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-
Sufficiency Case Manager, Contract Case Management Provider, or Welfare-to-Work).  Continue to use the Referral and Transmittal (IM-311) when referring to other agencies.

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).

FORMS MANUAL

Attached to this memorandum is the Family Information Record (IM-
309) and Family Information Record-Attachment (IM-309A) forms and forms' instructions.

TRAINING

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.

Review this memorandum with appropriate staff.

 

Begin using the Family Information Record (IM-309) and Family Information Record-Attached (IM-309A) after training.

 

Destroy supply of Work First Assessment (IM-2JNA) and Personal Information Record (FP-9) immediately after each staff member in the county has been trained on the new forms, but no later than May 5, 2000.

 

Remove Work First Assessment (IM-2JNA) and instructions from the Forms Manual and line through Work First Assessment (IM-

2JNA) in the Forms Manual index.
 

Destroy supply of the Personal Information Record (FP-9).

 

Discontinue use of Appendix A (FUTURES FORMS) in the previous FUTURES Manual.  All previous FP forms have been revised to the IM-300 series.  Refer to IM-171 dated November 30, 1999, FUTURES (FP) FORMS TO IM-300 SERIES.

 

File the Family Information Record (IM-309) and the Family Information Record-Attachment (IM-309A) in the Forms Manual immediately after IM-303 CONCILIATION/FACE-TO-FACE APPOINTMENT LETTER.  List both forms on the Forms Manual Index.

 

File attached Temporary Assistance Manual revision pages and index pages.