 Supportive Services Documentation¹

12.4.7 Exit and Follow-up Documentation