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Montana WIA Forms

The following chart lists the forms in the order they appear in this section of the manual.  While some forms are universal for all programs, others are specific to adult, dislocated worker or youth programs, or fiscal.  Not all of the forms are required but are intended as useful tracking tools.   The chart indicates which forms apply to each program.  The following forms are facsimiles.  Service providers are responsible for copying and maintaining the forms necessary for their day-to-day operation. 

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(click for form)

Name of Form

Adult

Dislocated Worker

Youth

Revision Date

WIA.01

Equal Opportunity is the Law

X

X

X

03/07

WIA.02

Complaint Information Form
(USDOL-CRO)

X

X

X

  

WIA.03

WIA Grievance/Resolution Form

X

X

X

  

WIA.04

Disclosure of Lobbying Activities

X

X

X

  

WIA.05

Confidentiality Agreement (MontanaWorks)

X

X

X

  

WIA.06

Authorization for Release of Information

X

X

X

  

WIA.07

Authorization for Release of Information (UI Wage Records)

X

X

X

  

WIA.08

Application Form

X

X

X
02/2008

WIA.09

Participant Agreement

X

X

X

  

WIA.10

Adult Eligibility Verification Worksheet & Instructions

X

 

 

 

WIA.11

Dislocated Worker Eligibility Verification Worksheet & Instructions

 

X

 

 

WIA.12

Youth Eligibility Verification Worksheet & Instructions

 

 

X

  

WIA.13

Youth 5% Barrier Eligibility Verification Worksheet

 

 

X

  

WIA.14

Applicant Statement

X

X

X

  

WIA.15

Telephone Verification & Instructions

X

X

X

  

WIA.16

Individual Employment Plan (IEP)

X

X

 

 

WIA.17

Individual Service Strategy (ISS)

 

 

X

  

WIA.18

Services Form

X

X

X

  

WIA.19

Referral Form

X

X

X

  

WIA.20

Direct Participant Payments

X

X

X

  

WIA.21

WEX Agreement

X

X

X
8/16/07

WIA.21a

WEX Agreement Modification

X

X

X

  
WIA.21B WEX Wage Subsidy Agreement
X
X
X
 New 08/07
WIA.21C WEX Wage Subsidy Agreement
X
X
X
 New 08/07

WIA.22

WEX Training Summary

X

X

X
8/16/07

WIA.23

WEX Union Concurrence Form

X

X

X

  

WIA.24

OJT Pre-Award Review

X

X

X

  

WIA.25

OJT Contract

X

X

X

  

WIA.26

OJT Training Summary

X

X

X

  

WIA.27

OJT Monthly Invoice

X

X

X

  

WIA.28

OJT Monthly Service Report

X

X

X

  

WIA.29

OJT Apprenticeship Notification

X

X

X

  

WIA.30

OJT Contract Modification

X

X

X

  

WIA.31

OJT Union Concurrence Form

X

X

X

  

WIA.32

Exit Form

X

X

X

  

WIA.33

Customized Skills Training Invoice

X

X

X

  

WIA.34

Eligible Training Provider Initial Application

 

 

 

 

WIA.35

Eligible Training Provider Subsequent Application

 

 

 

 

WIA.36

Follow-up Form

X

X

X

  

WIA 37

WIA Core to Intensive to Training Form

X

X

X

  

WIA 38

ITA Worksheet

X

X

 

 

WIA 39

Sample Verification of Rent

X

X

X

  
Fiscal Forms

WIA 40

Authorized Signature Sheet

 

 

 

01/04/08

WIA 45

Service Provider Cash Request and Summary

 

 

 

01/04/08

ETA 9130

Instructions for Providers

 

 

 

New 01/08
ETA 9130 Basic ETA Financial Report      
New 01/08
ETA 9130 Local Adult ETA Financial Report      
New 01/08
ETA 9130 Local DW ETA Financial Report      
New 01/08
ETA 9130 Local Youth ETA Financial Report      
New 01/08
ETA 9130 State Rapid Response Financial Report      
New 01/08
           
SDH.01 State Displaced Homemaker Reports Matching Contributions/QSR/QER        
SDH.02 State Displaced Homemaker QSR Form      
New 01/08
SDH.03 Eligibility Worksheet      
New 01/08