IM-47 03/17/00 IM-309 FORMS AND INSTRUCTIONS
|TEMPORARY ASSISTANCE MANUAL REVISION #9
IMNL SECTION 0260.010.00
FORMS MANUAL REVISION #8
FAMILY INFORMATION RECORD (IM-309) AND INSTRUCTIONS
FAMILY INFORMATION RECORD-ATTACHMENT (IM-309A) AND
|The purpose of this memorandum is to introduce
the new screening form, Family Information Record (IM-309) and the Family
Information Record-Attachment (IM-309A). State law, Senate Bill 387,
states that no participant may be assigned to any education, training or
employment component of the state's welfare-to-work program prior to an
individualized assessment for skills, prior work experience, and employability.
These forms were developed in cooperation with Division of Family Services
staff and other interested agencies and organizations to meet this requirement.
FAMILY INFORMATION RECORD IM-309
The Family Information Record (IM-309) is a screening tool that determines job readiness levels of Temporary Assistance participants. The tool obtains basic information concerning the individual's work and educational background, supportive service needs, and goals. The Family Information Record IM-309 replaces the Work First Assessment (IM-2JNA) and the Personal Information Record (FP-9).
Individuals applying for Temporary Assistance will complete the Family Information Record at application. Individuals receiving Temporary Assistance will complete the Family Information Record if the individual is not active with a Contracted Case Management Provider or Welfare-to-Work at reinvestigation or interim contact.
The Family Information Record was developed so it could be understood and completed by the participant. However, the caseworker/case manager should assist the individual in completing the form if necessary. The caseworker/case manager will review the form after the individual completes it.
After each section, there is a FOR OFFICE USE ONLY comment box. The caseworker/case manager may use this space to take notes during the interview. This area contains questions to assist the caseworker/case manager during the interview. Do not limit the interview to only the questions listed.
Discuss each section with the individual, evaluating each section as (1) Strength, (2) Some Difficulty, or (3) Serious Difficulty to employment. Always review your evaluation with the individual. Take into consideration the opinion of the individual regarding his/her situation, and whether there is a barrier. The individual may feel a section is a strength or of some difficulty while the worker may believe it is a serious difficulty or vice-versa.
EXAMPLE: The individual states he/she has no driver's license and no functional car. The case manager believes this would be a serious difficulty to employment. The situation is discussed with the individual who sees this barrier as some difficulty to employment. The individual states his/her mother is their main form of transportation and is very reliable. There is also backup transportation of a neighbor. The individual is in the process of studying for the driver's test and has a vehicle he/she is fixing up. Transportation would be coded some difficulty as the individual feels he/she can obtain employment with assistance.
The Family Information Record may reveal that additional referrals and case management are necessary for the family to attain self-sufficiency. If the supportive service needs are not available through DFS, refer the family to local agencies that may offer services specific to their needs.
Evaluate any barriers to participation in the Case Management Program, and attempt to resolve them. If the barriers are too extensive to allow the individual to participate in the program, determine if an exemption or exclusion applies.
Case managers should always offer guidance to the individual regarding how to address the individual's barriers so that participation may occur in the future.
NOTE: An individual will NOT be placed in any component, including Job Search, or referred to Contracted Case Management Provider or Welfare-to-Work until the Family Information Record (IM-309) is completed.
FAMILY INFORMATION RECORD-ATTACHMENT IM-309A
The Family Information Record-Attachment (IM-309A) is a tool to summarize information obtained from the Family Information Record, determine level of work participation, and list referrals and dates made to other agencies.
The caseworker/case manager should complete this form. Transfer the evaluation of each section from the Family Information Record to the Family Information Record-Attachment. Use the Family Information Record-Attachment to assist in determining level of work participation and to develop the Family Self-Sufficiency PACT. The evaluation will help the participant prioritize necessary steps they need to take to meet their goal of employment.
Check the box and enter the date by each
provider where the individual is referred. Attach a copy of the Family
Information Record (IM-309) when referring to case management agency (Self-
The Family Information Record-Attachment can be used as a history keeping form on agencies and dates the individual was referred.
IMNL SECTION 0260.010.00 THE FAMILY INFORMATION RECORD (IM-309)
Section 0260.010.00 THE FAMILY INFORMATION RECORD (IM-309) has been added to the Temporary Assistance Manual. This section explains the use of the Family Information Record.
Pages in the Temporary Assistance Manual that make references to Work First Assessment (IM-2JNA) have been updated to read Family Information Record (IM-309).
Attached to this memorandum is the Family
Information Record (IM-
Statewide training will be conducted on the Family Information Record (IM-309) and Family Information Record-Attachment (IM-309A). Begin using both of these forms immediately after training.
Some attachments not available on line.