Purpose Work Book Participation 01 15

User Manual: Work Book Work Participation 01-15

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T HE WOR K B OOK

©

WOR K P A R T IC IP A T ION

Revised January 2015

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Table of Contents
SECTION

101
102
102.1
103
103.1
103.2
103.3
103.4
103.5
103.6
103.7
103.8
103.9
103.10
103.11
104
104.1
104.2
104.3
104.4
105
105.1
105.2
105.3
105. 4
105. 5
105. 6

105.7
105.8
105.9
105.10

Revised April 2014

TOPIC
Background
Reasonable Accommodations
Definitions
What is Universal Engagement?
Universal Engagement
Specific Households
Subject to Sanction
Two Parent Households
Households with SSI Recipients
Families with Disabled Members
Parent Caring for a Disabled Family Member
Needy Caretaker Relatives Other Than Parents
Citizenship
Minors
Single Parent of a Child Under Age One
Substance Abuse
Domestic or Family Violence
Federal Work Participation Rate
Federally Defined Core Activities
Federally Defined Non-Core Activities
State Defined Activities
Holidays and Excused Absences
Federally Defined Core Activities
Unsubsidized Employment (WEJ)
Subsidized Private Sector Employment (WSU)
Subsidized Public Sector Employment (WSP)
Work Experience (WEX)
On the Job Training (OJT)
“J”CODED Work Activities and Needy State Status
Job Search and Job Readiness
Community Services Programs (WEM)

Vocational Education (BEV)
Child Care for a Customer Participating in a WEM (WEC)

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Table of Contents

SECTION

106
106.1
106.2
106.3

107
108
108.1

109
109.1
109.2

110
110.1
110.2
110.3
110.4
110.5
110.6
110.7
110.8
110.9
110.10
110.11
110.12

111
111.1
111.2
111.3
111.4
111.5
112

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TOPIC

Federally defined Non-Core Work Activities
Satisfactory Attendance at a Secondary School or GED
Program (BED)
Education Directly Related to Employment (BER)
Job Skills Training Directly Related to Employment (IST)
Verification of Work Activities (General)
Guidelines on Acceptable Verification

Attendance
Fair Labor Standards Act
Determining if the Work Program is Employment or
Training
FLSA Minimum Wage Provision
Substance Abuse
Overview of Substance Abuse Activity Requirements
The Addictions Specialist
Referral to Addictions Specialist for Screening/Signature
Requirements
Redetermination or Interim Change
Screening and Referral Assessment
Compliance
Work Requirements
Supportive Services
Social Services Referrals
Employment
Non-compliance with Substance Abuse
Individual Sanctions
Voluntary Quit and Reduction of Effort
General Policy
Good Cause for Quitting a Job or Reducing Work Hours
Applicants
Recipients
Closing the TCA Assistance Unit
Reports

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APPENDIX
Appendix 1

How TCA Substance Abuse Sanctions Affects Food Stamps and Medical
Assistance Eligibility

Appendix 2

CARES Procedures for when an Applicant or Recipient Voluntarily Quits
a Job or Reduces Work Hours

Appendix 3

TCA Core Case Activities

Appendix 4

TCA NON-CORE CASE ACTIVITIES

Appendix 5

FLSA- Activity Review sheet

Appendix 6

FSLA Minimum Wage Calculation
FORMS

DHR/FIA 1176 (Revised 10/05)
Consent for the Release of Confidential Alcohol and Drug Treatment Information

DHR/FIA 1176 (Revised 10/05)
Consent for the Release of Confidential Alcohol and Drug Treatment Information

DHR/FIA 1177 (Revised 10/05)
Substance Abuse Screening Referral Form
DHR/FIA 1178 (Revised 10/05)
Substance Abuse Identification and Treatment Notification

DOMESTIC VIOLENCE SUPPLEMENT

Introduction
Hidden Losses to the Workplace
Tips to Make The Work Place Safer
Danger Assessment
Sample Safety Plan

Revised January 2015

Background
Temporary Assistance for Needy Families (TANF) is the federal program that was
established out of the Personal Responsibility and Work Opportunity Reconciliation Act
(PRWORA) of 1996. Maryland’s program is Temporary Cash Assistance (TCA).
Primary funding for the TANF program comes from Federal Title I funds (Block Grants
for Temporary Assistance for Needy Families). The Deficit Reduction Act (DRA) of
2005 reauthorized the TANF program. The DRA required States to change their work
participation programs effective October 1, 2006.
Reasonable Accommodations
When there is customer contact with the local department regardless of who initiated
the contact, the local department must ask the customer if the customer requires
special accommodation because of a disability. Equal rights for disabled individuals is
required by many Federal and State laws. Reasonable accommodation requirements
are covered under the American’s with Disabilities Act. When the local department
contacts a customer about a required interview, participation in a work activity or for
other reasons, the local department must advise the customer that reasonable
accommodations will be made to assist the customer. Customers who are not able to
come to the LDSS or a vendor appointment because of a disability should be offered a
phone interview, home visit or other accommodation. One important aspect of ADA
requirements, the customer may not be able to get a DHR/FIA 500 form completed
showing a disability that exempts the customer from a work activity, but the customer
may be considered disabled under the law. More information on working with TCA
customers with disabilities is available in the Customers with Disabilities section of THE
WORK BOOK.

101 Definitions
A. Assessment is an evaluation completed at application, recertification or as the
customer's needs change that considers the customer's educational level, job
skills and readiness, and interests to determine appropriate activities for the
customer. There is a sample assessment included in the appendix.
1. An assessment:
•
•
•
•

Lays the ground work for customer success in becoming self-sufficient
Identifies customer skills and resources and potential skills and resources
Identifies existing and potential obstacles to customer success
It helps determine how long it will take the customer to reach his/her
goals.

2. The assessment should include the customer’s:
•
•
•

Education,
Work history,
Job readiness,

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•
•
•

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Job skills,
Training interests,
Family resources to facilitate independence, and
Family health

3. Without an assessment chances are the customer will continue to churn on
and off of assistance
4. The Family Investment Plan can not be developed until the assessment is
completed.
B. Core Work Activities: federal law defines work participation activities into core
activities and non-core activities. Core activities are those activities the federal
law determined to be most effective in helping people obtain employment.

C. Excused absence-means that a customer can be granted up to 16 hours per
month of excused absence from their assigned work activity without being found
in non-compliance. The hours are counted for work participation as excused
hours.
• Credit for days missed due to an excused absence is not available for unpaid
leave for participants in employment activities (WEJ, WSP, WSU and OJT).
• In order for excused absence hours to count the WEI parent must be
scheduled in the activity or activities for those days.
• In non-employment activities, recipients may count up to 16 hours of excused
absence per month at the discretion of the local department case manager,
not to exceed 80 hours during the most recent 12-month period.
D. Family Independence Plan
1. Plan means the Family Investment Program’s written and signed mutually
agreed upon Family Independence Plan. The Family Independence (FI) plan
is the most important step in helping customers to achieve self-sufficiency.
2. The FI plan tells the case manager and the customer where the customer is
going and how the customer is going to get there.

• Leaving any portion of the FI plan incomplete is likely to hinder and delay
the customer’s success.
3. The FI plan is developed by the case manager and the customer together and
starts with an assessment. The Family Independence Plan is essential to the
customer’s progress in working toward leaving TCA.
4. The Family Independence Plan includes:

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•
•
•
•

•
•
•
•
•
•
•
•
•

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A statement of the goals and intent of the Plan
Activities and other actions the customer is expected to complete;
The supportive services the local department is expected to provide to the
family.
• All past and updated assessments
Barriers or problems identified that must be overcome such as current or
history of:
• Identified disabilities including illnesses that may be in remission
• Family violence
• Substance abuse
Information regarding counseling referrals, acceptance, or refusal
Social Services referrals and support offered, accepted or refused
Other supportive services offered, accepted or refused
Testing
Education programs referred, accepted or refused
Job search history
Job training history
Work experience
Employment

5. Compliance with the FIP Plan:
•

Customers develop the Plan with the case manager and must agree to
follow the Plan

6. Non-compliance with the FIP includes:
•
•
•

Failure to provide required verification
Refusal to sign required forms
Not following the FIP Plan

7. Send a Notice of Adverse Action (NOAA) and close the case after the 10
days adverse action period expires for not complying with the FIP.
8. Do not close the case, after 10 days adverse action, because the customer
did not comply with work requirements that are included in the FIP. Noncompliance with work requires conciliation and sanction.
Remember that sometimes our customers do not have goals other than getting through
the day. Many don’t know how to set goals and don’t believe they can reach any goal
they set. One of the goals of the FIP Plan is to help customers develop and strive for
attainable goals.

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D. Federally defined work activities- are activities specifically designated and
defined by Federal law defining what are considered countable or non-countable
hours for work participation.
E. Good cause- means the customer is trying or tried to comply with a
requirements but through no fault of their own was not able to comply.
F. Good faith effort means the customer has made every effort to meet the terms
outlined for the customer in the Plan but through no fault of his or her own can’t.
G. State defined activities-primarily designated as “O” coded activities, these
activities designate what the customer is “doing” for self-sufficiency when the
customer is not participating in a federally defined activity.
H. Supervision –daily supervision means a responsible person that has daily
oversight of the individual’s participation, but not necessarily daily contact.

• Paid employment: supervision is a normal part of employment, the business
supervisor provides supervision.
I. Supportive services- services provided to the TCA family based on the
assessed needs of the customer by the local department or through referrals to
service providers (such as, but not limited to, counseling, Social Services,
vocational rehabilitation referral, education, training, other evaluations).
J. Universal Engagement- from the day of application customers must be
engaged in a State or federal activity that helps move the family to selfsufficiency.
K. Work eligible individuals (WEI) are the individuals applying for or receiving
TCA benefits who are required to be counted in the federal work participation
rate. These are what we previously called the mandatory people.

102 What is Work Participation?
102.1 Universal Engagement
A. Each week, mandatory TCA recipients or work eligibles are required to
participate in work activities for 30 hours. The participant may engage in a blend
of activities to achieve 30 hours in the week.
B. A minimum of 20 hours each week must be in one of the Core Work Activities.
C. The customer may be engaged for the full 30 hours in the Core Work Activity.

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 If the customer is engaged for 20 or more, but less than 30 hours per week
in a Core Work Activity, engage the customer in other activities up to the
remaining 10 hours each week so that the total number of hours of
engagement equals 30.
E. Encourage customers to participate for additional hours, but do not sanction:
1. Customers who achieve 30 hours of participation, but do not achieve 40
hours per week, or
2. Customers with a child under age 6 who achieve 20 hours per week, but not
40.
Note: Closely monitor and enforce participation for the initial 30 (or 20) hours in one
of the Core Work Activities.
F. If a participant is absent, for any reason, and the absence results in achieving
less than 30 hours (20 hours for families with a child under 6) in Core Work
Activities in the week, the participant must make up those hours in additional
Core Work Activities unless the absence is an excused absence. (excused
absences are discussed further in this section.)
G. Participation includes but is not limited to, performing up-front job search,
attending orientation, completing an employability assessment, and developing a
Family Independence (FI) Plan.
H. The FI plan should be done as soon as possible but no later than 30 days after
the customer files a TCA application.
I. Participation must continue as long as the customer receives TCA.
J. All of the following are work eligible TCA recipients and must be engaged in a
countable activity:
1. adults
2. teen parents coded as either the head of household or children on the case,
with no high school diploma who are not enrolled full-time in school
3. teens, ages 16 and 18 with no children in the assistance unit and with no high
school diploma, who are not enrolled full-time in school and
4. full-time students who are to graduate during the year of their nineteenth
birthday
5. legal immigrants
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6. 2 parent families when both parents are able bodied
o To meet universal engagement requirements both parents must be
engaged in an activity.
o One parent providing child care for their own children is not a countable
activity for universal engagement.
K. The following individuals are exempt from work participation:
1. Long term disabled adults or children applying for or receiving SSI and SSDI ,
unless they want to voluntarily participate in a work activity.
2. Single parents with a child under 1 (may be used for a maximum of 12
months in the adult’s lifetime)
•

The exemption begins the day the baby is born and lasts for 12 months

•

The 12th month is the month before the baby turns one, when the
exemption began at the baby’s birth

•

The exemption ends at the baby’s first birthday for all other instances.

3. Needy caretaker relatives
4. Children under age 16
5. Parent caring for a disabled family member who lives in the home
L. Special Circumstances Limiting Work Hours
1. Customers may have circumstances, such as short-term illness or
incapacitation, which prohibit them from participating in a federally defined
work activity.
2. For the purposes of making them countable toward the 100% universal
engagement rate, the case manager must require that these customers
participate in State defined activities. For example, a customer with a broken
leg who will not be able to participate in a federally defined work activity for 9
months would be placed in the State defined activity code OTM (wellness
rehabilitation).
•

In order to remain in OTM and to avoid non-compliance, the customer
must go to all doctors’ appointments and physical therapy sessions during
the 9-month period of incapacitation.

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3. Also included in this category are the Work Eligible people who have a
covered disability under ADA.
•

This could include for example, someone who has migraines. Most days
the customer can participate, but may be 2-3 days a month the customer
may have a migraine.

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103 Specific Households
103.1 Subject to Sanction
A. Case managers must notify non-compliant individuals that the non-compliance
without good cause makes them subject to sanction.
B. Send the customer a Notice of Non-Compliance (NONC) informing them of the
non-compliance behavior and that they are subject to sanction.
C. Required wording is: Client’s Name failed to comply with work program
requirements and is subject to sanction.
D. Code WORKS:
1. OTC for clients in conciliation.
2. OTU for under appeal for work sanction
3. OTX for adverse action or sanction because of non-compliance with a work
requirement
103. 2 Two Parent Households
A. Two parent households are households in which:
1. The adults have a child in common,
2. Both parents receive TCA, and
3. Both parents are able bodied.
Note: If one or both parents are disabled, the household is not counted as a two parent
household. Two parent households are paid out of State General funds and are not in
the WPR.
B. The parents in the household are required to participate for a combined minimum
of:
1. 35 hours averaged weekly when one parent is providing child care to their
own child and the other parent is completing all of the hours, or
2. 55 hours per week averaged weekly if the household receives federally
funded child care.
C. The first 30 of the 35 hours, of participation must be in a federally defined core
activity. The hours of participation may be attained by one parent or both
parents.

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D. If the assistance unit has POC the number of required hours is 55 with 50 of the
55 hours in core activities. The hours must be completed by both parents.
E. A two parent household is not eligible for the child under one exemption. That
exemption is allowed for a single custodial parent only.
•

The two parent household may be eligible for 12 weeks postpartum good
cause

103.3 Households with SSI Recipients
A. SSI and SSDI recipients are exempt from work requirements in Maryland.
B. Encourage SSI recipients to contact Social Security about the Ticket to Work
program if they would like to participate in a work activity. They may also be
referred to an appropriate TCA work activity.
C. The Data Manager must manually register an SSI recipient in WORKS, if the SSI
recipient wants to volunteer.
103. 4 Families with Disabled Members (For more detailed information on disabled
households see the section on TCA for Disabled Customers)

A. Households with an Individual-who is disabled for 12 months or more
1. Long term disabled individuals are not work eligible individuals. They are
required to:
a. Apply for all benefits the customer is potentially eligible for, and
b. Follow all Social Security Administration requirements for obtaining SSI or
SSDI including appealing any denial,
c. Have a medical disability form DHR/FIA 500 completed verifying the
impairment.
Remember, pregnancy is not a disability and does not give the customer good cause for
not participating. There must be some other factor that prevents the customer from
participating in a work activity to have good cause or an exemption. Some other factors
could include: doctor putting the customer on bed rest for a verified medical condition
(use DHR/FIA 500) such as but not limited to, high blood pressure or swelling. The
condition can be a result of the pregnancy, but the pregnancy is not a good cause for
not participating in a work activity.
2. Code long term disabled individuals as OTD in WORKS for universal engagement
purposes.
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3. Use caution when referring a disabled individual to a work activity.
a. Case managers and vendors must be very careful when referring a
disabled customer to a work activity.
b. Review the DHR/FIA 500 carefully. If the form indicates the customer may
participate in an educational or vocational program, evaluate the programs
available to ensure the customer is in a program that he or she can
succeed at and gain employment skills and knowledge.
c. There are several things we do not want to happen. We must ensure that
customers are not:
i.

Denied SSI because they are employed

ii.

Set up for failure by putting them in activities they can not do, and

iii.

“Warehoused” by just putting them in an activity that does not move
them toward independence and self-sufficiency.

B. Short term disabled
1. Short term disabled individuals (disabled less than 12 months) are work
eligible individuals, but may have good cause for not complying. They are
included in the WPR (denominator) and count against us in the WPR
calculation.
2. Short term disabled individuals can meet universal engagement requirements
by participating in wellness activities. Code the short term disabled person
OTM in WORKS.
3. The disability must be verified with a DHR/FIA 500 disability form.
Remember that a disability is not a technical factor of TCA. If the customer
does not provide a medical form to verify the disability , do not deny the
case. When the customer does not provide a DHR/FIA 500 form to verify
his or her disability, refer the customer to a work activity.
103.5 Parent Caring for a Disabled Family Member
A. A parent caring for a disabled family member, living in the home, is exempt from
work requirements.
1. The disabled person may be a spouse, child or other adult living in the
household.
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2. The disabled individual, in the assistance unit, must have a medical statement
DHR/FIA 500 (unless the individual receives SSI or other federal disability
assistance) verifying the disability.
3. The applicant or recipient must also provide a statement from the health care
provider that the TCA applicant/recipient is needed in the home to provide
care for the disabled individual.
4. If the disabled individual is a child, the parent must complete a 434-C form
stating why the parent is needed in the home to care for the child.
B. If the disabled person is a child and the parent did not complete the 434-C, do
not deny or close the case or make the customer mandatory for work.
•

The case manger should review the information that has been submitted
and see if it is obvious the parent is needed in the home.

•

Narrate the case record very thoroughly about the disability and why the
decision was made.

Actual case example: Customer has three year old triplets. One of the children
receives SSI and has severe medical problems (lung/ breathing problems, a
tracheotomy (a tube in the child’s throat) and a colostomy (a tube and bag to help
eliminate body waste). All medical conditions were verified by a DHR/FIA 500. The
mother did not complete a 434C. The TCA case was denied.
The TCA should not be denied or closed. The case manager was able to determine
that the customer is clearly needed in the home to care for the child/ren. Please
remember we work with people.

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103.6 Needy caretaker relatives other than parents
A. Needy non-parent caretaker relatives are exempt from work requirements in
Maryland.
B. FIA takes the payment for the portion of the TCA for a needy caretaker from a
different payment source.
C. The payment for the non-parent caretaker relative is included in a “Room and
Board payment” for the children.

• The children receive a TCA payment that is one person higher than the
number of children in the TCA assistance unit. This change does not affect
how needy caretaker cases are processed in the local department.

D. If the spouse of a needy caretaker relative lives in the home, the spouse must be
included in the TCA also and is also exempt from work requirements.
When a non-parent caretaker relative or the caretaker’s spouse has income, the income
is counted only against the portion of the TCA that is for the caretaker relative. The
caretaker is not financially responsible for the children.
EXAMPLE:
The TCA for a caretaker and 2 children is $ 576 (effective October 2013). The
children’s portion is $ 455. The TCA grant would never be lower than $455 (unless the
children have income) regardless of how much income the caretaker has. The
caretaker’s income would only be count against the $121 difference between the $ 576
and $ 455. If the caretaker’s income reduces the grant below the $ 455 for the children,
the caretaker is removed as a TCA recipient. See the TCA Manual section 303 for
additional information on caretaker relatives and counting their income.
D. You may encourage a caretaker relative to participate in a work activity, but not
require and or sanction for not participating.
NOTE: For CARES and WORKS to correctly identify a caretaker relative; DO NOT
CODE the children who are not the caretaker’s children as “CH” on the CARES
STAT screen.
103.7 Citizenship
A. Qualified Immigrants Not Eligible for Federal TCA
1. Qualified immigrants who do not meet the requirements to receive federallyfunded TCA are paid out of state funds

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• Immigrants who are admitted with work authorization only are not eligible
for either State or federal TCA
2. Eligible immigrants are required to participate in work activities if not
otherwise exempt and may be sanctioned for not participating.

• They are exempt from federal work participation rates.
3. Eligible immigrant adults are paid a “Room and Board payment” equal to the
number of children in the TCA assistance unit plus the eligible parent/s. This
is completed at FIA and is invisible to the local department
B. Ineligible and Undocumented Immigrants
1. Undocumented immigrants are people who are in the United States without
proper legal status. They are here without the consent of the United States
Department of Citizenship and Immigration Services (US CIS).
2. Immigrants who do not have a “qualified” status are not eligible for federallyfunded or state paid TCA.
3. Although undocumented immigrants are not eligible for TCA, citizen children
of undocumented immigrants are eligible for TCA. Most children born in
the US are considered citizens even if their parents aren’t.
4. Do not require ineligible immigrants to participate in a work activity and do not
sanction for not participating.
5. The income and resources of ineligible immigrant parents of citizen children is
countable to the assistance unit.
6. When an immigrant does not have documentation of immigration status or
has expired documentation, refer the person to US CIS. Do not contact US
CIS directly to obtain documentation unless requested to do so by an
immigrant who is:
•

Hospitalized,

•

Disabled, or

•

Has other good cause for not having the documentation and obtaining it
would cause undue hardship

103.8 Minors
A. Minor parent

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1. Minor parents and the spouse of the minor parent have a requirement to be
registered in school, attend 80% of the time
2. If the minor parent or the spouse of the minor parent drops out of school,
implement conciliation and sanction.
3. Minor parents or the spouse of a minor parent who is under 18 years of age
and has graduated from high school or obtained a GED is a work eligible
individual.
4. Although the spouse of a minor parent is not included in the WPR, the
requirements for the spouse (in Maryland) do not change.
5. A minor parent may not claim the child under one exemption.
B. Non-parent minors (age 16-18 or 19 if graduating high school in the year the
minor turns 19)

• A 19 year, who is not attending high school or who will not graduate before
the end of the year in which the child turns 19, is not eligible for TCA.
C. Non-parent minors (age 16-18 or 19 if graduating high school in the year the
minor turns 19) must be in school and attending 80 percent of the time
D. If the non-parent minor under age 19 is not in school without good cause, impose
a PPI disallowance and refer to a work activity.
1. At redetermination ask for verification of school attendance.
2. If the minor does not go to school, impose a disallowance and refer to a work
activity
3. If the minor does not comply with work requirements, remove the PPI
disallowance and implement conciliation and an individual sanction.
4. If the minor complies with the work requirement but does not go to school, the
PPI disallowance continues. School is the goal.
E. In the case of an 18 or 19 year old not in school without good cause, remove the
18 or 19 year old from the TCA or close the case after timely and appropriate
adverse action if the 18 or 19 yr. old child is the only eligible child on the TCA.
F. All teen parents, either heads of household or children on the case, and full time
students who will graduate during the year of their nineteenth birthday are
considered fully participating in federally defined work activities by maintaining
satisfactory school attendance (80%).
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G. All 16 and 17 year old teens who are not enrolled full time in school, home school
or Job Corps must participate in federally defined work activities as mandatory
adults.
103.9 Single parent of a child under one
A. The single parent of a child under age 1 is exempt for a maximum of 12 months
in the parent’s lifetime.
B. The 12 months begins the day the baby is born and ends the month before the
baby turns one when the exemption begins at the baby’s birth.
C. For customers eligible for the child under 1 exemption, case managers should
schedule an appointment with customer, in the last month of the exemption to
discuss referring the customer to an activity on the first day of the next month
and to assist the customer with obtaining child care.
1. Customers are exempt until the last day of the month before the baby’s first
birthday when the exemption begins at the baby’s birth.
2. If the customer does not come in for the appointment, the case may be closed
after 10 days adverse action, for failure to keep a scheduled appointment
(CARES code 566). It is not a work sanction.
D. Customers whose child under 1 exemption begins during the baby’s first year but
after the birth month are exempt for 12 months through the baby’s first birthday.
Example: Customer applies for TCA. She has an eight-month-old baby. The customer
is exempt with a child under one for four months. Two years later she reapplies for
assistance and has a two and half year old child and a five-month-old baby. The
customer is eligible for the child under one exemption for seven months.
E. Once the 12 months of the exemption have been used, the customer may not
claim the child under one exemption again.
F. Child under one exemption always has preference over the 12-week post
partum. The child under 1 removes the customer from the denominator of the
Work Participation Rate.
G. Customers can not use both the 12 weeks post partum and the 12 months child
under one.
Customers can see-saw, on and off the child under 1 exemption for the full 12 months
of the baby’s first year.

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Example:
Jan 08

Feb
Baby’s
birth-

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

EXEMPT

Goes
back to
activity

Misses
4 days
of
activity

1 day
excused
absence

20 hrs
per
week
in
activity

20 hrs
per
week
in
activity

Misses
3 days, 1
day not
excused.
EXEMPT

20 hrs
per
week in
activity

20 hrs
per
week in
activity

20 hrs
per
week in
activity

WPR

WPR

WPR

Child
<1

WPR

WPR

WPR

EXEMPT

EXEMPT

Jan 09
Misses 3
days,
1 day not
excused
EXEMPT

Child
<1
Feb 09
No
longer
child
under 1.

Child
<1

WPR

Child
<1

The customer uses 5 months of the child under 1 exemption and is countable in
the Work Participation Rate (WPR) for 7 months.
The customer cannot be exempt and countable in an activity at the same time.

Child
<1

103.10 Substance Abuse (See the section on substance abuse for additional information.)
A. Substance abuse can be considered good cause for non-cooperation with an
actual work activity.

• As long as the customer is participating with substance abuse requirements
and is not able to participate in a work activity, the substance abuse treatment
is considered the individual’s activity.
B. Individuals participating in substance abuse treatment beyond 4 consecutive
weeks and for more than a total of 120 hours (single custodial parent with a child
under 6) or 180 hrs (all other work eligibles) in the previous 12-month period
should remain in JBT (actively involved in substance abuse treatment) for the
purposes of being countable toward the universal engagement rate.
C. They, however, will no longer be countable toward the WPR during the year as
long as they are in JBT, once they have exceeded the 4 consecutive weeks or
120 (child under 6) or 180 hours (all other work eligibles) maximum.

• WORKS flips the code to an OBS if the hours are not needed for the WPR.
D. It is recommended that individuals receiving substance abuse treatment on an
outpatient basis participate in work activities other than JBT. Most substance
abuse experts recommend that substance abusers participate in a training
program or in work.
E. The TCA case manager, after consulting with the local addictions specialist, has
the final decision regarding an individual’s ability to participate in other federally
defined work activities.
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F. Customers who do not comply with substance abuse requirements are
sanctioned for non-compliance with substance abuse requirements.
•
•

Refer the customer to a work activity
If the customer is non-compliant with work requirements, also implement a
work sanction.

103.11 Domestic or family violence
A. A victim of domestic family violence is someone who is subjected to one or more
of the following:
•
•
•
•
•
•
•
•

Physical acts that result in or threaten to result in, physical injury to the
individual
Sexual abuse
Being forced as a caretaker relative of a dependent child to engage in
nonconsensual sexual acts or activities
Threats of, or attempts at, physical or sexual abuse
Neglect or deprivation of medical care
False imprisonment
Mental injury, verbal abuse (i.e. threats, controlling behavior, deprivation of
freedom, denial of personal liberties and isolation)
Intimidation of the caretaker and/or the children in the household

B. Staff in the local departments of social services who interview customers must:
1. Screen and attempt to identify victims of domestic/family violence (See
Danger Assessment in the Appendix section) :
•

When a TCA applicant or recipient is identified as a victim of
domestic/family violence the case manager should advise them of their
rights as a victim of domestic/family violence and the protections and
services available.

2. Refer victims of domestic/family violence to appropriate services:
•

Case managers must refer victims to the domestic/family violence experts
in order for the customer to receive appropriate counseling and other
supportive services.

3. Grant “good cause” waivers from certain TCA requirements when it is
determined to be in the best interest of the family.

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a. The family Violence Expert determines if a victim of domestic/family
violence is eligible for a “good-cause waiver”.
b. Good-cause waivers temporarily waive TCA program requirements until
victims can meet the requirements safely.
c. Victims may receive a waiver of their work requirement or their child
support cooperation requirement. Legal action against an abuser may
place the victim at greater risk.
4. Protect the confidentiality of domestic/family violence victims and their
children:
•

All information on domestic violence victims and their children is to be kept
confidential to decrease the risk of violence against them.

C. Case managers and Employment Specialists must use caution when talking with
an individual who may be a victim of domestic or family violence.
D. Customers who are or have been in domestic/family violence situations must
agree to cooperate with a counselor and attend counseling sessions as long as
the cooperation does not put the customer or the customer’s children in jeopardy.
E. In addition to the customer’s statement, the customer may have:
1. Police reports or court documents or other legal documentation of the
violence, or
2. Medical records documenting injuries, or
3. Statements from witnesses who can verify the abuse.
F. Do not require compliance or sanction any customer for non-compliance if the
customer believes and can document that his or her life or the life of his or her
children may be in danger if the customer participates in a work activity.
G. At some point in the recovery, if the counselor agrees, the customer may
participate in federally defined work activities.
H. Responsibilities of the Family Violence Expert:
1. Receives all referrals of Family Violence
2. Provides a safe haven if the customer needs and wants to escape the
domestic violence situation immediately
3. Develops and signs a written safety plan with the customer

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4. Does an assessment on the customer to determine if domestic violence has
taken place
5. Helps the customer document domestic violence
6. Provides therapeutic counseling and consultation for the customer or helps
the customer seek therapeutic counseling and consultation
7. Advises the FIA case manager if the customer needs good cause for child
support or a waiver for work requirements.
8. Maintain the customer’s right to confidentiality.
I. Responsibilities of the TCA interviewer:
1. Interviews each family who is applying for or receives Temporary Cash
Assistance, incorporating either the suggested questions for family violence
or another method to determine if the family is suffering from domestic
violence.
2. Completes Danger Assessment
3. Refers all customers who say they are experiencing or the local department
has reason to believe are experiencing family violence to the in-house family
violence expert.
4. If child abuse or neglect is suspected or disclosed, the case manager must
refer the case to services.
5. Gives the customer automatic “good cause” from child support requirements
until the family violence expert does an assessment.
6. Codes the DEM2 screen on CARES in the DMVIOL and the TLEX –Rsn
fields.
7. Codes all appropriate Child Support screens in CARES for “good cause”.
8. Makes a decision of good cause within 30 days of the receipt of the domestic
violence claim.
9. Reviews the “good cause” claim at each redetermination.

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J. Maryland Safe at Home Address Confidentiality Program
1. Customers escaping from an abusive relationship can register with the
Maryland Secretary of State (SOS) for the Maryland Safe At Home Program.
2. When registered, the customer’s mail goes to an SOS address and then
forwarded by the SOS to the customer.
3. When customers are registered in the State program or in a County or local
domestic violence program that provides a “safe” address, all mail to the
customer is sent to the safe address.
•
•

The customer’s true address is not entered in any system or case
narration. Use the “Safe” address.
The customer is not required to provide their actual address.

4. The customer’s information is confidential and should not be provided to
anyone.

104 Federal Work Participation Rate
A. A significant percentage of all work eligible TCA recipients must be participating
in a federally defined work activity.
1. The actual percentage of countable recipients in a federally defined work
activity each month is called the federal work participation rate (WPR).
2. Calculating the Work Participation Rate (WPR).
a. The mathematical calculation of the work participation rate is comprised of
a fraction with a numerator and a denominator.
b. Dividing the denominator into the numerator produces a percentage. That
percentage is the work participation rate.
c. The numerator includes all countable work eligible TCA recipients.
d. The denominator includes all work eligible TCA recipients.
e. DHR calculates the participation rate every month for each local
department and for the State.
Example:
If a local department has a numerator of 37 countable work eligible TCA recipients
and a denominator of 100 work eligible TCA recipients for the month, the local
department’s work participation rate is 37%. (37/100 = 37%)
B. Activities must be of a certain type and hours must be of a certain monthly
average for the customer to be either countable or non-countable.
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C. To be countable in the participation rate calculation, customers must participate
in certain activities an average of 30 hours per week each month.
D. WORKS is the system used to track work activities and participation hours.
When a customer changes activities the code in WORKS must be updated.
Note: A minimum of 20 (20 hours total for single parent families with a child
under 6) of the 30 hours must be in a federally defined core work activity
(FDWA).
104.1 Federally Defined Core Activities. There are 9 core activities:
Unsubsidized employment
Subsidized private sector employment
Subsidized public sector employment
Work experience
On-the-job training
Job search and job readiness

WEJ
WSU
WSP
WEX
OJT
JBS/OBS

Substance Abuse Treatment (part of job search and job readiness)
Mental Health Treatment
(part of job search and job readiness)
Rehabilitation Services
(part of job search and job readiness)
Community service programs
Vocational education
Child care for an individual participating in community service

JBT/OBM
JBM
JBR
WEM
BEV/OEV
WEC

104.2 Federally Defined Non-Core Activities.
•

Customers completing 20 hours of the required 30 hours in a federally defined,
core, activity, may complete the final 10 in either a federally defined core activity
or one of the three federally defined non-core activities.
Satisfactory attendance at a secondary school or in a GED program
Education (directly related to employment)
Job skills training directly related to employment

BED
BER
IST

104.3 State Defined Activities.
Prenatal/12 week postpartum
Caring for a child under age (max. 12 months in parent’s lifetime)
Disabled for more than 12 months
Illness or incapacity/wellness rehabilitation < 12 months
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OTP
OTB
OTD
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Caring for a disabled household member
Court ordered appearance
Temporary incarceration
Family crisis/family services
Breakdown in transportation/seeking trans (max. 30 days)
Breakdown in childcare/seeking childcare (max. 30 days)
Substance abuse referral/waiting list
Substance Abuse Treatment (when exceeding allowed time)
Mental Health Treatment (when exceeding allowed time)
Rehabilitation Services(when exceeding allowed time)
Domestic /family violence
In conciliation
Pursuit of Income Supports
Adverse action or sanction period
Under appeal for work sanction
Customer transferring between districts or district offices

OTG
OTO
OTJ
OTF
OTT
OTZ
OTS
OBT
OBM
OBR
OTV
OTC
OTL
OTX
OTU
OTQ

A. There are certain limitations placed upon the use of core and non-core federally
defined work activities.
B. Participation in job search/job readiness (JBS) and substance abuse treatment
(JBT) counts, for work participation rate purposes, for a maximum of four
consecutive weeks and for a maximum of 120 hours for a single custodial parent
with a child under 1 and 180 hours for all other work eligibles in the previous 12month period. (Customer begins a JBS activity in March 2008. The 12-month
period ends February 2009.)
Example:
Winnie Morris applies for TCA on November 29. She is referred to a Job
Search/Job Readiness Workshop that begins on December 6. The four-week
program combines classroom, job club, and job search activities, for 30 hours per
week. Ms. Morris attends every week. Count Ms. Morris as a work eligible TCA
recipient for the month.
Ms. Morris, however, does not find a job. She is scheduled to begin a work
experience assignment (WEX). Unfortunately, she must wait a week for the
assignment. She and the case manager decide she will complete a supervised Job
Search during the week she is waiting. The week Ms. Morris completes Job Search
is the 5th consecutive week of JBS (Job Search/Job Readiness). Because it is the
5th consecutive week and TANF regulations do not permit more than 4 consecutive
weeks during a 12 month period, Ms. Morris’s hours are not countable for that week.

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Example:
Two years ago, Maggie Vickers participated for 9 months in a vocational education
(BEV) activity. She has now reapplied for TCA. Ms. Vickers and the case manager
believe that 4 months in a different BEV activity will help her become re-employed.
She will be countable for purposes of the participation rate for 3 of the 4 months she
is in the BEV activity.
C. Vocational education (BEV) activities are subject to a 12-month lifetime time limit
for each participant.
D. Travel time from home to a work site or classroom and back is not countable.
104.4 Holidays and excused absences
A. Holidays
The following ten designated holidays are allowable holidays for TCA:
•
•
•
•
•
•
•
•
•
•

January 1, for New Years Day
January 15**, Dr. Martin Luther King Jr’s. Birthday
The third Monday in February for President’s Day;
May 30**, for Memorial Day
July 4, for Independence Day;
The first Monday in September for Labor Day;
November 11, for Veteran’s day;
The fourth Thursday in November, for Thanksgiving;
The Friday following Thanksgiving;
December 25, for Christmas;

**, unless the United States Congress designates another day for the observance of
that holiday, in which case, the holiday is the day designated by the United States
Congress.
B. Excused Absence
1. Local departments may develop policies regarding excused absences and
creditable hours of participation similar to those in common personnel
practices.
2. Examples of good cause activities include but are not limited to: sick time,
doctor’s visits or meetings at the child’s school or other activities deemed
appropriate by the case manager.

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3. In order for holiday and excused absence hours to count the customer must
be scheduled to participate in the activity or activities on those days.
4. Absences should be scheduled in advance when possible.
5. Good cause absences are considered excused absences.
6. Customers may not use more than 16 hours of excused absences in a
month and no more than 80 hours excused absences per federal fiscal year
(October 1-September 30.)
7. Excused absence may also be used to cover some periods of time that a
customer is in a program that extends past any time limits (such as Voc.
Education or job Search or Job Readiness)
8. Customers not able to attend their work activities on specific days because
the State work site is closed for a service reduction day should be coded with
an excused absence in WORKS.
Example: The terrible winter weather in 2014 meant that State offices and many other
facilities were closed part or all of specific days. Customers could not complete their
work activities and maintain countable hours. In situations like this, use excused
absence for up to 16 hours and good cause for the remaining missed hours. Customers
cannot be penalized for problems beyond their control.
Example:
Customer has to go to her child’s school for a meeting. She will be 3 hours late for her
activity. This is a good cause absence. She has 3 hours of excused absence.
Note: For federal reporting purposes, an excused absence does not count in the WPR
unless the excused absence hours make the customer countable for a month.
However, for case management purposes, all excused hours, regardless of whether or
not they made the customer countable, must appear on State reports.
8. Customers are excused from activity participation on days the placement site
is closed for holidays or inclement weather. The hours are counted as if the
customer participated.
9. Customers may not be excused for more than 16 hours when a placement
site is closed. (Such as a college closing for spring break.)
10. For scheduled breaks lasting longer than 16 hours in a report month, the
participant should be scheduled in a temporary activity so that he or she may
generate countable hours during the break period.

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Example:
Estelle Brauer has medical documentation to support her incapacitation for 5
months. She is not exempt from participation in federally defined work activities.
The case manager places her in the State defined activity OTM (disabled for less
than 12 months). Because she is a mandatory TCA recipient, Ms. Brauer appears
in both the UE and WP denominators. She is countable for the universal
engagement rate. She is not countable for the federal work participation rate.

105 FEDERALLY DEFINED CORE WORK ACTIVITIES
105.1 Unsubsidized Employment (WEJ)
A. WEJ is full- or part-time employment in the public or private sector that is not
subsidized by TANF or any other public program.
B. Unsubsidized employment also includes active duty service in the armed forces,
entry into a registered apprenticeship program or self-employment.
105.2 Subsidized Private Sector Employment (WSU)
A. WSU includes full-time or part-time employment in any private-for-profit or
private-non-profit sector job where the employer receives a subsidy from TCA or
other public/government funds to offset some or all of the costs of employing a
recipient. The term "subsidized" does not include tax credits to which the
employer may be entitled for employing the person.
B. Subsidized private sector employment includes:
1. Grant Diversion, where part or the person’s entire grant is diverted to
reimburse the employer for some or all of the wages paid to the person.
2. Work-study employment where local, state, or federal funds subsidize the
individual’s wages.
3. Supported work programs for individuals with disabilities or other special
circumstances.
4. Employment contract is limited to 16 weeks.
105.3 Subsidized Public Sector Employment (WSP)
•

WSP includes full-time or part-time employment in any public sector job where
the employer receives a subsidy offsetting the person's wages with government
funds, including work-study. An example of this type of activity is Grant
Diversion, in which part or all of the person's grant is diverted to reimburse the

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employer for some or all of the wages paid to the person by a public sector
employer.
•

All subsidized employment is considered a paid internship or apprentice ship.

•

Employment contract is limited to 16 weeks.

NOTE: Pay stubs or a wage form listing hours the customer worked can be used for
verification for subsidized or unsubsidized employment and hours of employment.
105.4 Work Experience (WEX)
A. WEX includes public or private sector work situations where the person has the
opportunity to acquire the skills and knowledge necessary to perform a broad
array of jobs, including learning about appropriate work habits and behaviors.
B. WEX helps to improve the employability of individuals who cannot find
unsubsidized employment.
C. Placements are designed to prepare participants to obtain unsubsidized
employment by helping them develop a current work history, establish
employment references and develop and improve marketable skills.
D. Prior to placement, potential work experience providers are evaluated to match
the participant with a position that is related to the participant’s employment goals
and the needs of the work site supervisor.
E. Examples of WEX placements are:
1. Learning routine office skills in a work setting such as a school, church, or
non-profit agency
2. Learning specific work skills in a hospital setting.
F. Typically, the person is not paid for participating in a work experience activity,
although he or she may receive a needs-based payment to cover the incidental
costs of participating.
G. WEX is defined as a work activity.
1. Some households are limited in the number of WEX hours that they can work
due to the Fair Labor Standards Act (FLSA). WEX is subject to minimum
wage requirements of $8.00 per hour effect January 1, 2015.
2. Work Eligible Individual participating in a WEX assignment cannot be required
to participate for more hours than the combined Temporary Cash Assistance
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(TCA) and Food Supplement benefits (FS) grants divided by the State
minimum wage.
3. Hours of participation are “deemed” to participants who are limited by FLSA
and they are considered participating for the full 20 of the core activity hours
for each week they participate for the number of hours allowed under FLSA.
105.5 On-the-Job Training (OJT)
A. Training provided to a paid employee by a public or private sector employer. The
training is productive work with the employer, and provides knowledge or skills
essential to the full and adequate performance of the position into which he/she
was hired. The employer pays the participant a training wage.
B. When the activity otherwise meets the definition of OJT and when the participant
is paid by the employer to attend them, this activity may include:
•
•
•
•

Internships
Practicum
Professional certification
Clinical training required by an academic or training institution

C. As long as the program is designed to lead to unsubsidized employment, the
activity meets the primary goal.
105.6 “J”CODED Work Activities and Needy State Status
A. Participation in a job search and job readiness activity can count for a maximum
of 120 hours (for a recipient with a child under age 6) or 180 hours (for all other
work mandatory recipients) in a fiscal year with no more than four consecutive
weeks being countable.
B. In two instances this can be extended:
•
•

if a State has an unemployment rate at least 50 percent greater than the
unemployment rate of the United States or
if the State meets the definition of a “needy State” under the Contingency
Fund provisions of the federal law.

C. A State qualifies as a “needy State,” based on its unemployment rate or on
increases in its Food Supplement caseload. Maryland qualifies as a “Needy
State” because of the increase in the Food Supplement caseload.
D. TCA customers whose work activity falls under one of the “J” codes (JBM-Mental
health Treatment, JBR-Rehabilitation Services, JBS-Job search and Job
Readiness or JBT- Substance Abuse Treatment) may have their hours of
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participation extended from 120 hours to 240 hours for an individual with a
child under age 6 and from 180 to 360 hours for all others.
E. Two able bodied parent households may have their hours of participation
extended from 210 to 420.
NOTE: The four consecutive week limitation still applies.
Examples: Week starts on Monday.
June is a five week month.
1. Customer participates in a “J” coded activity for 30 hours per week for the
weeks of:
June 1, June 8, June 15, June 22 and June 29. The week of June 29 is the 5th week
and the customer is not countable because she has used 4 consecutive weeks.
2. Customer participates in a “J” coded activity for 30 hours per week for the weeks of:
June 1, June 8, June 15, June 22. She does not participate in a “J” coded activity for
the week of June 29. She does participate in a WEX activity for the week of June 29.
The customer is countable.
July is a four week month.
The week of July 6, the customer goes back into her “J” coded activity for 30 hours per
week. She participates 30 hours per week for the weeks of July 6, July 13 and 20. The
week of July 27, the customer participates in a community service (WEM) activity for 30
hours per week. She is countable in all four weeks, but has only 3 consecutive weeks
of “J” code activity.
August is a five week month.
The customer has been in her “J” code activity for 8 weeks (240 hours). It is determined
that she needs additional time in the “J” code activity. In August, the customer
participates 30 hours per week for the weeks of August 3, August 10, August 17, and
August 24. She exhausts her 360 hours of countable “J” code activity. It is determined
she needs one more week of “J” code activity to be work ready. The week of August
31, the customer participates for 30 hours. She has exceeded the allowable 360 hours
and is not countable. It is in the customer’s best interest that she continues in the “J”
code activity regardless of whether she is countable.

Customer B
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Customer is in a “J” code activity 20 hours per week (child under age 6) one week per
month. She participates in a community service activity the other weeks. The customer
can participate and be countable for 12 months per year (a total of 240 hours). She has
no consecutive weeks of “j” code activity.
Customer C
June is a five week month. June 1, June 8, June 15, June 22 and June 29.
Customer is in a “J” code activity for 8 hours per week, 12 hours of WEX and 10 hours
of BER. The week of June 29 is the 5th week and the customer is not countable
because she used 4 consecutive weeks. Any hours used are countable against the 4
consecutive weeks.
July is a four week month and the customer may not be in a “J” code activity for the first
week of July or she will not be countable because it would be the fifth consecutive
week.
105.7 Job Search and Job Readiness Assistance (JBS)
A. The definition of these codes includes a variety of activities aimed at assisting a
TCA parent in locating unsubsidized employment. Assistance in the act of
seeking or obtaining employment, including life skills training, and substance
abuse treatment, mental health treatment, or rehabilitation activities for people.
B. Job search and job readiness activities must have a direct connection to
improving customer employability or finding employment.
C. Travel time between job interviews when multiple interviews are scheduled on
the same day is countable, but travel time to the first interview or travel time
home after the last interview are not countable.
• Estimated hours are not allowed. Only actual hours of travel may be counted.
D. Participants in these activities do not count as engaged in work activities for more
than 120 hours for a single custodial parent with a child under 6 and 180 hrs. for
all other work eligibles, in a 12 month period year and no more than four
consecutive weeks. (See Section 105.6 “J” codes and extension of time
limits)
•

A countable week equals 20 hrs for a single custodial parent with a child
under 6 and 30 hrs for all other work eligible households.

•

Any hours of participation in job search/job readiness during a 7-day period
triggers a week for the 4-week limit.

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E. Job Search also includes the following activities and codes:
•
•
•

Substance Abuse Treatment (JBT)
Mental Health Treatment
(JBM)
Rehabilitation Services
(JBR)

F. Job Search activities include:
1. Instruction in effective strategies that can be used by individuals in
seeking/obtaining their own jobs,
2. Making contact with potential employers,
3. Applying for vacancies,
4. Resume writing,
5. Interviewing skills,
6. Labor market information,
7. Telephone techniques,
8. Information on job openings, and job acquisition strategies, as well as the
provision of office space and supplies for the job search.
G. Job Readiness Assistance includes:
1. Instruction in career exploration,
2. Instruction on basic work place expectations and behaviors.
Note: Substance Abuse Treatment (JBT) or other barrier removal activities can be
considered to be a form of Job Readiness activities.
Although only work programs that involve preparing for and seeking work meet
the definition of job search and job readiness, some substance abuse
treatment activities should be reviewed to determine if they are countable as
another activity. These activities may include housekeeping, preparing meals,
or scheduling group activities. It does not matter whether the person is in
residential treatment or outpatient if the other activities are performed.

H. Substance Abuse Treatment, Mental Health Treatment and Rehabilitation
Services activities (JBT)
1. Such treatment or therapy must be determined to be necessary according to
a qualified medical or mental health professional.
2. This is a treatment-oriented service to help individuals make the transition
from welfare to work.

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3. If a portion of the activity more closely meets the definition of another work
activity, then the hours associated with that activity may count under the
appropriate work category
4. JBT includes all stages of substance abuse treatment including referral,
waiting list, and treatment.
5. Treatment includes both residential and outpatient:

• Detoxification,
• Medical or mental health treatment,
• Therapy, counseling, and other services to address mental, physical or
emotional disorders that can interfere with an individual’s ability to work or
look for work.
Note: A recipient’s participation in job search/job readiness (JBS) counts, for
WPR purposes, for a maximum of four consecutive weeks and for a total of 120
hours in any 12 month period for a single custodial parent with a child under six
or 180 hours for all other families.
Individuals participating in substance abuse treatment beyond four consecutive
weeks and for more than a total of 120 or 180 hours should remain in JBT (now
coded OBT) for the purposes of being countable toward the universal
engagement rate. They, however, will not be countable toward the federal WPR
during the 12 month period.
See page 26 for revised and additional information on extended hours

105.8 Community Service Programs (WEM)
A. WEM includes two key elements: it must be a structured activity that provides a
direct benefit to the community (public or non-profit organizations).
B. Community service activities must be limited to activities that that serve a useful
community purpose in fields such as health, social service, environmental
protection, education, urban and rural development, welfare, recreation, public
facilities, public safety and child care.

• Design community service programs to improve the employability of
recipients who may not otherwise able to obtain unsubsidized employment.

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C. Self-initiated activities are included in WEM. Include a description of how selfinitiated WEM provides direct community service and improves the recipient’s
employability in the case narrative.
D. The principle difference between work experience and community service is that
the community service activity must serve a useful community purpose.
E. Some community service activities are subject to the requirements of the FLSA
Example:
A TCA recipient develops a WEM opportunity at her church. The case manager,
employment specialist or vendor representative needs to know the direct community
service the program provides. The recipient provides a letter from the pastor that
she will cook and deliver meals to shut-in and ill parishioners five days per week
under his supervision. This level of structure meets the direct community service
requirement. After a discussion with the recipient, the LDSS staff or vendor decides
that the activity improves the employability of the recipient as it is a tangible worklike assignment that can be added to a resume and her performance of duties
creates a work habit profile of punctuality, customer service skills, making deliveries
timely and representing an institution to the public.
E. Supervision: A responsible person has daily responsibility for oversight of the
individual’s participation but may not have daily in-person contact.
105.9 Child Care for an individual participating in a community service program
(WEC)
A. Providing childcare to enable another TCA recipient to participate in a community
service activity.
B. WEC is used only when an individual cannot be placed in another activity.
C. The activity must be structured and designed to improve the employability of the
individual who completes the WEC activity.
D. One parent in a two parent family may not participate in WEC so the other parent
can participate in a community service activity.
•

Providing care for the individual does not help prepare the parent providing
the care for employment.

•

There is no supervision involved in the activity if the individual is providing
care for his or her own children.

•

Hours may not be projected for this activity.

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105.10 Vocational Education (BEV)
B. BEV includes organized educational programs related to preparing the individual
for employment in current or emerging occupations. BEV is now considered a
career and technical education activity.
•

Any vocational activities that do not meet this definition may meet the
definition of another activity such as job search and job readiness or job skills
training directly related to employment.

B. An educational organization (e.g. Vocational-Technical School, Community
College, or proprietary school) must provide the training.
C. Post secondary education leading to an advanced degree may be counted as
Vocational Education.
Note: Do not place a teen head of household who does not have a GED or is
not a high school graduate in a BEV activity. Place the teen HOH in BED or
BER.
•

Time sheets or activity logs that report hours of participation for every day of
every week in each month are acceptable.

•

Actual hours spent in class as well as time spent performing clinical
requirements, lab work, fieldwork and student teaching that are required for
approved vocational educational training programs are considered to be a
part of the primary activity for which they are required and are countable.

D. Vocational Education cannot be counted for more than 52 weeks during a
customer’s lifetime.
E. If as little as one hour of BEV used, it counts as a week of the 52-week limit
during a customer’s lifetime.
F. For federal reporting purposes, FIA will not count any BEV hours unless the BEV
hours help make the customer countable for the month.
G. For case management purposes, all BEV/OEV hours must appear on State
reports.
H. If the BEV code is used and the customer does not need the hours to be
countable for the month, WORKS will change the BEV code to a companion SDA
code (OEV).

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Case record paper documentation may not show the same codes. End of
month files must be reviewed to prevent audit issues.

I. The case manager should evaluate any program a customer is enrolled in to
determine whether the program meets the definition of a BEV program. By
carefully structuring participation, activities may be countable under several
different work activities.
Examples:
1. Customer is in a construction trade vocational school that lasts 18 months.
The customer is only countable in BEV for 12 months and has never been in
a BEV coded activity before. The customer is gaining skills that enable him or
her to become employed when the program is completed.
Customer is in a Certified Nursing Assistant (CNA) training program that lasts
18 months. The customer is only countable in BEV for 12 months and has
never been in a BEV coded activity before.
The customers in the above scenario are gaining skills that enable him or her
to become employed when the program is completed. They should remain in
the programs.
2. To become a licensed practical nurse usually takes at least two years. The
training usually involves a combination of classroom instruction and clinical
activities.
o Clinical training in a hospital or other setting could count as work
experience or community service.
o If the student gets paid the activity could be considered on the job training
or unsubsidized employment.
J. Review the customer’s activity options and try to “Save” the customer’s BEV
hours for those activities that do not count as any other activity:

• If the decision is to use the BEV , the hours spent in basic and remedial
education, as well as English as a Second Language (ESL) do not count as
BEV unless the following conditions are met:
•

There must be a need. The results of the individual’s initial assessment are
used to determine the need for basic and remedial education or ESL.

•

The basic and remedial education or ESL education must be embedded in an
activity that meets the definition of BEV and it must clearly state in the FIP
plan, vendor contract or participant independence plan that the classes are
needed to meet the goals and

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There must be an explicit statement of the number of hours per week and the
number of weeks the program lasts.

106 FEDERALLY DEFINED NON-CORE WORK ACTIVITIES
106.1 Satisfactory Attendance at a Secondary School or GED program (BED)
A. BED includes educational instruction provided by a secondary school or an
alternative educational program leading to a high school diploma or high school
equivalency (e.g., GED)
B. Countable hours of participation
1. The number of hours verified as spent in BED is the number of hours
countable for the activity.
2. Hours are only countable toward the WPR after the person has participated
for 20 hours per week in one of the core work activities (activity categories
numbered 1 through 9 above).
3. Teen heads of household (HOH) or teen spouses in this activity are
considered to be meeting the work requirement regardless of how many
hours per week they participated and without first participating in a core work
activity, as long as they attend school 80% of the time.
4. Time spent on unsupervised homework assignments counts for up to one
hour of home work time for each hour of class time.
5. Actual hours spent in class as well as time spent performing clinical
requirements, lab work, fieldwork and student teaching that are required for
approved BED programs may be considered to be a part of the primary
activity for which they are required and are countable under that category or
may be reviewed to determine eligibility for another category.
6. BED may not include activities such as adult basic education or language
instruction unless they are linked to attending a secondary school or obtaining
a GED.
C. Verification
1. Documentation for BED and other unpaid work activities must reflect the
actual hours of attendance for each week in the reporting period.

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2. For in-school, teen parent heads of households, the school will provide
documentation (report card) at the end of each term to verify
student/participant full time attendance.
3. Documentation could include, but is not limited to, report cards, time sheets,
service provider attendance records, or activity logs on a biweekly or monthly
basis or a signed and dated statement from the BED site supervisor. For high
school, whatever documentation we can obtain from the school will be
sufficient to meet this requirement.
4. Documentation must verify the other component of progress, attendance.
Participants must participate 80% of the scheduled days.
D. Supervision
1. Daily supervision of an unpaid work activity consists of a responsible party
who is aware of the participant’s daily activities. Daily supervision does not
necessarily mean daily in person contact.
2. Faculty, instructors, instructional aides, lab supervisors, study hall
supervisors, and supervisors of work-based learning activities provide daily
supervision for the hours of education.
3. The responsible party must sign documentation related to attendance; the
participant’s statement is not acceptable. The exception to this is for teen
parents, who are supervised in the classroom by educators.
106.2 Education Directly Related to Employment (BER)
A. BER includes education related to a specific occupation, job or job offer. This
includes:
1. Courses designed to provide the knowledge and skills for specific work
settings
2. Adult basic education or ESL, and for activities that prepare participants for
employment requiring a high school education
3. Immigrants may have the equivalent of a high school diploma from their
native country but the diploma is not comparable with an American high
school diploma or can not be verified to be comparable.
•

Determine on a case by case basis whether an immigrant should
participate in this activity.

4. GED class
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5. Education related to a specific occupation, job or job offer
B. Important Note: Individuals in a BER activity must not have received a high
school diploma or a GED.
C. Hours spent by a person in this type of activity are only countable toward the
WPR after the person has participated for 20 hours per week in one of the core
work activities (activity categories numbered 1 through 9 above).
D. Teen HOH or teen spouses who participate in this activity are considered
countable participants, without first having participated in a core work activity.
E. Countable hours of participation
1. The number of hours verified as spent in BER is the number of hours
countable for the activity.
2. BER includes monitored and documented study sessions. Actual hours spent
in class as well as time spent performing clinical requirements, lab work
fieldwork, student teaching that are required for approved BER programs are
considered to be a part of the primary activity for which they are required and
are countable.
•

Review the curriculum with the student to determine if all of the hours are
actually BER hours or can the hours be considered WEX, WEM or OJT
hours.

3. Time spent on unsupervised homework assignments count for up to one hour
of home work time for each hour of class time.
F. Verification
1. Documentation for BER and other unpaid work activities must reflect the
actual hours of attendance for each day of each week in the reporting period.
2. Documentation could include, but is not limited to, time sheets, service
provider attendance records on a biweekly or monthly basis or a signed and
dated statement from the BER site supervisor.
3. A responsible party who may sign the documentation includes faculty,
instructors, instructional aides, lab supervisors, study hall supervisors, and
supervisors of work-based learning activities.
G. Supervision

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1. Daily supervision of an unpaid work activity consists of a responsible party
who is aware of the participant’s daily activities but may not have daily in
person contact.
2. The responsible party must sign documentation related to attendance; the
participant’s statement is not acceptable.
3. The local department case manager provides overall supervision and
monitoring of participant progress and compliance.
106.3 Job Skills Training Directly Related to Employment (IST)
A. IST includes, training or education for job skills required by an employer to
provide an individual with the ability to obtain employment or to advance or adapt
to the changing demands of the work place.
B. Job skills training directly related to employment must be supervised daily.
C. IST may include literacy or language instruction when the instruction is explicitly
focused on skills needed for employment or combined in a unified whole with the
job training.
D. Countable hours of participation
1. Hours spent by a person in this type of activity are only countable toward the
WPR after the person has participated for 20 hours per week in one of the
core work activities (activity categories numbered 1 through 9 above).
• As with other programs, review the skills training requirements to determine if
portion of the training can be considered a countable activity in another
category.
• Job skills sometimes require activities that could be determined to meet the
definition of WEX or OJT.
2. The number of hours verified as spent in IST is the number of hours
countable for the activity.
3. IST includes monitored and documented study sessions. Time spent on
unsupervised homework assignments is countable up to one hour for each
hour of class time.
E. Verification
1. Documentation for IST and other unpaid work activities must reflect the actual
hours of attendance for each week in the reporting period. IST providers and
program participants report actual hours of participation on time sheets or
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activity logs that report hours of participation for every day of every week in
each month.
2. Documentation could include, but is not limited to, time sheets, service
provider attendance records on a biweekly or monthly basis or a signed and
dated statement from the IST site supervisor.
F. Supervision
1. Daily supervision of an unpaid work activity consists of a responsible party
who is aware of the participant’s daily activities.
2. A responsible party who may sign the documentation includes faculty,
instructors, instructional aides, lab supervisors, study hall supervisors, and
supervisors of work-based learning activities.
3. The responsible party must sign documentation related to attendance; the
participant’s statement is not acceptable.
4. The local department case manager provides overall supervision and
monitoring of participant progress and compliance.

107 VERIFICATION OF WORK ACTIVITIES – IN GENERAL
A. Participants in work activities or Employment and Training service providers must
submit periodic (weekly, bi-weekly or monthly) verification of hourly attendance
for each work activity.
1. Accept attendance verification on:
a.
b.
c.
d.

Locally designed attendance tracking forms,
Employer letterhead or pay stubs,
Service provider letterhead or forms, or
The DHR 1391-A (Time and Attendance form).

2. The documentation must clearly support the hours entered on
the WORKS attendance screen that indicates the customer is
engaged in the assigned work activities for the month.
•

WORKS does not verify information. It only holds the
information that has been data entered. What is in WORKS
must be verified and must match the documentation in the
case record.

B. For customers engaged in federally defined work activities:
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1. The LDSS must make a “reasonable effort” to obtain written
documentation.
2. “Reasonable effort” means the LDSS or their vendors attempted to obtain
written evidence from a “reliable source” that the customer actually
participated for the number of hours of attendance recorded in WORKS.
3. “Reliable source” means someone other than the customer or his/her
immediate family whom the local department believes to be truthful.
4. If documentation of the customer’s attendance in the work activity is
not available and attempts to verify the attendance in other ways
cannot clearly demonstrate that the customer participated in the
activity that month, do not enter any attendance in WORKS.
Example:
Ms. Rogers has been assigned to the local community college for
vocational education and work experience. She is required to
participate in 20 hours of classroom instruction each week and 20 hours
of work experience. As part of their contract with DSS, the community
college keeps records of attendance for the classroom instruction and
has sign-in sheets for the work experience activity. Each month the
community college provides those documents to the local department.
A copy of the records for Ms. Rogers is maintained in her file by the
community college, local department, or both.
Example:
Mrs. Baxter is needed in the home to care for her disabled husband.
The local department has a current DHR/FIA 500 medical for the
husband and a statement from his doctor that Mrs. Baxter is needed in
the home to care for him. Mrs. Baxter provides a signed and dated
monthly statement that indicates the hours spent providing care to Mr.
Baxter during the month.
C. For customers engaged in State defined work activities:
1. The LDSS must make a “reasonable effort” to obtain written
documentation.
2. The term “reasonable effort” means that the LDSS or their vendors
attempted to obtain written evidence from the customer or other
knowledgeable person that the customer participated in the
designated state defined activity, consistent with their Family
Independence Plan, in the month.

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3. The documentation must clearly indicate that the customer was
engaged in an activity: otherwise,
4. Follow appropriate conciliation and sanction procedures.
Example:
Ms. Jones has a torn Achilles tendon and provided a DHR/FIA 500 medical
statement showing the length of her disability to be less than 12 months. The
LDSS determines that Ms. Jones is in compliance with her Family
Independence Plan for the specified time period by receiving necessary
medical treatment. Ms. Jones submits a signed and dated monthly statement
indicating that she is attending her scheduled doctor appointments, going to
physical therapy and taking her medications. For universal engagement
purposes Ms. Jones is coded in wellness rehabilitation. (OTM/OTD)

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108 GUIDELINES ON ACCEPTABLE VERIFICATION
Level of
Acceptability

Preferred

Source of Documentation

Reliable person who supervises
or oversees the activities of the
customer.

Reliable person who has
knowledge of the customer’s
attendance, excluding family
members.
Acceptable

Not
Acceptable

Customer’s word or statement for
activities in which supervision of
the customer’s attendance is not
possible.

Customer’s word or statements
from members of the
customer’s family (except for
individual Job Search or other
activities in which supervision of
the customer’s attendance is
not possible).

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Examples of Documentation
Signed statement of attendance from
employer/supervisor; pay stubs; daily/weekly
attendance sheets that are signed by both the
customer and a supervisor. A copy of the signed
and dated conciliation letter for customers in an
OTC WORKS activity code. WORK NUMBER
screens showing pay and # of hours worked.

Signed and dated written summaries of a
conversation between a staff member and the
supervisor of the customer’s activities, or other
reliable person; signed and dated statement from
customer for individual Job Search or other
activities in which the customer is not being
directly supervised. WORK NUMBER screens
showing pay and # of hours worked.

Copies of the WORKS Attendance Screen, unsigned
documents and documents that are undated or
dated for periods other than the report period.

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108.1 Attendance
A. At least monthly, the LDSS must enter work activity and attendance information
into WORKS for every customer engaged in one or more of the federally defined
activities. Attendance data must be recorded in WORKS no later than the last
day of the following month.
B. Attendance documentation must reflect actual daily attendance for each week in
the month, except for unsubsidized employment where weekly or bi-weekly pay
stubs showing total hours worked are acceptable.
C. The weeks in the month begin with the first Monday in the month and include all
Mondays in that month.
D. Example: June 2014 includes five weeks with the first week (the first Monday)
beginning on June 2 and the last week beginning on June 30th
and ending on July 4rd.
E. Participants in work programs are to be credited with hours of attendance equal
to the normal daily maximum hours for the program for days in which the service
provider or employer is closed:
•

Due to a holiday, inclement weather, or

•

For days the participant is engaged in jury duty.

F. Participants engaged in programs through a community college or other
educational institution cannot be given credit for attendance during any breaks
(e.g. Spring Break) or any period lasting more than 2 days in a week.
G. Participants engaged in Vocational Education, Secondary Education/GED or
Education, directly related to employment, may be given credit for hours of
participation in classroom activities. Homework credit may be given for up to
one hour of homework time for each hour of class time according to the
standards set by the educational institution.
Example: A college states that the “rule of thumb: is 1 hour of homework for each hour
of class time. Allow the customer I hour of homework time per hour of class time.
H. Attendance information is captured on the WORKS Attendance Screen.
•

Enter the customer’s social security number on the Customer’s Search Page
and press enter or click the Search Customer button. The Search Results
Page displays basic information on the customer.

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•

Once you select the appropriate program i.e. TCA, TCA Diverted, Food
Supplement Program, NPEP, the left navigation bar expands.

•

Select Attendance from the left navigation bar and the Attendance Screen will
open and display activity codes with the service providers.

•

Enter the actual attendance hours for each activity, for each week based on
the documentation.

•

Totals will automatically display at the bottom of each column for each week
and monthly totals are displayed to the right.

•

After entering all attendance information, press the submit button and you will
see Database Update Successful.

•

Select another function from the left navigation bar to leave the Attendance
Screen and continue working in WORKS or log out.

•

Run the WORKS Missing Attendance Report to identify customers recorded
in WORKS, as engaged, but for whom there has been no attendance
entered for the report period.


This is a helpful management tool that will assist local departments in
meeting the data entry requirement.

109 FAIR LABOR STANDARDS ACT (FLSA)
109.1 Determining if the Work Program is Employment or Training.
Local departments should review each of their work programs to determine whether
the program is employment or training and ensure the program meets the
requirements associated with each. The key in determining whether a placement
meets the definition of employment, rather than training, is who benefits the most
from the placement (refer to the activity review sheet in the appendix.) FLSA is based on
hours per week. Participants may not exceed the FLSA hours allowed per week.
A. When the employer benefits more than the customer:
1. The activity is considered employment, and
2. FLSA minimum wage provisions apply.
B. When the customer benefits more than the employer:
1. The placement is considered to be training, and
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2. FLSA provisions do not apply, and
3. Placement in such activities is limited to a period of 90 days or less.
C. Bona fide trainee and internship placements are not subject to FLSA. A
trainee or intern is not considered an employee if all the following factors are met:
1. The training offered is similar to that provided in a vocational school, although
training may include operations of the employer’s facility.
2. Training is for the benefit of the trainee or intern.
3. The trainee or intern does not displace regular employees, and works under
close observation.
4. The trainee or intern’s activities provide no immediate advantage to the
employer and may actually hinder operations.
5. Trainees or interns are not necessarily entitled to a job upon completion of the
trainee or internship assignment.
6. Both the employer and the trainee or intern understands that the trainee or
intern is not entitled to wages for the time spent as a trainee or intern.
7. The length of time a trainee or intern can stay in any particular assignment is
limited to a period of 90 days or less.
D. All placements that do not meet the federal definition of training are considered
employment and FLSA minimum wage standards apply.
1. An example is Work Experience (WEX)
a. The participant receives knowledge and skills in an actual work setting.
b. The employer receives more of a benefit because he receives the
customer's labor.
c. Since the employer receives more benefit, the participant is considered to
be working and federal Fair Labor Standards Act (FLSA) requirements
apply.
d. The monthly combined TCA and FS grant for the household must equal or
exceed the monthly federal minimum wage.

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2. Work placements are not time limited. DHR suggests a review of these
assignments every six months to ensure the participant is making satisfactory
progress towards self-sufficiency and have not become a fill in work force for
the employer.
E. Local department autonomy in designing employability strategies has created
activities variously described as trainee or internship programs.
1. Each local department must ensure that their trainee and/or internship
programs meet the federal definition of training.
2. Local departments must limit the length of these programs to 90 days or less.
3. At the end of the 90-day period, the trainee or intern must be reassigned if the
placement is to continue as training.
4. This subsequent assignment may include another position at the same
employer.
Example: Mary Green is a trainee at a local hospital in the medical records
department. Her 90-day assignment is now ending. Both Mary and her case manager
believe that while it has been a beneficial placement she still requires additional training.
The hospital has another trainee position in one of the clinics. Mary could be referred to
this second placement in the hospital because it is not the same job and offers
additional training in a different department. (Conversely, extending Mary’s assignment
in the medical records department past 90 days would be considered employment and
FLSA rules would then apply).
109.2 FLSA Minimum Wage Provision
•

FLSA does not mean that the employer must pay the customer a salary since the
TCA and Food Supplement Program (FSP) benefits a family receives counts
towards the minimum wage requirement. In many instances, the combined
monthly TCA and FSP amount meets or exceeds the monthly minimum wage
used in assigning actual work hours. Local departments must complete a
minimum wage calculation for all customers assigned to Work Experience. (Refer
to the calculation sheet in the appendix.)

Examples.
The first example uses 30 hour per week activities to determine if FSLA standards are
met. Regardless of the number of hours in the activity, the calculation must be
completed to determine if the combined TCA and FSP grant equals or exceed the
Monthly Minimum Wage.
30 hrs. per week x $8.00 hourly minimum wage = $240.00 per week
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$240.00 x 4.3= $1032 (monthly minimum wage)
Customers whose TCA and FSP do not equal $1032 per month may not be assigned a
WEX or Community Service activity that is considered work for more than 30 hrs per
week.
To determine the number of hours a customer may participate in an activity considered
work divide the total of the TCA and FSP by the minimum wage. A customer may work
that monthly total. Divide that amount by 4.3 to obtain the weekly number of hours.
Example 1: A single parent with 2 children under six years old: The parent is engaged
in a placement that meets the definition of employment for 24 hours per week and in job
skills training (IST) for 16 hours per week. Monthly combined TCA ($549.00) and Food
Supplement benefits ($408.00) is $957.00.
$957/$8.00 = 119 hours per month
119/4.3= 27 hours per week
The placement for the above customer meets FLSA requirements.
Example 2: A single parent with one child under six. The parent is engaged in a
placement that meets the definition of work. She is in the activity 20 hours per week.
Her TCA grant is $276.00 because she receives Social Security (survivor’s benefit) of
$100. Food Supplement benefits are $259.00 per month. The customer’s combined
TCA and FS amount is $535 per month.
$535 (TCA +FSP) /$8.00 = 66.8 hrs. per month
66.8 hrs /4.3 = 15.5 hrs per week.
(Remember the minimum wage changes again July 1, 2015 to $8.25 per hour)
The customer can not be assigned in an activity classified as work for more than 15.5
hours per week. Her hours in the WEX or WEM activity must to be reduced

110 SUBSTANCE ABUSE
110.1 Overview of substance abuse activity requirements
A. Certified addictions specialists must be on site in all LDSS to conduct substance
abuse screening, conduct or refer for customer assessment, refer drug felons for
testing, refer for treatment, and provide information case managers need to
determine eligibility for benefits.
B. Substance abuse treatment providers are required to report information
concerning TCA customers directly to addictions specialist.

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C. When a TCA customer is referred, on a waiting list or enrolled and actively
participating in a substance abuse treatment program, the treatment may be
considered a federally defined work activity for a maximum of four consecutive
weeks and for a total of six weeks in any federal fiscal year. The appropriate
activity code to use when documenting this activity is Substance Abuse
Treatment (JBT).
D. If the recipient fails to cooperate in the treatment program (as defined by the
Alcohol and Drug Abuse Administration), only an individual sanction may be
imposed.
E. When an individual sanction is imposed for substance abuse, the customer loses
the good cause for non-cooperation with work requirements. When the customer
is referred to Family Services and cooperates with Family Services, he or she is
meeting the work requirement, however the customer is still not in compliance
with substance abuse requirements.
F. Failure to cooperate with Family Services will require the customer to participate
in federally defined work activities other than JBT. Failure to participate in work
activities results in a full family sanction.
110.2 The Addictions Specialist:
A. Is the liaison between the Family Investment Program (FIP) case manager and
the substance abuse treatment provider for TCA customers referred to treatment.
B. Maintains ongoing contact with treatment providers who are required to report
certain information concerning the treatment status of TCA recipients.
C. Reports information needed to determine eligibility to the FIP case manager
concerning the customer's compliance with substance abuse requirements and
treatment protocols.
D. Makes referral for supportive services for customers who screen positive or self
identify for substance abuse.
E. Provides monthly reports to the Family Investment Administration (FIA) and the
Alcohol and Drug Abuse Administration (ADAA) on TCA substance abuse
treatment activity.
110.3 Referral to Addictions Specialist for screening/signature requirement
A. The FIP case manager:
1. Informs all TCA adults and minor parent applicants/recipients and all TCA
custodial parents convicted of a drug related felony about the FIP Substance
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Abuse Treatment and Services (SATS) requirements and the sanctions
imposed for failure to comply with screening and treatment.
2. After the application interview, refers the applicant or recipient to the on-site
addictions specialist for screening using the Screening Referral (DHR/FIA
1177) form.
♦ Completes the top portion of the form, providing as much demographic
information as possible and forwards to the addictions specialist.
B. The addictions specialist returns the 1177 to the FIP case manager, within 10
working days of the referral date, indicating the individual's compliance with
signature requirements, screening and/or assessment referral.
C. The FIP case manager:
1. Reviews the information on the 1177 returned by the addictions specialist.
2. Processes the TCA application or recertification within appropriate time
frames.
3. Uses appropriate CARES coding (see CARES Procedures) and
4. Certifies the case for 12 months, ,if all TCA eligibility requirements are met.
110.4 Redetermination or Interim Change
A. Only recipients who self identify or are identified by the case manager as needing
substance abuse services are referred to the addictions specialist.
B. Whenever an adult is added to the assistance unit or a minor in the unit becomes
a parent, refer the individual to the addictions specialist for signature
requirements, screening and assessment.
110.5 Screening and referral for assessment
A. Upon receipt of the 1177, the addictions specialist:
1. Interviews the individual,
2. Secures the individual's signature on the Consent For the Release of
Confidential Alcohol and Drug Treatment Information (DHR/FIA 1176)
when the substance abuse screen is positive, and
3. Screens the TCA adult or minor parent applicant or recipient for substance
abuse using instruments approved by the addiction’s agency.
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4. Notifies the FIP case manager using the middle section of the 1177 about:
a. The results of the substance abuse screening and referral for assessment,
or if
b. The TCA adult or minor parent / custodial parent convicted of a drug
related felony fails to sign the 1176, or
c. Fails to complete the screening or assessment,
d. Referral for drug testing
B. All adult and minor parents FIP applicants/recipients who screen positive are
required to sign the 1176 consent form authorizing the release of confidential
information.
C. The addictions specialist secures the TCA adult or minor parent's signature on
the 1176.
1. The addictions specialist gives the pink copy of the 1176 and 1177 to the FIP
case manager to be retained in the permanent section of the TCA case
record and retains the white copies of both forms in the addictions specialist’s
case file for the customer.
2. If necessary, the addictions specialist forwards a copy of the 1176 to an
assessor and
3. When appropriate, to treatment providers.
D. If the substance abuse screen is negative (#3 on 1177):
1. No further action concerning substance abuse treatment is required by the
addictions specialist or the FIP case manager.
2. Process the TCA application or recertification using appropriate CARES
coding (see CARES Procedures).
110.6 Compliance
When the case manager receives an 1177 or 1178 from the addictions specialist, the
case manager must review the information to determine if the customer is in compliance
with FIP substance abuse treatment requirements.
A. The 1177 indicate whether the individual has complied with the substance abuse
signature and screening requirements.

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B. An individual is in compliance if he or she completes the substance abuse screen
and signs the 1176 when screened positive, regardless of the results of the
screen (#3, 5, 6, 7, and 9).
C. The individual is not in compliance if the 1177 indicates he or she:
1. Screened positive and failed or refused to sign 1176 (#4), or
2. Failed or refused to appear for screening or assessment (#1, 2 and 8), or
3. If a custodial parent convicted of a drug related felony fails to complete the
drug test (#13).
D. The 1178 indicates that the individual:
1. Screened positive for substance abuse,
2. Was referred for a comprehensive assessment, drug testing, and/or treatment
services, and
3. Provides ongoing information concerning the individual's compliance with the
recommended treatment protocol.
4. If the individual is in compliance, eligibility for TCA is continued as long as the
individual meets other TCA eligibility requirements.
5. The addictions specialist gives the pink copy of the 1178 to the case manager
with the assessor/treatment provider’s findings.
E. The individual is considered in compliance if the 1178 indicates that the:
1. Results of the comprehensive assessment indicate no need for treatment,
2. Individual is awaiting availability of a treatment vacancy,
3. Individual is enrolled in a treatment program,
4. Individual has successfully completed the treatment program, or
5. Individual was referred to a new program.
F. The individual is considered not in compliance if the 1178 indicates that he or
she:
1. Failed to keep appointment for comprehensive assessment, treatment
referral, drug test or enrollment,
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2. Is not maintaining active attendance/participation, or
3. Was discharged from a treatment program for non-compliance.
G. If the customer’s substance abuse screen is positive or the customer
acknowledges a substance abuse problem:
1. The addictions specialist also requests a copy of the customer’s Family
Independence Plan from the case manager.
2. This becomes a permanent part of the addictions specialist's record.
110.7 Work Requirements
A. TCA customers who participate in substance abuse treatment programs are,
potentially countable in the monthly calculation of the federal work participation
rate.
B. To be countable for a particular month, the customer must:
1. Attend treatment as required.
2. Attend as the only activity for the required number of hours (20 hours per
week if they have a child under 6) or in combination with other federally
defined work activities for the required number of hours per week.
C. State regulations cite participation in a residential treatment program as
potentially being “Good Cause” for not participating in other federally defined
work activities.
D. Individuals receiving substance abuse treatment on an outpatient basis may, and
often should, participate in federally defined work activities other than JBT. The
addictions specialist, after consultation with the treatment provider, notifies the
TCA case manager regarding an individual’s ability to participate in other
federally defined work activities.
E. The addictions specialist, after consultation with the treatment provider, advises
the case manager when the addictions specialist believes the customer is able to
work or participate in job readiness/training/ education.
F. After the consultation with the addictions specialist the case manager makes the
final decision on referring the customer to a work activity.
G. Many substance abusers have secondary medical conditions including but not
limited to: mental health issues, hepatitis, and HIV. Follow up to see if the

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customer should be granted good cause or an exemption because of a medical
condition or if the customer is disabled 12 months or more.
•

Code CARES and WORKS appropriately based on the good cause or
exemption status allowed by the underlying medical condition and not the
substance abuse. Save the limited JBT hours or include them if needed to
make the customer countable.

H. The addictions specialist and the FIP case manager work together with the
customer to ensure that the individual's Independence Plan is consistent with the
recommended substance abuse treatment plan.
I. Participating in substance abuse treatment is countable as a federally defined
work activity for the purposes of work participation for no more than four
consecutive weeks or a total 120 hours during each federal fiscal year.
•

Participating in substance abuse treatment is countable as a State defined
activity (OBT) for the purposes of Universal Engagement. There is no time
limit on the length of OBT participation.

J. When the 1177 indicates the individual screened positive, acknowledged a
substance abuse problem, or is currently in treatment at application, the case
manager does not refer the customer for up-front job search or work readiness
activities. The addictions specialist, after consultation with the treatment
provider, will advise the case manager via the 1178 of the individuals’ ability to
work and whether he or she can participate in work readiness activities.
•

After the consultation with the addictions specialist the case manager makes
the final decision on referring the customer to job readiness activities.

K. When a treatment provider indicates an individual is not able to work or has not
assessed the individual's job readiness, and the individual fails to comply with
substance abuse treatment requirements, follow the established substance
abuse conciliation and sanction procedures.
•

Register the customer in treatment for substance abuse in WORKS as JBT.

•

Register a customer who has been referred for treatment and is beyond their
4 consecutive or 6 total weeks in WORKS as OTS.

110.8 Supportive Services
A. When there is a positive assessment for substance abuse, the addictions
specialist makes referrals:

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1. For supportive services needed to enter treatment such as, transportation,
childcare, or other wraparound services.
2. To the Family Services unit if the customer is non-compliant.
B. The addictions specialist indicates on the referral that the customer has a
substance abuse problem and may need preventive services and interventions
for the difficulties intrinsic to families of substance abusers.
C. The addictions specialist or the case manager notifies the Family Services unit
when the customer fails to comply with treatment.
110.9 Social Services Referrals
A. Referrals to Family Services are initiated by the addictions specialist or the case
manager via the DHR/FIA 461 “Referral for Services” form when:
1. The substance abuse screen is positive
2. The case manager has begun the conciliation process or has sanctioned the
recipient for non-compliance with SATS requirements, or
3. The family requests Family Service s intervention.
B. The addictions specialist or the case manager completes Section I and II of the
DHR/FIA 461 indicating:
1. Case information
2. Who is being referred
3. The reason for the referral (In comments section#11, indicate the customer is
being referred because they are in need of substance abuse treatment.)
C. FIA case manager or the addictions specialist:
1. Maintains a copy of the DHR/FIA 461 in their case record when referring the
customer for Family Services.
2. Does not refer the individual to work activities if the sanctioned individual
accepts Family Services intervention
3. Refers the individual to the appropriate work program or work activity if the
sanctioned individual does not accept the referral to Family Services, and
4. Follows procedures for notification, conciliation, and full family sanction for
failure to meet work requirements if the individual fails to comply with the work
referral or work activity.
D. The Child Welfare Screener completes Section III of the DHR/FIA 461 indicating
1. Whether the customer has an active Child Welfare or Family Services case.

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2. Forwards a copy of the DHR/FIA 461 to the appropriate Child Welfare case
manager if the individual has an active services case.
3. Follows existing LDSS procedures to coordinate a team meeting between the
customer, FIA, Child Welfare and the addictions specialist to develop goals
for the Independence Plan.
4. Forwards the DHR/FIA 461 to the Child Welfare Voluntary Services
component, Family Services Intake unit for review and disposition if the
individual does not have an active services case.
5. Returns the DHR/FIA 461 to the FIA case manager or the addictions
specialist within 10 days of the referral.
110.10 Employment
A. When the FIA case manager has information that a customer who is currently in
or has completed substance abuse treatment has become employed , the case
manager :
1. Notifies the addictions specialist of the individual’s employment via the #1177
in block 11 indicating:
•
•
•

Date employment began
Name of employer
Address of employer

2. Retains the pink copy of the #1177 in the case record
B. When employment information is reported to the addictions specialist he or she:
1. Reminds the customer that he or she is required to notify the FIA case
manager of the employment
2. Reminds the individual about personal responsibility and about the benefits of
reporting:
• Employment must be reported within 10 days of the first paycheck
• The 60 month clock stops when the individual is employed
3. Notes employment information in the SATS case record if the customer is still
active with SATS
4. Records the number of customers who are in treatment or who have
completed treatment and are employed on the ADAA/FIA SATS report.
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110.11 Non-Compliance with substance abuse policy requirements
A. When an applicant is non-compliant:
1. If the individual is an adult or minor parent who is head of household, deny
the TCA application.
2. If two parents are in the household and one or both parents fails to comply,
deny the TCA application.
3. If the individual is a minor parent who is not the head of household, process
the application, but do not include the minor parent’s needs in the TCA
assistance unit. Include the minor parent’s child.
B. Procedures for Processing Non-Compliant Individuals Being Added to TCA
Assistance Units
1. Individuals being added to TCA assistance units at interim change or
recertification are to be treated as applicants and are not subject to
sanctioning procedures since they have not received cash benefits. This
provision remains consistent with substance abuse regulations governing
TCA eligibility requirements at application.
2. Any mandatory applicant being added to a TCA household who refuses to
comply with the substance abuse treatment and services (SATS)
requirements; completing the screening requirement, signing the 1176 when
the substance abuse screen is positive, or completing the drug-testing
component, is ineligible for TCA and will be denied.
•

To calculate the earned income of an ineligible parent use either TCA
Calculation Worksheet (DHR FIA 428) form to determine the countable net
income. Make sure that you allow all disregards and the case record must
include the calculation work sheet.

3. Count the unearned income of the ineligible parent, as it is actually received.
4. Follow these steps to calculate the countable net income amount when the
ineligible parent has earnings:
•

Apply the 20% disregard (initial needs test) that is applied to all new
applicants with earned income , allowing all disregards

•

Apply the 40% gross income test when the customer passes the initial
needs test.

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EXAMPLE 1:
Carrie is a 17-year-old, applying for TCA for herself and her one-year-old son. She lives
with a non-relative friend since her parents moved out of town and left her. Carrie
attends the screening with the addictions specialist. The substance abuse screen is
positive but when asked to sign the 1176 consent form, she refuses. Carrie says that
she is not signing the form, she does not have an alcohol or drug problem, and does not
see why signing that form is part of what she has to do to get benefits. The addictions
specialist notifies the case manager via the 1177 that Carrie failed to sign the 1176. If
Carrie does not comply by the end of the 30th day of the application, deny the TCA
application. Her applications for food stamps and Medical Assistance must be
processed.
EXAMPLE 2:
Mr. and Mrs. Carson are applying for TCA for themselves and two children. After the
interview with the case manager, both adults are referred to the addictions specialist
using 1177s. Mr. Carson completes the screening with the addictions specialist and the
screen was negative. However, Mrs. Carson leaves after the interview with the case
manager and tells her husband she is "not going to any screening for substance abuse."
After ten days, the addictions specialist returns both 1177's to the case manager.
Although Mr. Carson completed the screening and his screen was negative, Mrs.
Carson's 1177 indicate that she failed to appear for screening. (Mrs. Carson has until
the end of the 30th day of the application to comply). If Mrs. Carson fails to comply by
the end of the 30th day, deny the TCA application. The food stamps and Medical
Assistance applications must be processed.
NOTE: In a two-parent household, if one or both parents refuse to comply with the
screening requirement the entire household is ineligible at application.
B. When a recipient is non-compliant:
1. The case manager sends a Notice of Non-compliance to the individual.
2. The case manager refers the individual to Family Services.
3. If the customer continues to be non-compliant, the case manager begins
conciliation procedures and after the 30-day conciliation period and
appropriate adverse action, sanctions the individual as the result of
information received from the addictions specialist.
4. The case manager informs the addictions specialist the customer is in
conciliation using the 1178.

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♦ During the conciliation and sanctioning process, the case manager and
the addictions specialist attempt to get the non-compliant individual to
comply.
♦ An individual sanction is imposed for failing to comply with FIP substance
abuse treatment requirements by removing the non-compliant individual's
needs from the TCA grant.
110.12 Individual Sanctions
A. When an individual refuses to participate or fails to comply with the FIP
substance abuse treatment requirements, the case manager must send
appropriate notice and follow the conciliation procedures.
B. The case manager or the addictions specialist refers the customer to the Family
Services Unit. If the customer cooperates with the Family Services Unit, he or
she is in compliance with work requirements but remains in non-compliance with
substance abuse requirements.
C. If the individual fails to comply after 30 days, the individual’s needs (difference
between the grant amount with the customer included and without the customer)
are removed from the grant.
EXAMPLE:
The Johnson’s are receiving TCA for themselves and 2 children. Mr. Johnson kept his
appointment for a comprehensive assessment in February and was referred to an
outpatient counseling program. The addictions specialist provided an 1178 to the case
manager in February confirming that Mr. Johnson was enrolled in the treatment
program but was not able to work.
April 18:

The addictions specialist gives the case manager an 1178 indicating that
Mr. Johnson was discharged from his treatment program for not
maintaining active participation. The addictions specialist notifies the
Family Service Unit that Mr. Johnson has failed to comply with substance
abuse treatment.

April 20:

The case manager sends a notice of non-compliance and begins the 30
day conciliation period. (This is his one-time-only conciliation for
Substance Abuse Treatment and Services requirements.)

April 27:

The case manager calls to try to persuade Mr. Johnson to return to the
program. The case manager talks with Mrs. Johnson who says she has
tried but cannot get her husband to return to the program. She says he
has been taking her money, making it difficult to pay rent and purchase
needed items for the children. In addition, since her husband returned to

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the home, her son has been having problems in school and is currently on
disciplinary removal for fighting. Mrs. Johnson says she is trying her best
to complete her work-training program and needs help with holding her
family together, especially in dealing with her son, until she completes the
training and gets employment.
May 9:

The Family Service case manager contacts the Johnson’s. Mr. Johnson
agrees to work with the Family Service case manager in resolving family
issues and his non-compliance with the substance abuse requirement.

May 12:

Although Mr. Johnson is working with the Family Service case manager
he remains in non-compliance with the substance abuse requirement. A
NOAA is sent to Mrs. Johnson notifying her that her TCA grant will be
reduced effective June 1. Mr. Johnson is meeting the work requirement
because he is working with the Family Service Unit.

June 1:

Mr. Johnson’s needs are removed from the grant ($697- $576 = $121)
(October 2013). The TCA benefit is reduced to $576. The case manager
completes an 1178 to notify the addictions specialist of the sanction and
also informs the Family Service unit of Mrs. Johnson's request for help
with family support. Mrs. Johnson remains payee of the benefit.

NOTE: A substance abuse sanction is cured by compliance with the substance abuse
provision for which the sanction was imposed. The addictions specialist will notify the
case manager via the 1178 if the individual is in compliance with the provision for which
the sanction was imposed. Following the LDSS procedures the addictions specialist will
notify the Family Service Unit that the customer has complied. Benefits are resumed
(prorated) from the day after the customer complies.
See Appendix for MA and FS policy when there is a TCA substance abuse
sanction and CARES procedures.
111 VOLUNTARY QUIT AND REDUCTION OF EFFORT
111.1 General policy
A. TCA applicants and recipients, age 16 (not a parent and not in school) and older
may not voluntarily quit a job or reduce the number of hours they work without
good cause.
B. Applicants or recipients age 16–18, whose participation requirement is education,
are exempt from the voluntary quit/work reduction provision provided that the
individual is registered in and attending school.

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C. Children, age 16-17 not registered in school or attending 80% of the time, are
subject to PPI requirements.
D. To be considered a voluntary quit the following conditions must exist:
1. The job was 30 hours or more per week or provided weekly earnings at least
equivalent to the minimum wage ($7.25 effective July 24, 2009) multiplied by
30 hours;
2. The quit happened within 30 days prior to the application being filed or any
time after filing, up to the time an eligibility decision is made, or while the
assistance unit receives TCA benefits.
3. The quit was without good cause.
E. The reduction of work effort applies if:
1. Before the reduction, the individual was employed 30 hours or more per week
or received weekly earnings at least equivalent to the minimum wage ($7.25
per hour effective July 24, 2009) multiplied by 30 hours;
2. The reduction occurred within 30 days prior to the date the application was
filed or any time up to the date the eligibility decision is made, or the
assistance unit receives TCA; and
3. The reduction was voluntary and without good cause.
111.2 Good cause for quitting a job or reducing work hours
A. Good cause for quitting a job includes one or more of the following:
 Quitting a job to take a new job with another employer;
 Discrimination based on race, sex, disability, religious or sexual orientation;
 Breakdown in transportation arrangements when there is no other accessible
means of transportation;
 Breakdown in child care arrangements or lack of child care resources;
 Domestic violence or other family crisis that threatens normal family
functioning;
 Hazardous working conditions;
 Documented illness or incapacitation;
 Incarceration;
 Resignation at employer's request;
 Lack of supportive services identified in the Family Independence Plan and
agreed upon by the recipient and the local department; and
 Other circumstances determined to be good cause by the local department.

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B. Acceptable verification.
1. Accept the best available information to verify good cause.
2. Acceptable verification comes from a variety of sources.
3. Accept the customer’s statement when other verification is not available.
For example, it would be highly unlikely for an employer to acknowledge that
he discriminated against an employee. It may also be impossible for a
customer to verify family violence.
111.3 Applicants
A. Eligible adult head of the TCA Assistance unit.
1. If the work eligible adult head of the TCA assistance unit (or either or both
adults in a two-parent household), quits a job or reduces his or her work
hours, without good cause, within 30 days of filing an application for TCA or
from the time the application is filed and the eligibility decision is due, the
assistance unit is ineligible for TCA for 30 days following the quit.
2. The TCA application should be pended the day of the application and then
denied. Repend the application the day after the 30th day following the quit or
reduction of effort. Use the date of the day after the 30th day following the quit
or reduction of effort as the application date. Narrate CARES very clearly.
Example 1: Tamara Johnson quit her job at WAWA on December 31. The manager
would not give her the evening off and she wanted to go out with her friends. Ms.
Johnson applied for TCA on January 10 for herself and her 18-month-old child. The
case manager discusses the situation with Ms. Johnson and explains the voluntary quit
policy to her. The case manager advises Ms. Johnson that she is not eligible for TCA
until January 31. January 31 is the day after the 30th day following the quit.
Example 2: Margaret Green applied for TCA benefits on January 4. Ms. Green told the
case manager she quit her job because the employer wanted her to work more than 40
hours per week but would not pay her for the additional time. The case manager
determined the quit was for good cause and did not apply the voluntary quit penalty.
B. When the applicant individual is not the head of household, but is work eligible,
and has reduced his/her work hours or quit a job, the needs of the individual are
removed from the TCA benefit until the day after the 30th day following the quit or
reduction in work effort.

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111.4 Recipients
A. When a customer is working, update the Family Independence Plan (FI) to
include the employment and the requirement that the customer must maintain
employment or find equal subsequent employment if the customer quits the job.
1. When the FI plan has been updated properly, the customer’s failure to
maintain employment or work hours without good cause is non-compliance
with the Family Independence Plan.
2. The customer is not entitled to a conciliation period. Conciliation and sanction
policies do not apply to voluntary quit or reduction of effort penalties.
3. Contact the customer to determine whether good cause exists. If good cause
does not exist, send adverse action to the customer and take the following
action.
B. Close the TCA case for 30 days from the date of the quit or reduction of hours
when the head of the household or either parent in a two-parent household quits
a job or reduces work hours without good cause. The household must reapply.
C. Remove from the TCA grant the needs of an individual who is not the head of
household and is not a parent in a two-parent household. Do not remove the
individual from the grant because eligibility for Medical Assistance (MA)
continues. At the end of the 30-day penalty contact the household regarding any
changes prior to adding the individual back to the TCA benefit.
Example: Garrett and Sarah Washington applied for TCA for themselves and two
children on July 9. Mr. Washington quit his job on June 28. He knew he was going to
get fired because he was always late for work. The case manager discusses the
voluntary quit policy with Mr. and Mrs. Washington. Mr. Washington does not have
enough quarters of earnings to be eligible for unemployment. The case manager
determines the quit to be without good cause and advises the Washingtons that they
can reapply on July 29, the day after the 30th day following the quit
111.5 Closing the TCA assistance unit
A. Use CARES code 566 to close a TCA case when the head of household
recipient quits a job or reduces work hours without good cause while receiving
TCA.
B. Conciliation and sanction procedures do not apply for voluntary quit.
C. CARES lists COMAR citation 07.03.03.04 “You did not do what you needed to
do according to regulations” on the notice. Add customer specific free-form text
to explain why the TCA benefit is being closed and the 30-day penalty.
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EXAMPLES
Example 1: Martha Johnson sent in her case information form (CIF) on herself and her
three children for her TCA redetermination on April 17. Ms. Johnson
reported that her oldest child, Susan, who is 17, quit her job on March 28
because of an argument with her boss. Susan had previously quit school
and was mandatory for the work program. The case manager had updated
the Family Investment Plan identifying Susan’s job as her work activity.
Susan and her mother had both agreed to the Plan.
The local department determined that there was no good cause for Susan
quitting her job. Susan’s needs are removed from the TCA grant after 10
days adverse action.
Example 2: Steuart Hill has been receiving TCA for himself and his son. On March 25
Mr. Hill reported that his son quit his job at McDonald’s on February 18.
Mr. Hill’s son is age 17 and a senior in high school. He attends school
regularly. The voluntary quit penalty does not apply.
Example 3: Tanya Spring applied for TCA on May 10 for herself and her daughter. Ms.
Spring reported that she quit her job on April 27 because her supervisor
was harassing her. Ms Spring indicated she filed for unemployment (UI)
benefits on May 2. Unemployment denied her benefits indicating the
employer stated she quit her job. Ms. Spring filed an appeal. The case
manager inquired on MABS and verified UI status was under appeal
because Ms. Spring is disputing what the employer reported. Ms. Spring is
eligible for TCA (as long as she meets all other eligibility factors).
On June 20, the case manager follows up on a 745 alert. Ms. Spring lost
her UI appeal. Ms. Spring remains eligible for TCA (it is past 30 days after
she quit) and she is not required to pay back any of the TCA benefits she
received during May and June.
Example 4: Dorothy has received TCA for herself and 2 children for 2 years. Her
oldest son, Michael (age 17) quit school before graduating and started
working at the local grocery store. The case manager added the
requirement that Michael remain employed or return to school to the FIP
plan. On June 10, Dorothy reported that Michael quit his job. The case
manager determined the quit, which occurred on June 9, was without good
cause. Michael does not intend to return to school.
A Notice of Adverse Action was sent to Dorothy advising her that Michael’s
needs were being removed from the TCA for 30 days from the date of the
quit. Michael’s needs are removed from the grant until July 10th.

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The difference between the TCA for 3 people and the TCA for 2 people is
the amount that would be prorated for restoring Michael to the TCA after 30
days.
Note: See Appendix for CARES procedures for voluntary quit and reduction in
work hours.

Assessments
As we said on one of the first pages of this guide, an assessment:
•
•
•
•

Lays the ground work for customer success in becoming self-sufficient
Identifies customer skills and resources and potential skills and resources
Identifies existing and potential obstacles to customer success
It helps determine how long it will take the customer to reach his/her
goals.

Starting with a good assessment is the best way to help the family become selfsufficient and independent of TCA. A good assessment may help identify hidden
barriers that the customer has. The more that is known about the customer’s situation,
the able to provide appropriate referrals and work activity placements.
In addition to being a good start, an assessment is required by law from many different
aspects.
Temporary Assistance to Needy Families (TANF) law requires an assessment as does
the American’s with Disabilities Act (ADA) and in Maryland COMAR require an
assessment. In COMAR assistance units reaching 60 months have to be granted a
hardship extension if an assessment was not completed.
Let’s look at an example:
Mary Jones receives TCA for herself and her two children-ages 10 and 14. Ms. Jones
was referred to a work activity at a local hospital. She has been late 3 times in the last
week. She also missed two days in the last month. The case manager sent her a good
cause notice and started her 30 day conciliation period.
At the conciliation conference, Ms. Jones indicates she has a child who has problems at
school and is not receiving the help she needs. Ms. Jones indicated she has had to go
to her child’s school twice this week. In addition, Ms. Jones’ oldest child has diabetes
and has not been following her diet, resulting in some serious health issues for her. Her
daughter passed out several times and Ms. Jones had to stay with her until her
daughter was alert and active.
In general, the basic TCA/FSP interview would not have uncovered what was going on
in Ms. Jones’ household. It would seem reasonable for Ms. Jones to be referred to an
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activity and expect her to be successful. She doesn’t need child care. She can go to
her activity and the sooner, the better.
What might have an assessment uncovered?
By asking questions like the following, the case manager may have found out that Ms.
Jones’ family has serious issues that need to be addressed before she can be
successful in a work activity. The case manager could potentially refer Ms. Jones to
people or places that could help her and her children.
Other similar questions about the customer or the household help case managers and
other LDSS staff identify needed steps in the ground work for the customer’s success.
Do any of your children . . .
a
.
b
.
c
.
d
.
e
.
f
.
g
.

Have health problems?
Have behavioral problems?
Have special needs?
Experience frequent disciplinary problems at
school?
Miss school frequently?
Face suspension or expulsion from school?
Face charges, involvement with the juvenile
justice system, detention or on probation?

Are you the primary caregiver for an elderly, disabled or sick family member or friend?
REPORTS
WORKS
There are many reports in WORKS that are helpful to LDSS offices in tracking
customer’s and their activity participation. Reports such as the Missing Attendance and
TANF Countable Participants are two that will show you who is registered, how many
hours they are participating and if the data has been entered into the WORKS system.
A user ID and password are required for access. Reports can be downloaded into Excel
for further analysis.
Scorecard and At- a-Glance
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Each LDSS has specific goals set for their office based on economic conditions in their
jurisdiction, seasonal adjustments, caseload size and makeup, and previous work
program history. The Scorecard and At A Glance Reports issued monthly from FIA
central help LDSS offices track and monitor where they are as far as meeting their
monthly and annual goals such as Work Participation Rate (WPR), Ten Dollar an Hour
placements, and full time employment placements for customers. These reports are
developed using information from the University of Maryland School of Social Work
(SSW) data and placed in the PIRIMID folder of each LDSS. These reports are placed
on shared drive.
School of Social Work
In addition, to the Scorecard data, the SSW also develops numerous other reports that
are available on the SSW reporting website. Access is provided to specific individuals
and a Log In and password are required. These reports provided data on the core case
load break down, including the number of disabled people in the caseload, the number
of work eligibles, and those with a child under age 6 to name a few. Reports can be
downloaded into Excel for further analysis.
DataWatch
Datawatch provides access to numerous reports from applications received,
applications processed and cases closed to application compliance and numerous other
areas. Reports can be downloaded into Excel for further analysis.

Various Ad-Hoc Reports
Various Ad-Hoc or non production reports can be created in CARES, SSW, and
WORKS. A memo/ request has to be provided to FIA central CARES staff or to Vince
Kilduff requesting the report and stating what is needed, why the ad hoc is needed and
the dates the report is needed for. The report needs to indicate whether the report
should be in paper or electronic format and if electronic whether it should be in Excel
format.

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A P P E NDIX

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Appendix 1- How TCA Substance Abuse Sanctions affects Food Stamps and
Medical Assistance Eligibility
Appendix 2- CARES Procedures for when an Applicant or Recipient
Voluntarily Quits a Job or Reduces Work hours
Appendix 3-TCA Core Case Activities
Appendix 4- TCA NON-CORE CASE ACTIVITIES
Appendix 5-FLSA- Activity Review sheet
Appendix 6- FSLA Minimum Wage Calculation
FORMS
DHR/FIA 1176 (Revised 10/05)
Consent for the Release of Confidential Alcohol and Drug Treatment
Information
DHR/FIA 1177 (Revised 10/05)
Substance Abuse Screening Referral Form
DHR/FIA 1178 (Revised 10/05)
Substance Abuse Identification and Treatment Notification
Sample Assessment Form
DOMESTIC VIOLENCE SUPPLEMENT♠
♠
♠
♠

Introduction
Hidden Losses to the Workplace
Tips to Make The Work Place Safer
Danger Assessment

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Appendix 1

A. How TCA Substance Abuse Sanctions affects the Food Supplement Program
(FSP) and Medical Assistance Eligibility
1. FOOD SUPPLEMENT PROGRAM (for substance abuse sanction cases)
•

If the TCA application is denied and the family has also applied for the FSP,
process the FSP application and pay benefits to all eligible household
members based on any income received (TCA is not counted as phantom
income at application).

•

If the TCA benefit amount is reduced because of a substance abuse sanction,
base FSP benefits on the TCA income (phantom income) and any other
income received by members of the assistance unit prior to the sanction.

•

If the TCA case was closed due to non-compliance with the drug testing
provision and the customer subject to drug testing is also receiving food
stamps, the food stamp benefit will be reduced.

•

Customers are still subject to and must meet the FSP Employment and
Training (FSP-ET) requirements.

2. MEDICAL ASSISTANCE (for substance abuse sanction cases)
•

If the TCA application is denied, process the MA application for all members
of the assistance unit.

•

If the TCA application is processed but the substance abuse sanctioned
individual’s needs are not included in the TCA benefit assistance unit, the
sanctioned individual is included in the Medical Assistance with the TCA unit
members. (See CARES procedures for Individual Sanctions)

•

If a TCA case is sanctioned (closed), the MA will trickle to the appropriate
coverage group.

•

If an active TCA case has a substance abuse individual sanction imposed,
the FO1 MA coverage will continue for the sanctioned individual. (See
CARES procedures for Individual Sanctions)

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B. Cares Procedures for Cases With an Individual Affected by Substance Abuse
Treatment Provisions
To identify a case with an individual affected by the substance abuse treatment
provisions, enter on the individual’s DEM1 screen in the HOSPITAL field:

1.













SA1 - enrolled in a substance abuse treatment program
SA2 - awaiting available vacancy
SA3 - successfully completed treatment program
SA4 - failed to enroll in appropriate and available substance abuse treatment.
SA5 - failed to maintain active enrollment in appropriate and available
substance abuse treatment.
SA6 - failed/refused to complete the screening or comprehensive assessment
SA7 - results of screening/assessment indicate individual not in need of
substance abuse treatment
SA8 - failed/refused to sign consent form
SA9 - discharged for non-compliance
SA10 - referred to a new program
SA11- failed/ refused to comply with drug testing

Individual Sanctions

2.

a. If the non-compliant individual is also the head of household, add a third party
payee to the AREP screen for TCA with Rep Type P1 and issue an EBT card
to that person
b. The sanctioned customer remains active on the TCA STAT screen and
therefore will continue to receive F01 medical coverage provided the
customer continues to meet eligibility for the program.
REMINDER: For all TCA assistance units with an individual affected by the substance
abuse treatment provisions (including those who are in compliance), use the
appropriate recertification end date but create an alert to review every four months.
CARES Procedures for Implementing an Individual Sanction in TCA and
maintaining MA Benefits:

3.

•

When the customer has been determined non-compliant with substance abuse
requirements and the customer’s needs are removed from the grant, complete
the following procedures:
a. Enter on the non-compliant individual’s UINC screen the amount of the
sanction (the difference between the amount of the grant for the household
size with the sanctioned individual and without the sanctioned individual) as:

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b. OA (Other Countable, Cash Only) - The grant will then be in the correct
amount for the sanctioning and still allow medical coverage.
c. Enter OT for the verification amount and AC for the frequency.
3. CARES Procedures for FSP Benefit Calculations for Individual Sanctions
♦

To issue the correct FSP benefit to a household that has an individual being
sanctioned for non-compliance with substance abuse treatment and services
requirements use the following procedure:
a. On the UINC screen of the Head of Household enter the TCA benefit
amount (this is the difference between the grant amount for the household
with the sanctioned individual and the amount without the individual) as
phantom income using the code OF (other unearned income, FSP
countable only).
b. This will maintain the FSP allotment at the level prior to the sanction.

Note: If the sanctioned individual is also a drug felon and fails to comply with the drugtesting provision or SATS requirements, the food stamp benefit will be reduced.
4. Free Form Text
On the CARES CAFI screen, press PF13 and enter the additional lines of text and
COMAR citation:
According to Code of Maryland Regulations 07.03.03.09.
When a minor parent who is not the head of household does not sign the consent form,
we cannot pay TCA for that person.
Individual’s Name failed to sign the substance abuse consent form so your grant was
. You may contact the Family Services Unit for help.
reduced by $
OR
According to Code of Maryland Regulations 07.03.03.09.
When an adult or minor parent does not have a substance abuse screening or an
assessment, we cannot pay TCA for that person.
Individual’s Name failed to have a Screening and/or Assessment so your TCA grant
was reduced by $___. You may contact the Family Services Unit.
OR
According to Code of Maryland Regulations 07.03.03.09.
When an adult or minor parent does not enroll in appropriate and available substance
abuse treatment, we cannot pay TCA for that person.
Individual’s Name failed to enroll in treatment so your TCA grant was reduced by $____.
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You may contact the Family Services Unit.
OR
According to Code of Maryland Regulations 07.03.03.09.
When an adult or minor parent does not stay enrolled in appropriate and available
treatment, we cannot pay TCA for that person.
Individual’s Name failed to stay enrolled in treatment so your TCA grant was reduced by
$____. You may contact the Family Services Unit.
OR
According to Code of Maryland Regulations 07.03.03.09.
When an adult or minor parent does not stay enrolled in a substance abuse treatment
program, we cannot pay TCA for that person.
Individual’s Name was discharged from a treatment program for not keeping program
rules so your TCA grant was reduced by $____. You may contact the Family Services
Unit.
OR
According to Code of Maryland Regulations 07.03.03.09, when a custodial parent
convicted of a drug felony committed after August 22, 1996 fails to have a drug test we
cannot pay TCA for that person. Individual’s Name failed to have drug test so your TCA
grant was reduced by $____. You may contact Family Services Unit for help.

OR
According to Code of Maryland Regulations 07.03.03.09, Individual’s Name was
convicted of a drug felony after July 1, 2000 and cannot get TCA through MMYY.

5. CARES WORK SCREEN
For individuals receiving substance abuse treatment enter the following information on
the WORK screen:
♦

If the individual is receiving Food Supplement benefits alone:
Under FSP in the Registration Status field enter EX and in the Exempt
Reason field enter DA (Drug/Alcohol Treatment).

6. WORKS

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Following are some guidelines for properly documenting TCA substance abuse
treatment in WORKS:
Activity Code – On the Add Activity Screen (DHR Form 1391), create a new Activity
File record identified with the Activity Code JBT. This Activity Code is a variation of
Activity Code JBS and has been created to separately identify drug abuse treatment
from other types of activities categorized as job search or job readiness assistance.
The remainder of this Activity File record should be completed following the guideline in
the WORKS Manual.

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Appendix 2

CARES Procedures for when an Applicant or Recipient Voluntarily Quits a Job or
Reduces Work hours
A. Denying the TCA application
Use CARES code 566 to deny a TCA application when the head of household applicant
quit a job without good cause within 30 days prior to the TCA application date or
eligibility decision date.
CARES lists COMAR citation 07.03.03.04: “You did not do what you needed to do
according to regulations” on the notice. Add customer specific free-form text to explain
why the application is being denied.
B. Reducing the assistance unit because of individual non-compliance
Reduce the TCA grant because of the non-compliant actions of an individual in the
household who is not the head of household.
1. Reduce the grant amount by the difference between the grant for the full
household size and the grant for the household size without the sanctioned
individual.
a. Enter the difference between the grant for the full household size and the
grant for the household size without the sanctioned individual on the
sanctioned individual’s CARES unearned income (UINC) screen.
b. CARES will remove the individual’s needs from the TCA.
2. Do not remove the individual from the TCA household. The individual remains
part of the TCA assistance unit.
C. Restoring the individual after the 30 day penalty
The day after the 30th day from the voluntary quit or reduction of work hours without
good cause, the individual can be added back to the household.
Follow these CARES procedures to prorate the benefit when the needs of the noncompliant individual are added back to the grant.
1. Remove the unearned income that was previously added to the CARES UINC
screen as the individual’s needs in both the current month and the ongoing
month.

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2. That action creates an underpayment BEG in the current month. Remove the
underpayment BEG on the CAFI screen by coding it PA.
3. The amount that was removed from the CARES UINC screen is the amount that
is to be prorated when restoring the individual. Using the proration chart find the
amount equal to the individual’s needs that were removed from the UINC screen.
Follow the chart over to the day the individual is being restored to the TCA. That
is the prorated amount of the BEG that needs to be issued.
4. Go to the CARES Welcome Screen and enter: “R- Benefit Error”
5. Enter: “E-Add another BEG”
6. Create the BEG for the prorated amount.
7. The supervisor approves the BEG.

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Appendix 3

TCA CORE CASE ACTIVITIES
Activity

Revised Activity Definitions
10/01/08

Unsubsidized
Employment (WEJ)

Full or part time employment in the
public or private sector that is not
subsidized by TCA or any other public
program.

Subsidized private
Sector Employment
(WSU)

Employment in the private sector for
which the employer receives
a subsidy from TCA or other public
funds to offset some or all of the
wages and cost of employing a
recipient.
Employment in the public sector for
which the employer receives
a subsidy from TCA or other public
funds to offset some or all of the
wages and cost of employing a
recipient.
A work activity that provides an
individual with an opportunity to
acquire the general skills, training,
knowledge and work habits necessary
to obtain employment. The purpose
of work experience is to improve the
employability of those who cannot find
unsubsidized employment.
Participants continue to receive TCA.

Subsidized public
sector employment
(WSP)

Work Experience
(WEX)

On-the-job-training
(OJT)

Revised November 2009

Training in the public or private sector
that is given to a paid employee while
he or she is engaged in productive
work that provides knowledge and
skills essential to the full and
adequate performance of the job.

Requirements
Specific to the
Activity
Customer has
countable earned
income.

Verification and
Supervision
Required
Use signed time sheets
or pay stubs to show
activity verification.
Use signed time sheets
or pay stubs to show
activity verification.

Grant Diversion
or P-10 funded

Fair Labor
Standards Act
(FLSA)

Not subject to
FLSA

Use signed time sheets
or pay stubs to show
activity verification.

Time sheets or activity
sheets, showing daily
activity and signed by
the supervisor or the
employer. Supervision
of the individual is
performed as part of the
normal workday by the
site supervisor,
employer, the vendor, or
the case manager.
Time sheets or activity
sheets. Supervision of
the individual is
performed as part of the
normal workday by the
site supervisor, the
vendor, or the case
manager.

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TCA CORE CASE ACTIVITIES
Activity

Job Search and Job
Readiness Assistance
(JBS) -

Community service
programs (WEM)

Vocational Educational
Training (BEV)

Child care for an
individual participating
in a community service
program (WEC)

Revised November 2009

Revised Activity Definitions
10/1/06

Requirements
Specific to the
Activity

The act of seeking or obtaining
employment, preparation to seek
or obtain employment, including
life skills training, and short-term
substance abuse treatment,
mental health treatment, or
rehabilitation activities for those
who are otherwise employable.
A qualified medical or mental
health professional must
determine that treatment or
therapy is necessary.

May only participate
for 4 consecutive
weeks and 120 hours
(child under 6) or 180
hrs. per federal fiscal
year to be countable
in the WPR.
Can only count
independent job
search if supervised
by an employment
specialist.

Time sheets or activity
sheets must show daily
time. Supervisor is
aware of daily activity.

TCA recipients perform work in
structured programs for the
direct benefit of the community
under the aid of public or
nonprofit organizations.
Community service programs
improve the employability of
recipients unable to obtain
employment.

Take into account
prior training,
experience, and skills
of a recipient in
making appropriate
community service
assignments.

Time sheets or sign
in/out sheets

Organized educational programs
directly related to the preparation
of individuals for employment in
current or emerging occupations
requiring training. Training must
be provided by an educational
organization. (e.g. VocationalTechnical School, Community
College, or proprietary school.)

Providing childcare to allow
another TCA recipient to
participate in a community
service program.

WEM is limited to
projects that serve a
useful community
purpose.
Is subject to FLSA.
Not to exceed 12
months (52 weeks) in
any individual’s
lifetime.
Must be provided by
education or training
organizations, such as
vocational –technical
schools, community
colleges, post
secondary education
institutions and
proprietary schools.
May only be childcare
for another TCA
recipient in a WEM
program.

Verification and
Supervision
Required

Supervision of the
individual is performed
as part of the normal
workday by the site
supervisor or the vendor,
or case manager.

Supervision of the
individual is performed
as part of the normal
workday by the site
supervisor, the vendor,
or the case manager.

Attendance records or
grading records showing
attendance.
Supervision of the
individual is through
vendor or case manager
contact.

Use log of hours care
was provided. May not
be used by one parent in
a 2 parent household.

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Appendix 4

TCA NON-CORE CASE ACTIVITIES
(Does not make the customer countable for work participation rate purposes
without 20 hours/week of core activities)
Activity

Job skills training
directly related to
Employment (IST)

Education directly
related to
Employment/ABE/
ESL (BER)

Satisfactory
attendance at
secondary school or
in a GED program
(BED)

Revised November 2009

Revised Activity
Definitions
10/1/08
Training or education for
job skills required by an
employer to provide an
individual with the ability
to obtain employment or
adapt to the changing
demands of the
workplace

Education related to a
specific occupation, job,
or job offer. When a
prerequisite for a job the
activity may include
education leading to a
high school diploma or
GED. Means education
related to specific job or
job offer.
May include immigrants
whose high school
diploma can not be
compared to a US
diploma.
Regular attendance in
accordance with the
requirements of the
secondary school leading
to a GED certificate.

Requirements
Specific to the
Activity
May be for a specific
occupation such as truck
driving, welding, nursing
assistance. May also be
for general training that
prepares and individual
for work.
Activities like ESL and
literacy training may be
included when the focus
of training is on the skills
the individual needs to
move to employment..
Adult education and
English as a second
language may be
included as long as they
are part of the normal
work-focused curriculum.

Verification and
Supervision
Required
Use attendance records
or report cards showing
attendance or sign in and
out sheet to verify
attendance and
supervision.

Use attendance records
or report cards showing
attendance or sign in and
out sheet to verify
attendance and
supervision.

Assessment or FIP must
document how job
related.

Recipients who have not
received a high school
diploma or equivalency.
May not include adult
education or ESl unless
they are linked to
attending the secondary
school.

Use attendance records,
report cards showing
attendance, or sign-inand-out sheet to verify
attendance and
supervision.

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Appendix 5

Activity Review for Determination of Training or Employment Status
To be completed by the WORK ACTIVITIES COORDINATOR
Date of Review: ________________________________________
Activity Title: __________________________________________
WORKS Activity Code___________________________________
According to the Wage and Hour Division of the U.S. Department of Labor, a trainee or
intern is not considered an employee, if all the following factors are met:
A. Training provided by the employer is similar to that offered in vocational schools.
Yes______

No______

B. Training benefits the trainee or intern more than the employer.
Yes______

No______

C. The trainee or intern does not displace any regular employee.
Yes_____

No______

D. The trainee or intern is under close observation.
Yes______

No______

E. The trainee or intern’s activities provide no immediate advantage to the employer and
may on occasion impede the operation of the business.
Yes______ No_______
F. The trainee or intern is not entitled to a job after training.
Yes______

No_____

G. The employer, trainee or intern all understand that trainees or interns are not entitled to
wages for any time spent in a trainee or internship activity.
Yes_____
No______
H. The trainee or internship activity is limited to ninety days or less.
Yes_____

No______

If the response is no to any statement, the activity is considered employment.

Employment: _____________________ (Fair Labor Standards Act provisions apply.)

Training:

_____________________ (May only be for 90 days or less)

Signature of Reviewer: ______________________________________
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Appendix 6

Minimum Wage Calculation for Employment Activities
For each customer in a federally defined work activity, the case manager responsible for the
work participation placement determines whether the TCA grant amount and FS benefit amount
equal or exceed the State minimum wage.

Participant’s name: ___________________________________________

Customer ID: ________________________________________________

Activity: ____________________________________________________

1. Number of Hours per week:

_______________

2. Multiplied by State minimum hourly wage:

x $8.00 as of January 1, 2015
$8.25 as of July 1, 2015

3. Equals Weekly Rate:

=_________________

4. Multiplied by 4.3 weeks per month:
5. Equals monthly State minimum wage:

x 4.3
__________________

6. TCA grant amount:

__________________

7. Plus FS grant amount:

+ _________________

8. Equals combined TCA and FS amounts

=_________________

I. Does the combined TCA and FS amount on line 8 equal or exceed the monthly
minimum wage on line 5?
Yes___
No___
If no, review participation hours for possible adjustment.
Reviewer’s Name: ___________________________
Date of calculation: __________________________
Revised November 2009

12

FORMS

CONSENT FOR THE RELEASE OF
CONFIDENTIAL ALCOHOL AND DRUG TREATMENT INFORMATION
by Substance Abuse Assessment and Treatment Providers to Departments of Social Services
Head of Household ____________________________ DSS Office ____________________________
MA#_______________________ AU ID#_______________________ SS#_______________________
I, ______________________________________________, authorize the substance abuse
assessment or
Print name

treatment provider that I am referred to for assessment or treatment, or that is treating
me, to report to the Department of Social Services (DSS) office named above the
information listed below, if it has this information about me:
•

That the substance abuse treatment provider has received my consent form and referral for treatment
from the Addictions Specialist;

•

That I did not keep an appointment for a comprehensive substance abuse assessment ordered by the
Addictions Specialist in the DSS office;

•

That a comprehensive substance abuse assessment indicates that I am not in need of substance
abuse treatment;

•

That I have been referred for substance abuse treatment;

•

That I did not schedule and appear for my first appointment for substance abuse treatment within 30
days of referral or as soon as I could get an appointment;

•

That I am waiting for room for me in the kind of substance abuse treatment program I was referred to;

•

That I am enrolled in a substance abuse treatment program;

•

That I am not maintaining active attendance or participation in the treatment program;

•

That I have been discharged from a treatment program for noncompliance;

•

That I successfully completed the substance abuse treatment that I was referred to;

•

That I was referred to another substance abuse treatment program, and the name of that program.

•

That I have been tested for drug use and results of the test. (FOR PERSONS CONVICTED OF A DRUG
FELONY)

This release is necessary to comply with State law which requires that this information has to be reported
to your local DSS office if you are going to receive Temporary Cash Assistance (TCA) benefits, and to
receive TCA and Food Stamps if you have been convicted of a drug felony.
I understand that my records are protected under the federal regulations governing Confidentiality
of Alcohol and Drug Abuse Patient Records, 42 CFR Part 2, and cannot be reported to anyone
without my written consent unless those regulations provide otherwise. I also understand that I
can cancel this consent at any time, but the cancellation will not apply to the past acts someone
who was covered by this consent at the time and relied on it; if I do cancel this consent, I could
lose my TCA or Food Stamp benefits. In any case, this consent will automatically be canceled
when my TCA and Food Stamp benefits end.
______________________________________________________________
________________________
Signature

Date

PROHIBITION OF REDISCLOSURE
This information has been disclosed to you from records protected by Federal confidentiality rules (42 CFR part
2). The federal rules prohibit any further disclosure of this information unless expressly permitted by the written
consent of the person to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization
for the release of medical or other information is not sufficient for this purpose. The Federal rules restrict any use
of the information to criminally investigate or prosecute any alcohol or drug abuse treatment patient.

SUBSTANCE ABUSE
SCREENING REFERRAL FORM
Date ____________________
DSS Office __________________________________________

MA No. __________________

Head of Household __________________________________

AU No. ___________________

Applicant/Recipient Name _____________________________

SS No. ____________________

Address ____________________________________________ Telephone No. (
_________________________ Zip ___________

)

-

)

-

. Drug Felon

DOB _______________ MCO (if applicable) _________________________________
LDSS Case Manager _________________________________ Telephone No. (
Addiction Specialist Completes
1. 
2 
3. 
4. 
5. 
6. 
7. 

Customer failed to appear for screening.
Customer refused to be screened and/or assessed.
Customer’s screen was negative.
Customer failed to sign 1176 when substance abuse screen was positive.
Customer’s screen was positive. (Forward Independence Plan to Addiction Specialist)
Customer acknowledged a substance abuse problem. (Forward Independence Plan to AS)
Customer referred for assessment/treatment to: ___________________________ on __________
(Name of Provider)
(Date)

8. 

Customer failed to appear for referred assessment/treatment by ___________________

9. 

Customer currently in treatment at __________________________________________

( Date)

Verified by ____________________________ (
(Contact person at provider)

)

-

_____________

(Telephone No.)

(Date)

10. 

Service Referral made on ______________

11. 

Comments: ____________________________________________________________________

(Date)

_____________________________________________________________________________________
For persons convicted of a drug felony
12. Referred for drug testing/assessment to ___________________________on _________________
(Name of Provider)

13. 

Results  Positive  Negative _________________________
(Date)

Addiction Specialist ______________________________

(Date)

 No Show

Telephone No. (

DHR/FIA 1177 (Revised 10/05) Previous editions obsolete.
WHITE–Addictions Specialist Copy

PINK– DSS Case Record Copy

)

-

SUBSTANCE ABUSE IDENTIFICATION AND TREATMENT NOTIFICATION
Enrollee Name _________________________________________
AU No.____________________________
MA No.___________________________
Address___________________________________Zip__________
SS No. ____________________________
DOB __________________ Telephone No. (
)
MCO ____________________________
Addiction Specialist/DSS Office __________________________________________________________________
Address ___________________________________________________ Telephone No. (
)
Treatment Provider ____________________________________________________________________________
Address ___________________________________________________ Telephone No. (
)
SAMIS Identification No._______________________________ Provider No._____________________________
Part I. Comprehensive Substance Abuse Assessment  or Drug Test  (Check one)
1.
Date provider received consent form and referral _____/_____/_____
2.
Date of appointment _____/_____/_____
3.
Results of drug test: Positive  Negative 
4.  Patient failed to keep appointment for comprehensive substance abuse assessment or drug test.
5.  Comprehensive assessment indicates patient not in need of substance abuse treatment.
6.  Patient referred for treatment to: __________________________________ on _____/_____/_____.
Signature of addictions specialist ______________________________ Telephone No. (
)
Print or type name ______________________________________________ Date ___________________
Part II. Treatment Compliance Notification
Level of Care Provided _________________________________________________________________________
1.
Date provider received consent form and referral _____/_____/_____
2.  Patient failed to appear for initial appointment within 30 days of referral or if no appointment available
within 30 days of referral, patient failed to schedule and appear for first available appointment.
3.  Awaiting available vacancy.
4.  Enrolled in treatment program
5.  Not maintaining active attendance/participation.
6.  Discharged for noncompliance.
7.  Successfully completed program.
8.  Referred to _____________________________ on _____/_____/_____.
New Program
Date
Admission date: _____/_____/_____

Discharge date: _____/_____/_____

Discharged to (provider) _________________________ Level of Care ____________________________________
New Provider’s Address ________________________ Zip ____________ Telephone No. (

)

-

Signature of addictions specialist _____________________________________ Date _____/_____/_____
Print or type name ____________________________________________ Telephone No. (
)
Part III. Work Readiness
1.  Not able to work
2.  Not ready to work but could participate in job readiness/training/education
3.  Able to work.
4.  Other__________________________________________________________________
Signature of addictions specialist ____________________________________ Date _____/_____/_____
Part IV. Case Manager Action Taken
Case Manager Name______________________________
1.  Conciliation _____/_____/_____ date began.
2.  Sanction _____/_____/_____ effective date.
3. Active Service case  YES  NO
Comments:_________________________________________________________________

DHR/FIA 1178 (Revised 10/05) Previous editions obsolete
WHITE–Addictions Specialist Copy YELLOW- ASSESSOR/TREATMENT PROVIDER PINK– DSS Case Record Copy

DOMESTIC/FAMILY VIOLENCE SUPPLEMENT
In order to successfully help victims of domestic or family abuse become employed and
self-sufficient you have to understand what domestic violence is. Domestic violence is
about power. The abuser has power over his victim. Domestic violence is against the
law. Following is information about some of the issues case managers and employment
specialists may see.
Domestic violence robs victims of their fundamental human right to maintain a
sense of control over their own lives. Victims of domestic violence often feel
hopeless and powerless in escaping the continuous abuse.
Source: The above information was adapted from materials provided on the following websites:
http://www.houseofruth.org/; http://www.fvpf.org; http://www.ncadv.org

The act of leaving an abusive relationship is a process.
Victims cannot assume that violence or the threat of violence will end when he/she
leaves the perpetrator. Many perpetrators of domestic violence will stalk and harass
former partners and victims of domestic violence for years.
Why Does the Victim Stay?
A question often posed by the victim’s family and friends. There are numerous reasons
for which men or women decide they should not leave an abusive relationship. Some of
the more common reasons are listed below.
•
•
•
•

•

•

•
•

Children – victims often desire for their children to grow up with both parents.
Control – victims often believe that they can control the violence by doing what the
abuser wants. This is almost never true.
Shame or embarrassment about their situation.
Isolation – many abusers will cut off relationships the victim has with family and
friends, leaving the victim to feel alone and with no control over the
situation.
Fear – the perpetrator will often make threats of increased violence and even
homicide if the victim threatens or attempts to leave. Women who leave their
batterers are at a 75% increased risk of being killed by the abuser as
compared to women who stay with the abuser (House of Ruth, 1998).
Financial concerns – victims of domestic violence often feel they have lost all
control over money and feel hopeless about their situation. In their first year
after a divorce, a woman’s standard of living drops, on average, 74%, while a
man’s standard of living improves by an average of 42% (Action Notes, 1989).
Deserve abuse – victims often have the false belief that the abuse is ‘deserved.’
History of childhood abuse – victims with a history of being abused as a child or
witnessing domestic abuse in their family often believe that violence is a
normal part of a relationship.

DHR/FIA 1178 (Revised 10/05) Previous editions obsolete
WHITE–Addictions Specialist Copy YELLOW- ASSESSOR/TREATMENT PROVIDER PINK– DSS Case Record Copy

Five Things You Can Say to a Victim Reluctant to Leave:
•
•
•
•
•

I am afraid for your safety and the safety of your children.
Without a change, the abuse tends to get worse.
I am here for you when you are ready to leave.
You deserve better than this.
There are people who can help you.

Show Support:
•
•
•
•
•

I believe you.
The abuse is not your fault.
How can I assist you in feeling safe?
Help me to understand how you feel.
Your reactions are normal for such a horrible experience.

Things NOT to Say to a Victim of Domestic Violence:
•
•
•
•
•
•

I know that you are a battered woman/man.
Did you try to stop the abuse?
What did you do to provoke the abuse?
Why don’t you just leave?
If someone ever hit me, I know I’d leave immediately.
That happened awhile ago; can’t you just forget about it?

(Source: Sarah Buel, “Prosecuting Batterers Without A Witness” Workshop, Tulsa, OK February, 1994
and U.S. Office of Personnel Management Website.)

DHR/FIA 1178 (Revised 10/05) Previous editions obsolete
WHITE–Addictions Specialist Copy YELLOW- ASSESSOR/TREATMENT PROVIDER PINK– DSS Case Record Copy

Today, the lines between work and home are becoming increasingly blurred, domestic
violence can and does easily spill into the workplace, often as incidents of workplace
violence.
Victims and perpetrators of domestic violence impact the workplace in many ways. In
addition to the increased risk for workplace violence, domestic violence also results in
decreased productivity, increased absenteeism, increased stress, increased health care
costs, and increased turnover rates. The victim of domestic often has to flee his/her
home in an effort to escape an abusive relationship. Escape from the home often
includes abruptly leaving the workplace as well.

DHR/FIA 1178 (Revised 10/05) Previous editions obsolete
WHITE–Addictions Specialist Copy YELLOW- ASSESSOR/TREATMENT PROVIDER PINK– DSS Case Record Copy

Hidden Losses to the Workplace
There are two primary reasons that domestic violence comes to work:
♠ Domestic violence is about control – the victim’s job represents independence and
while the victim is at work, she/he is not under the abuser’s immediate control.
♠ The victim is vulnerable at work because his/her work hours, parking arrangements,
and geographical location are predictable. The abuser knows where and when he/she
can find the employee.
•
•
•
•
•

Domestic violence is responsible for an estimated 175,000 lost workdays per year (Family
Violence Prevention Fund, San Francisco, 1997).
According to the most recent statistics available, domestic violence costs employers
between $3 & $5 billion dollars per year in medical expenses (Bureau of National Affairs, 1990).
Businesses forfeit an additional $100 million a year in lost wages, sick leave,
absenteeism, and non-productivity due to domestic violence. (Colorado Violence Coalition, 1991)
37% of women victims of domestic violence reported feeling the effects of abuse in the
workplace reflected in lateness, missed work, difficulty keeping a job, and difficulty
advancing in their careers (EDK National Telephone Poll, 1997 – A Survey for the Liz Claiborne Company).
In a recent study of Fortune 1000 Senior Executives regarding domestic violence and the
related costs to the workplace:
•
•
•

66% reported that their company’s financial performance would likely
benefit from addressing domestic violence among their employees;
47% reported that domestic violence negatively affects productivity;
44% reported that domestic violence directly increases health care
costs.

Tips to Make the Workplace Safer

Because domestic violence is so prevalent in our society, it is safe to assume that there is
currently someone employed at your organization that is involved in an abusive relationship.
As a supervisor or manager, it is no longer acceptable to say, “That’s a personal problem” or
“There’s nothing I can do.” Supervisors and managers can help to improve the safety of the
work environment for both victims of domestic violence and co-workers who could be placed at
increased risk for becoming a victim of workplace violence.
Listed below are some suggestions to use in the workplace to improve safety.
Things to be observing and documenting regarding the employee:
•
•
•
•

unusual absences and/or late arrivals
bruises, or other signs of emotional distress
changes in work performance
mood swings or changes in personality

Things you can do to educate yourself and your workforce in an effort to prevent
incidents of workplace violence and to offer assistance to the employee you are
concerned about:
•

•
•
•
•

Contact your Employee Assistance Program (EAP) professional and the Office of Human
Resources to discuss concerns and resources, as well as to discover ways to offer support
to the employee.
Know the work-site and community resources
Read and understand the policies and procedures regarding workplace and domestic
violence.
Educate the victim and other employees about the workplace violence policy and
procedures for reporting incidents of violence.
Provide security with a picture of the perpetrator.

Actions you can take with an employee you are concerned about:
•
•
•

o
o
o
o
o

Discuss safety/security issues with the employee and suggest possible actions (i.e. safety
plan, referral to EAP).
Help the employee document all incidents of harassment and/or stalking that occur in the
workplace.
Encourage the victim to save any threatening e-mail or voice-mail messages. These can be
used in the future for legal action and/or evidence or violations of an existing restraining
order. Offer to change parking arrangements for the victim so that he/she is close to the
building entrance.
Offer to screen phone calls and transfer potentially harassing calls to security.
Assess the safety of the victim’s workplace, and relocate the victim to another more secure
building or area when appropriate.
Make sure the restraining order includes the workplace, and make sure the workplace has
a copy on hand at all times (if applicable).
Encourage the victim to identify an emergency contact person if the supervisor or manager
is unable to contact the victim.
Use an escort service to walk the victim to and from his/her vehicle.

Do not ignore the situation.
If a workplace intervention is appropriate, either at the employee’s request or to respond to a
workplace threat, early intervention can often prevent incidents of workplace violence.
Ask the victim what additional changes are needed to make the workplace safer and more
secure. No one knows the perpetrator better than the victim!
Source – The information above was adapted from U.S. U.S. Office of Personnel Management Website.

Danger Assessment
Each situation of domestic violence is different and there are no true indicators that will point to the
fact that the violence will occur again, or how severe. However, there are indicators that increase the
likelihood that your customer may be in danger.
Case managers should review these questions with customers who indicate there is current
abuse in the household.
DO NOT ASK THESE QUESTIONS IF THE SUSPECTED ABUSER IS IN THE INTERVIEW WITH
THE CUSTOMER.
Note: Even if there are few indicators present, this does not mean that your customer is safe. He or
she is the best judge as to whether or not they feel safe.
Ask Yourself:
(On a scale of 1 to 10, 10 being the highest)
1. How dangerous do you think your partner is?
2. How safe do you feel?
Other Questions to Ask Yourself:
1. Has the frequency of the abuse increased? (Is it happening more often?)
2. Has the severity of the abuse increased? (Are the injuries getting worse?)
3. Does your partner use drugs or alcohol?
4. Is your partner obsessive? (Is he/she very controlling?)
5. Do you feel isolated (or does your partner restrict who you can have contact with)?
6. Are there, or has there ever been, weapons involved?
7. Does your partner suffer from mental illness (suicidal or strange behaviors)?
8. Is there sexual abuse involved?
9. Is the abuser abusive to the children?
10. Are you pregnant, or has your partner abused you while you were pregnant?
Abuse does not always have to manifest itself into physical behavior in order for it to be harmful.
Below are some indicators of Non-Physical Indicators of Abuse.

Non-Physical Indicators of Abuse
1.
2.
3.
4.
5.
6.

My partner screams and yells at me.
My partner insults or shames me in front of others.
My partner does not respect my feelings.
My partner frightens me.
My partner demands obedience to their orders.
My partner does not allow me to have friends of the opposite sex (or same sex if appropriate).

7. My partner demands that I stay home, or follows me when I go out.
8. My partner demands sex, whether I want it or not.
9. My partner is controlling with money.

Creating A Safety Plan
Regardless of how dangerous the situation appears, a safety plan is an important piece of information
that can help you think about how to keep yourself safe. In developing a safety plan, it is important to
consider some of the following suggestions -Are you thinking about leaving your partner?
•

Identify things that have worked in the past to keep you safe.

•

Think about what has happened in the past and how the abuser has acted. Identify clues that
indicate when things are about to get violent (i.e. behavioral -- body language, drug/alcohol use,
etc. -- and event driven -- paydays, holidays, etc.).

•

Identify what you will do if the violence starts again. Can you call the police? Is there a phone in
the house? Can you work out a signal with the children or neighbors to call the police or get help?

•

Explore ways to have dangerous weapons (i.e. guns, hunting knives, etc.) removed from the
house.

•

Identify dangerous locations in the house (i.e. the kitchen - knives, hot water, oven, etc.) and try
not to be trapped in them. Install a lock on the inside of the bathroom or other room where you can
be safe.

•

Make a routine for going out each day (i.e. walking the dog, taking out the trash, etc.). Let others
know your routine so they will know when something is off.

•

Plan an escape route and practice it. Know beforehand where you can go and who you can call
for help. Keep a list of addresses and phone numbers where you can go in crisis and keep them in
a place where the abuser cannot find it.

Are you planning on leaving your partner?
•

What is your plan? How and when can you most safely leave? Do you have transportation, money
and a place to go? What are you waiting for?

•

Inform people you trust about your plan and allow them to help you. Consider alternative plans if
you have to leave prior to their scheduled leave date.

•

Make sure you have a safe place to go; somewhere where someone is supportive and the abuser
does not know about (shelter, relative, hidden apartment, etc.).

•

Who will you tell and not tell about leaving? Who in your support network do you trust?

•

Pack a bag and keep it in an undisclosed but accessible place (either at home, at a friend or
neighbor's house, or at work) in order to leave quickly.

•

How will you travel safely to and from work, or to school to pick up the children?

•

Seek legal advice so that you know what they can and cannot do, and what you can and cannot
have. (i.e. Can you take the car? Can you take the children to another state?)

•

It is important to see your life first and their possessions second.

•

If possible, open a bank account or hide money to establish or increase independence (i.e. tell the
abuser you paid $40 for a coat you bought for $10).

•

Leave money, an extra set of keys, copies of important documents, and extra clothes with
someone you trust so you can leave quickly. Some items you want to consider having available:
birth certificates, social security cards, marriage and driver's license, car title, bank account
number, credit and/or ATM cards, savings account information, lease agreements, house deed,
mortgage papers, insurance information and forms, school and health records, welfare or
immigration documents, medications and prescriptions, divorce papers or other court documents,
phone numbers/addresses for family/friends/community agencies, clothing and comfort items for
them and their children, extra keys.

Are you living on your own (not with your partner)?
•

Change the locks on doors and windows (if the abuser has a key or access to a key).

•

Install a better security system (window bars, locks, better lighting, smoke detectors, and fire
extinguishers).

•

Increase emergency response's (police, ambulance) ability to find your house (have large visible
street address outside the house).

•

Obtain a PO Box and have all mail sent to it.

•

Ensure that the phone company, BGE, etc. does not give out your information.

•

Determine the safest way to communicate with the abuser if you must have contact with them. If
you agree to meet, always do it in a public place (preferably a place with a security guard or police
officer), and it's best to bring someone else. Make sure you are not followed home.

•

If your partner follows in their car, drive to a police station or fire station and keep honking the
horn.
Create a safety plan for leaving work. Talk with your supervisor and building security at work and
provide a picture of the abuser if possible. Arrange for a Domestic Violence presentation at your
worksite.

•

•

Teach your children a safety plan, including calling the police or family and friends if they are
taken.

•

Talk to your schools and childcare provider about who has permission to pick up the children and
develop other special provisions to protect the children.

•

Inform neighbors and/or landlord of the situation and advise them to call the police if they see
suspicious activity around your house/apartment.

•

Use the legal system. Understand the legal system cannot provide total protection. You must
contribute to your own safety. Follow any court orders. If a judge orders your partner to stay away

and not have contact, you should not speak to the abuser if contacted. Inform the police or judge
immediately.
•

Keep a journal of harassing phone calls and times you may see your abuser around the work
place or neighborhood. Keep a journal of anything that happens between you, the abuser, and the
children regarding visitation.

•

Concentrate on staying safe and don't let your guard down.

Safety planning around technology issues
•

If you are leaving, or making plans to leave, use a public computer (i.e. at a library), or a work
computer where the abuser does not have access.

•

Be aware when visiting domestic violence sites on the internet that it's not possible to completely
erase the history. Likewise, it may raise more questions, if the history is suddenly blank.

•

Be careful with sent or received e-mail on an account that is shared by your abuser.

•

Know what features your cell phone is equipped with. Many cell phones now come standard with
GPS (Global positioning satellites) that can be traced.

•

Save and/or print any threatening e-mails.

• In addition to the information provided here, there is information on the DHR website:
www.dhr.state.md.us.

SAFETY PLAN
What is a Safety Plan?
A safety plan is a plan that helps you to reduce the risks that you and your children face.
There is no right or wrong way to do a safety plan. Check off and fill in the things that work for
you. Make it your plan. Review it often. Make changes as you need to.
There is help for you to develop a safety plan. You can ask your social worker, family violence
worker or some other person in the community to work with you on this.
Safety Plans will help you be as safe as you can be from future abuse. They are used by people
who:
• Want to leave, but it is not safe
• Are not sure about leaving, but need help in case the abuser gets violent
• Have left and the threat of violence is still there
Safety Plans Can Help You:
• Get help in an emergency
• Get away safely
• Keep children safe
• Safely get your clothes, pets or other personal items

Personalized Safety Plan
The following steps are my plan for increasing my safety and preparing for possible further
violence.
Although I do not have control over my (ex) partner’s violence, I do have a choice about how I
respond and how to get myself and my children to safety.

STEP 1: SAFETY DURING A VIOLENT INCIDENT.
In order to increase safety, battered people may use a variety of strategies.
I can use some or all of the following strategies:
• If I decide to leave, I will
_____________________________________________________________
___________________. (Practice how to get out safely. What doors, windows, elevators,
stairwells or fire escapes would you use?)
• I can keep my purse/wallet and vehicle keys ready and put them (place) in order to leave more
quickly.
• I can tell _______________________________________________________ about the
violence and ask that they call the police if they hear suspicious noises coming from my home.
• I can also tell ___________________________________________________ about the
violence and ask that they call the police if they hear suspicious noises coming from my home.
• I can teach my children how to use the telephone to contact the police and fire department.
• I will use ______________________________________________ as my code word with my
children or my friends so they can call for help.
• If I have to leave my home, I will go to, (Decide this even if you don’t think there will be a next
time.)_____________________________________________________________
• If I cannot go to the place above, then I can go to
_________________________________________ or
____________________________________________________________________________
• When I expect we are going to have an argument, I will try to move to a space that is lowest
risk, such as
______________________________________________________________________.

(Try to avoid arguments in the bathroom, by the telephone, garage, kitchens, near weapons or
in rooms without access to an outside door.)
• I will use my judgment, experience and intuition. If the situation is very serious, I can give my
partner whatever is necessary to maintain my own and my children’s safety.
• I have to protect myself until I/we are out of danger.

STEP 2: SAFETY WHEN PREPARING TO LEAVE.
Battered people frequently leave the residence they share with the battering partner. Leaving
may be done quickly, but sometimes leaving must be done over a period of time in order to
increase safety. Batterers often strike back when they believe that a battered person is leaving a
relationship.
I can use some or all of the following safety strategies:

• I will leave money and an extra set of keys with
__________________________________________so I can leave quickly.
• I will keep copies of important documents or keys at
__________________________________.
• I will open a savings account by _____________________________________________, to
increase my independence.
• I can get legal advice from a lawyer who understands domestic abuse.
Other things I can do to increase my independence are:
• The local shelter number is _________________________________. I can seek shelter and
support by calling this help line.
• I can keep change for phone calls on me at all times. I understand that if I use my telephone
credit card, the following month the telephone bill could tell my batterer those numbers that I
called after I left. If I use a cell phone, the following month's bill could tell my batterer the
numbers that I have called or the batter may be able to have the company trace my calls. To
keep my telephone communications confidential, I must either use coins or I might get a
friend to let me use her telephone credit card for a while when I first leave.
• I will check with _______________________________ and
______________________________ to see who would be able to let me stay with them or lend
me some money.
• I can leave extra clothes with
________________________________________________________.
• I will sit down and review my safety plan every ___________________________________ in
order to plan the safest way to leave the residence.
______________________________________ (women’s advocate or friend) has agreed to
help me review this plan.
• I will rehearse my escape plan and, as appropriate, practice it with my children.

STEP 3: SAFETY IN MY OWN HOME.
Safety measures I can use include: There are many things that a person can do to increase

safety in their own residence. It may not be possible to do everything at once, but safety
measures can be added step by step.
• I can changes the locks on my doors and windows as soon as possible.
• I can replace wooden doors with steel/metal doors.

• I can install security systems including additional locks, window bars, poles to wedge against
doors, an electronic alarm system, etc.
• I can purchase rope ladders to be used for escape from second floor windows.
• I can install smoke detectors and purchase fire extinguishers for each floor in my
house/apartment.
• I will teach my children how to use the telephone to make a collect call to me and to
(friend/helper/other) in the event that my (ex) partner abducts them.
• I can install the “call blocking” option on my telephone. This will allow me to make telephone
calls, even to the batterer, without my number being identified on another telephone’s display
mechanism.
• I will tell all the people who provide child care for my children about who has permission to pick
up my children and who does not. The people I will inform about pick-up permission include:
• School _______________________________________________
• Day Care Staff _______________________________________________
• Babysitter _______________________________________________
• Sunday School Teacher _______________________________________________
• Teacher _______________________________________________
• Other _______________________________________________
• I can tell ________________________________________________________________
(neighbor),
__________________________ (clergy), and ___________________________________________

(friend) that I am separated and they should call the police if my (ex)partner is seen near my
residence.

STEP 4: SAFETY WITH A PROTECTION ORDER.
Protection orders are legal restrictions on movement and actions that come in different forms:
peace bonds, restraining orders, bail conditions, parole conditions, child custody/access orders,
etc. Many batterers do obey protection orders, but one can never be sure which violent partner
will obey and which will violate probation orders. It is often necessary to ask the police and the
courts to enforce a protection order.
The following are some steps that I can take to help the enforcement of my protection order.

• I will keep my protection order document(s) (original if possible) in
____________________________
(location). (Always keep it on or near your person. If you change purses , that’s the first thing
that you should check).
• I will inform my employer, my clergy support, my friend and
_________________________________and
___________________________________________________________________ that I have
a protection order in effect.
• If my partner destroys my protection order, I can get another copy from the courthouse, my
lawyer,
or__________________________________________________________________________.
• If my (ex) partner violates the protection order, I can call the police and report the violation,
contact my (ex) partner’s parole officer, contact my lawyer and/or my advocate, and/or advise
the court of the violation. (Report every violation of the order.)
• If the police do not help, I can contact my support worker, my (ex) partner’s parole officer, or
my lawyer as well as filing a complaint with the police department.
• I can also file a private criminal complaint with the court in the jurisdiction where the violation
occurred. I can charge the batterer with a violation of the protection order and all the crimes
committed in violation of that order. I can call the local shelter to help me with this.

STEP 5: SAFETY ON THE JOB AND IN PUBLIC.
Each battered person must decide if and when he or she will tell others that their partner has
battered them and that he or she may be at ongoing risk. Friends, family and co-workers can
help.
I might do any or all of the following:
• I can tell my boss, building security and or my supervisor and
_______________________________________ at work of my situation.
• I can ask _______________________________________________ to help screen my calls
at work.
• When leaving work, I can
___________________________________________________________.
• When going home if problems occur, I can
_____________________________________________.
• If I use the bus/taxi, I can
___________________________________________________________.
• I can use different grocery stores/shopping malls and shop at different times than I did before
to reduce the risk of contact with my (ex) partner.
• I can also
________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________.

STEP 6: SAFETY AND DRUG OR ALCOHOL CONSUMPTION.
Many people drink alcohol or use drugs (legal or otherwise). The legal consequences of using
illegal drugs can be very hard on a battered person, may hurt their relationship with their
children and put them at a disadvantage in other legal actions with their abusive partner.
Therefore, people should think carefully about the potential cost of using illegal drugs. But
beyond this, the use of any alcohol or other drugs can reduce an individual’s awareness and
ability to act quickly to protect themselves from their abusive partner. Furthermore, the use of
alcohol or other drugs by the batterer may be used as an excuse for violence. A battered
individual needs to make specific safety plans for when he or she drinks or takes drugs.
If drug or alcohol consumption has occurred in my relationship with the abusive partner, I can
increase my safety by some or all of the following:
If I am going to drink alcohol or use drugs, I can do it in a safe place and with people who
understand the risk of violence and care about my safety.
I can also ________________________________________________________________________.
If my partner is consuming, I can _____________________________________________________.
To safeguard my children, I might _____________________________________________________
and ____________________________________________________________________________.

STEP 7: SAFETY AND MY EMOTIONAL HEALTH.
The experience of being battered and verbally degraded by partners is usually exhausting and
emotionally draining. The process of building a new life requires much courage and incredible
energy.
To conserve my emotional energy and resources and to avoid hard emotional times, I
can do some of the following:
• If I feel down and ready to return to a potentially abusive situation, I can
____________________________________________________________________________
____________________________________________________________________________

• When I have to talk with my partner in person or by telephone, I can
____________________________________________________________________________
____________________________________________________________________________
• I can try to use “I can...” statements with myself and to be assertive with others.
• I can tell myself - “_______________________________________________________” whenever I feel others are trying to control or abuse me.
• I can call, ____________________________________, and
________________________________________________ as other resources to support me.
• I can find out about and attend workshops and support groups in the community by calling the
local shelter for information.

STEP 8. ITEMS TO TAKE WHEN LEAVING.
When an individuals leave abusive partners, it is important for them to take certain items with
them. Beyond this, individuals can sometimes give extra copies of papers and an extra set of
clothing to a friend just in case they have to leave quickly.
Items with asterisks on the following list are the most important to take. If there is time, the other
items might be taken, or stored outside the home. Keeping them all together in one location
makes it easier if a woman needs to leave in a hurry.
When I leave, I should take:
_ Identification for myself
_ Protection Order papers/documents
_ Social insurance cards
_ School and vaccination records
_ Checkbook, bankcards
_ Keys - house/vehicle/office
_ Medications
_ Divorce/separation papers
_ Lease/rental agreement, deed, mortgage
_ Insurance papers
_ Address book
_ Items of special sentimental value
_ Children’s favorite toys and/or blankets
_ Children’s birth certificates
_ My birth certificate
_ Immigration papers
_ Money
_ Credit cards
_ Driver’s license and ownership
_ Passport
_ Medical records
_ Bank books
_ Small saleable objects
_ Pictures/photos
_ Jewelry
Telephone numbers I need to know:
RCMP:
Counselor:
Battered Women’s Program:
Domestic Violence Help line (24 hours):
Lawyer:
Work number:
Supervisor’s home number:
Minister/Rabbi/Priest/Elder:
Other: _____________________________________________



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