IM-107 08/11/99 FORMS MANUAL REVISION: IM-46 AND IM-47
| SUBJECT: |
| FORMS MANUAL REVISION #33: IM-46 JOB SEARCH PLAN IM-47 CHILD CARE SEARCH LOG |
| DISCUSSION: |
| Attached to this memorandum are the two
forms referenced above and the instructions for their completion.
The two forms were created to accommodate the Work First process, the (IM-46)
Job Search Plan and the (IM-47) Child Care Search Log. Individuals
participating in Level I of their Self-Sufficiency Plan must utilize either
the Job Search Plan (IM-46) or the Child Care Search Log (IM-47) to record
Level I activities.
IM-46 JOB SEARCH PLAN Provide Level I Job Search individuals four Job Search Plans (IM-46). The weekly Job Search Plan allows applicants/recipients to track job applications. The IM-46 identifies the name, DCN, and social security number of the individual conducting the job search. The form specifies the date the form is to be returned to the agency and the dates of the job search period. The individual must record the following information on each contact:
IM-47 CHILD CARE SEARCH LOG Applicants/recipients unable to begin Level I of their Self-Sufficiency Plan due to the unavailability of child care will be given a "Child Care Search Log" (IM-47) instead of the Job Search Plan. Individuals seeking child care will list weekly contacts with potential child care providers. The Child Care Search Log records the date of the provider contact. The individual seeking child care will list the name, address and phone number of each provider contacted and the person they spoke to at the site. Careful selection of a provider may require several visits to the child care facility. Returning to the same provider will count as only one contact. However, it will be a second contact if during the initial visit the provider indicated that vacancies may exist in the near future and asks the individual to recontact at a later date. The individual records the results of each provider contact. The IM-47 allows the individual to comment on their child care search. The participant will sign, date and return the Child Care Search Log by the specified date. |
| NECESSARY ACTION: |
Distribution #2 |
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IM-46
JOB SEARCH PLAN PURPOSE: The Job Search Plan provides a written log of all job search activities by the participant. The Job Search plan must be completed weekly and returned by the scheduled date. NUMBER OF COPIES AND DISPOSITION: Original is retained in the case record. INSTRUCTIONS FOR COMPLETION: Each individual participating in Job Search will complete one form weekly. The form requests specific information concerning Job Search contacts with additional space for contacts on the back of the form. SECTION COMPLETED BY AGENCY Name: Enter the individual's name. DCN: Enter the individual's DCN. Social Security Number: Enter the individual's social security number. Date for Return: Enter the date in which the Job Search Plan is to be returned to the agency. Dates of the Job Search: Enter the beginning and ending dates of the job search period. SECTION COMPLETED BY THE JOB SEARCH INDIVIDUAL Date of Contact: Individual enters the date of the job search activities. Name of Business and Address: The individual is required to enter the name and address of each business contacted. The individual may not contact the same employer more than once during the Job Search period, unless during the initial contact there was an indication that vacancies may soon exist and the employer asked the individual to make another contact. Person Contacted (First name-Last Name): The individual is required to list the name of the person at the business contacted for job search, not the person's title. Type of Work: The individual is required to list the type of work for which an application was completed.
01/99
IM-46, Page 2 Result: The individual is required to report the results of the job search contact. Comments: The individual may enter any comments concerning the Job Search period. Signature of Individual: Individual signs and dates the form. Workers name, load number, and phone number: The Income Maintenance worker completes this section with their name, load number, and office phone number.
01/99
IM-47 CHILD CARE SEARCH LOG PURPOSE: The Child Care Search Log provides a written document of all child care contacts. The log must be completed weekly and returned to the agency by the scheduled date. NUMBER OF COPIES AND DISPOSITION: Original is retained in the case record. INSTRUCTIONS FOR COMPLETION: Individuals seeking child care will complete one form weekly. The form requests specific information concerning child care provider contacts with additional space on the back for comments. SECTION COMPLETED BY THE AGENCY Name: Enter the individual's name. DCN: Enter the individual's DCN. Social Security Number: Enter the individual's social security number. Date for return: Enter the date in which the Child Care Search Log is to be returned to the agency. Dates of the Child Care Search: Enter the beginning and ending dates of the child care search period. SECTION COMPLETED BY THE INDIVIDUAL SEEKING CHILD CARE Date of Contact: Individual enters the date of the child care provider contacts. Name, Address and Phone Number of Child Care Provider: The individual enters the business name, address and phone number of each child care provider contacted. Returning to the same provider will count as only one contact unless during the initial visit the provider indicated that vacancies may soon exist and the provider asked participant to make another contact. Person Contacted (First name-Last name): The individual is required to list the name of the person at the business contacted for child care. Result: The individual is required to report the results of the provider contact. 01/99
IM-47, Page 2 Comments: The individual may enter any comments concerning the Child Care search period. Signature of Participant: Participant signs and dates the form. Workers name, load number, and phone number: The Income Maintenance worker completes this section with their name, load number, and office phone number. 01/99
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