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NMW CASE REVIEW FORM
INCOME SUPPORT DIVISION
NMW Contractor
NMW Office
ISD Office
Parent’s Name
Parent’s SSN
Case File Dates Reviewed (From/To)
Case Name
Case SSN
CDS
D=deficient Y= Yes N= No U = Unable to Verify N/A = Not Applicable
| REVIEW ELEMENTS |
| CODE |
| COMMENTS |
| 1. |
| The case file being reviewed is identified as: |
( TANF 1-P
( TANF 2-P
( TANF - mandatory work requirement
( TANF - state only exempt – voluntary work requirement
( TANF - federal exempt – voluntary work requirement
( TANF Eligible
( Education Works
( NMW Diversion payment recipients
( Wage Subsidy
· Transition Bonus ( SNAP E&T – voluntary work requirement ( SNAP ABAWD – voluntary work requirement
( Sanctioned ( Meeting [ ] Not Sanctioned and Not Meeting # of months on TANF (casehead): ______________
| II |
| ORIENTATION, ASSESSMENT, STATUS CHANGES |
| 2. |
| A copy of the form DWP 022 NMW Program Requirements is in the NMW case file |
| 3. |
| Parent orientation was conducted on (date): Was it timely (no later than 15 days after approval of benefits? |
| 4. |
| Initial parent assessment was conducted and consent form is in file. |
| 5. |
| Mandatory parent appointment was scheduled no later than 5 calendar days following approval of benefits? |
| 6. |
| Follow-up assessment was conducted at 30 months, 55 months (interview only) and when determined by CDS? |
| 7. |
| The following barriers were identified or self-identified during assessment: |
| 8. |
| Referrals were made to support service agencies pursuant to parent request or identified barriers. The following referrals were made: |
| 9. |
| The case record has corresponding DWP 009s for all referrals to support services and communications on parent status changes |
| 10. |
| Employment assessments were conducted. |
| 11. |
| The WPA DWP 005 was completed and signed on or before the 15th day from approval of assistance, updated as necessary, and signed by ISD case worker |
| 12. |
| The WPA included appropriate core and non-core activity hours (including FLSA calculations, if appropriate) |
| 13. |
| The parent has been assigned appropriate core/non-core activities for the type of case, months on TANF, and identified barriers |
| 14. |
| Each limited activity is within the timeframes established by policy and proper tracking forms are used (i.e. Work Readiness tracking) |
| 15. |
| If the parent is waived from an activity, the appropriate documentation is in the case record. Parent must be in continuous engagement of activities that are specific to the parent’s circumstances. |
| 16. |
| An IRP /IEP DWP 006 was completed and signed on or before the 15th day from approval of assistance |
| 17. |
| The IRP included steps to reaching interim and employment goals |
| 18. |
| An updated IRP was completed at 6 months |
| 19. |
| The case record includes detailed and descriptive narratives, reflecting such entries as follow-ups on referrals to support services, updates on parent’s current status, parent’s progress, and other relevant information. (Hard-copies of narratives in the case record must match on-screen narratives.) |
| 20. |
| A resume is on file for all job ready parents. |
| 21. |
| The case file contains a Job Search Card (DWP 277), if applicable |
| 22. |
| The case record has progress reports for the assigned activity, including grade reports for EWP |
| 23. |
| Parent hours are tracked according to activity requirements (i.e. DWP 007, timesheets) |
| 24. |
| Parents are being sanctioned timely and appropriately |
| 25. |
| The NMW Contractor notified the Department of noncompliance issues within 10 working days from determining that non-compliance has occurred, after conducting: 1) a home visit or if home visit is not possible, an attempt to reach parent by phone or mail is conducted and documented. |
| 26. |
| The NMW Contractor was notified of the Department’s action on the individual’s noncompliance and the individual was correctly coded |
| 27. |
| The narrative reflects appropriate documentation on the issue(s) leading to non-compliance and the multi-step sanctioning process that was followed, if applicable |
| 28. |
| The case file contains FSP 282/FAP 282, if applicable |
| 29. |
| The NMW Contractor provided a summary of evidence, if a Fair Hearing or pre-hearing conference was requested |
| 30. |
| If a Fair Hearing or pre-hearing conference occurred, the NMW Contractor attended the hearing/conference and documentation is available in case file |
| 31. |
| The work registration codes are correctly reflected on PFPS |
| 32. |
| The Work Program screen #1 reflects the appropriate referral, assessment, and NMW Contractor information |
| 33. |
| The Work Program screen #5, reflects the support services issued (i.e. mileage, work related expenses etc.) |
| 34. |
| The Work Program screens #2 ,3 and 4 reflect the individual’s current activity and attendance and indicate continuous engagement without inappropriate placement gaps. |
Synopsis:
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9/7/10