Minnesota Minnesota

MFIP Employment Services Manual

MFIP Employment Services Manual


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24.13 Workforce One Electronic Document Storage Requirements

ISSUE DATE: 02/2024

DHS requires certain documents to be uploaded to Workforce One EDS. This guidance applies to all county and Tribal Nation MFIP/DWP Employment Service Providers.

Utilizing the WF1 EDS system creates consistency in document storage, a streamlined the process for transferring cases, and ensures documents are available for county and Tribal Nation MFIP/DWP employment services case files for the TANF WPR Case File Documentation Reviews.

The following chart contains a list of required and optional documents to be uploaded into WF1 EDS. Documents denoted with an asterisk are required.

The chart also indicates which EDS Document Type and EDS Document Name is chosen when uploading the document. The EDS User Defined Document Name are suggestions to further categorize specific documents.

Document Name

EDS Document Type

EDS Document Name

EDS User Defined Document Name

N/A

Appeals and Complaints

Sanction Document

N/A

N/A

*Appeals and Complaints

* Appeal

N/A

N/A

Appeals and Complaints

Verification of Good Cause

N/A

Brief Screening Tool for Special Learning Needs (DHS-3504)

Assessments

Skills Assessment or Inventory

N/A

MFIP Special Learning Needs Scoring Form (DHS-3504A)

Assessments

Skills Assessment or Inventory

N/A

Other Assessment Forms

Assessments

Skills Assessment or Inventory

Examples: WorkKeys, other assessments

MFIP Self-Screen (DHS-3482)

Assessments

Assessment

N/A

MFIP Self-Screen Scoring Form (DHS-3482A)

Assessments

Assessment

N/A

Personality Assessment

Assessments

Personality Assessment or Inventory

N/A

Extension Assessments and Documents

Assessments

Assessment

Example: 48 Month Interview Paperwork

Face to Face Extension Checklist

Assessments

Assessment

N/A

Employability Measure

Assessments

Assessment

N/A

Interests and Skills Summary Sheet (Assessment Summary)

Assessments

Interest Assessment or Inventory

N/A

Job Search Readiness Checklist

Assessments

Job Search Readiness Checklist

N/A

Self-Directed Search (SDS), Career Assessment Inventory (CAI), Campbell Interest and Skill Survey (CISS)

Assessments

Career Assessment

N/A

TABE Test

Assessments

Reading, Math Assessment

N/A

Employment Service Responsibilities, Rights and Consent (DHS-3172)

Consent, Release of Information

Rights and Responsibilities

N/A

MFIP Overview Checklist

Consent, Release of Information

Overview Document

N/A

Notice of Privacy Practices (DHS-3979).

Consent, Release of Information

Data Privacy Form or Tennessen Notice

N/A

 blank

Consent, Release of Information

Equal Opportunity (EO), How We Use your Personal Information

N/A

Notice of Requirement to Attend MFIP Overview (DHS-2929)

Consent, Release of Information

Overview Document

N/A

 Blank

Consent, Release of Information

Consent to Share Wage and Employment Information

N/A

Release of Information

Consent, Release of Information

Consent for Release or Exchange of Information

Example: Consent for credential training

Authorization to Communicate Through Email and Texting

Consent, Release of Information

Authorization to Communicate via Email and Texting

N/A

Letters

Correspondence

Letter

Examples: correspondence with participant
letters sent by program staff, letters received

Email Correspondence

Correspondence

Email

N/A

*MFIP Notice of Intent to Sanction (DHS-3175)

*Correspondence

*Non-Compliance Letter or Failure to Comply Notice

 Example: NOITS if completed in paper form

Sanction Outreach

Correspondence

Non-Compliance Letter or Failure to Comply Notice

N/A

Background Check

Court and Legal

Background Check or Criminal History Record

N/A

N/A

Court and Legal

Court Document, Order Document or Record

N/A

N/A

Court and Legal

Other Legal Document

N/A

Books and Fees/Supplies Statement

Education and Training

School Books or Supplies List

N/A

*Class Schedule

*Education and Training

*Class List or Schedule

Example: 2020 Spring Semester

Credential

Education and Training

Credential

N/A

*Credit Hour/Study Time Policy

*Education and Training

*Verification of School Attendance or Progress

 Example: School Attendance Log (Agency Form)

*Study Time Statement

*Education and Training

*Study Time Statement

Example: Century College Blanket statement, 2018

Diploma/Degree

Education and Training

Certificate of Attendance or Completion

N/A

Education Career Assessment Guide

Education and Training

Career Assessment Guide

N/A

FAFSA

Education and Training

FAFSA (Free Application for Federal Student Aid) Report

N/A

Fee Statement

Education and Training

Financial Aid Award Letter or Fee Statement

N/A

Financial Aid Award Letter

Education and Training

Financial Aid Award Letter or Fee Statement

N/A

Financial Aid Information Form

Education and Training

Financial Aid Information Form (DHS-2646)

N/A

*Grades / Transcripts

*Education and Training

*Grades or Transcripts

N/A

*Minnesota Family Investment Program (MFIP) education activity log (DHS-4209N)

*Education and Training

*Verification of School Attendance or Progress

Examples: Education Activity Log, Dates of Log

Post-Secondary Training Checklist

Education and Training

Post-Secondary Training Checklist and Request

N/A

*Request for Verification of School Attendance/Progress (DHS-2883)

*Education and Training

*Verification of School Attendance or Progress

N/A

*MFIP Education and Training Guide/Occupational Training Packet

*Education and Training

*Education Plan

N/A

Cover Letter

Employment

Cover Letter

N/A

Employee's Injury Report to Employer/Witness Report (all)

Employment

Workers Compensation Record or Claim

Examples: Proof of Income, Disability Status

*Employment Plan Signature Page

*Employment

*Employment Plan Signature Page

N/A

*Employment Verification Form (DHS-2146)

*Employment

*Authorization for Release of Employment Information (DHS-2146)

N/A

*Employment Verification

*Employment

*Employment Verification

Examples: proof of employment status/information, letter from employer, subsidized employment information

Injury Protection Program (IPP) - First Report of Injury (DHS-3995)

Employment

Injury Protection Program (IPP)

Example: First Report of Injury

Injury Protection Program (IPP) - Participant Information & Authorization to Release

Employment

Injury Protection Program (IPP)

N/A

Injury Protection Program (IPP) - Participant Injury Status Report (DHS-3997)

Employment

Injury Protection Program (IPP)

N/A

Injury Protection Program (IPP) - Participant Medical Referral and Medical Care

Employment

Injury Protection Program (IPP)

N/A

MFIP Paid Work Experience Program Participant Information

Employment

Paid Work Experience Program Participant Information

N/A

*Employment Plan (DHS-4209: 4209A-4209M)

*Employment

*Employment Plan

N/A

*Job Search Activity Log (DHS-5784)

*Employment

*Job Search Activity Log

Example: Week of 8/2/20-8/2/20

OJT Contract

Employment

On-the-Job Training (OJT) Contract or Documentation

N/A

Pay Stubs

Employment

Pay Stub or Check Stub

N/A

Resume

Employment

Resume

N/A

Safety Training/Compliance Agreement

Employment

Work Site Agreement

N/A

Sample Application for Employment

Employment

Sample Application for Employment

N/A

*Self-Employment Plan

*Employment

*Business Plan

N/A

WEP Time Card

Employment

WEP Time Card

N/A

Work Experience Evaluation

Employment

Work Experience Evaluation

N/A

Worksite Agreement

Employment

Work Site Agreement

N/A

*Authorization for Release of Employment Information (EVF)

*Employment

*Authorization for Release of Employment Information

N/A

*Social Service Activity Log

*Employment

*Job Search Activity Log

Examples: Week of 8/2/20-8/2/20, August 2020

Temporarily Unemployable Participant

Employment

Employability Assessment

N/A

Internship Evaluation

Employment

Internship

N/A

*Layoff Notice

*Employment

*Layoff Letter, Notice, or List

N/A

N/A

Employment

Professional References

N/A

N/A

Employment

Union Statement

N/A

Direct Deposit form

Financial - Assets, Income

Direct Deposit Form

N/A

N/A

Financial - Assets, Income

Car Title

Example: Proof of assets (vehicle value)

N/A

Financial - Assets, Income

Title/Deed Paper

Example: Proof of assets (property value)

N/A

Financial - Authorizations, Purchase Orders, Payments

Authorization

N/A

N/A

Financial - Authorizations, Purchase Orders, Payments

Purchase Order

N/A

N/A

Financial - Bills, Expenses

Transportation Support Request

N/A

N/A

Financial - Bills, Expenses

Bill or Bill Statement

Example: Proof of Expenses

N/A

Financial - Bills, Expenses

Bus Card Distribution Tracking Log

N/A

N/A

Financial - Bills, Expenses

Child Care

Example: Proof of Expenses

N/A

Financial - Bills, Expenses

Day Care Provider Statement

Example: Proof of Expenses

N/A

Financial - Bills, Expenses

Estimate or Quote

N/A

N/A

Financial - Bills, Expenses

Invoice and Supporting Documents

N/A

N/A

Financial - Bills, Expenses

Receipt

Example: Proof of expenses

N/A

Financial - Bills, Expenses

Lease Agreement

Example: Proof of Expenses

Mileage Form/Proof of Mileage

Financial - Bills, Expenses

Mileage Form or Log

N/A

Vehicle Insurance Card

Financial - Bills, Expenses

Insurance (Car, Property)

Example: Proof of expenses and residency

Obligation Worksheet

Financial Other

Obligation Form

N/A

W-4

Financial - Taxes

W-4

N/A

Birth Certificate

Identity

Birth Certificate

Examples: Proof of identity, citizenship, name

Driver’s License

Identity

Driver’s License

N/A

Immigration and Naturalization Document

Identity

Immigration and Naturalization Document

N/A

Permanent Resident Card

Identity

Permanent Resident Card

N/A

State ID

Identity

State ID

N/A

*Medical Opinion Form (DHS-2114)

*Medical

*Request for Medical Opinion (DHS-2114)

N/A

N/A

*Medical

*Assessor/Treatment Provider Report (DHS 4316)

Example: Proof of Health Conditions

N/A

*Medical

*Chemical Dependency Evaluation

N/A

N/A

*Medical

*Doctor's Statement

N/A

N/A

Medical

Health Insurance Card or Medicare Card

N/A

Medical Opinion Form (County Specific Form - NOT DHS-2114)

*Medical

*Medical Document, Form, Record, or Report

N/A

N/A

*Medical

*Physician Certification (DHS-1503)

Example: Proof of Health Conditions

N/A

*Medical

*Psychological Document, Form, Record, or Report

N/A

N/A

*Medical

*Social Worker Document or Statement

Example: Proof of Family Status

DWP/MFIP Employability Assessment

Program Specific

Intake

N/A

*FSS Case Review/FSS Pre-Sanction Checklist/Screening

*Program Specific

*Family Stabilization Services (FSS) Eligibility

Examples: FSS Pre-Sanction Checklist, FSS Eligibility Screening Form

Referrals

Program Specific

Referral

N/A

Child Care Requests

Program Specific

DWP/MFIP Child Care Transmittal, Request for Authorization

N/A

MFIP Extension Decision Form

Program Specific

Extension Decision Form

N/A

Participant Case Transfer Form

Program Specific

Case Transfer Checklist

N/A

*Diversionary Work Program/Minnesota Family Investment Program Employment

*Program Specific

*DWP/MFIP Employment Services Referral (DHS-3166)

 Example: Referral if completed in paper form

DWP/MFIP Observation Checklist (DHS-3483).

Program Specific

DWP/MFIP Observation Checklist (DHS-3484)

N/A

*DWP/MFIP Status Update Form (DHS-3165)

*Program Specific

*DWP/MFIP Status Update Form (DHS-3165)

Examples: Emailed Status Update, County Specific Status Update Form

*Family Violence Referral (DHS-3323)

*Program Specific

*Family Violence Referral (DHS-3323)

N/A

N/A

*Program Specific

*Family Violence

 Example: Verification

N/A

*Program Specific

*Family Violence Waiver Safety Plan

N/A

N/A

Program Specific

Volunteer Transportation Referral Form

N/A

N/A

*Program Specific

*Uncompensated Work Experience

 Example: Activity Log

N/A

Program Specific

Sanction Policy Case Review

N/A

Notice of Intent to Sanction (NOITS)

Program Specific

Notice of Intent to Sanction (NOITS)

N/A

N/A

*Other

*Battered Women's Shelter Statement

N/A

N/A

Other

Interpreter and Translator Services

N/A

N/A

Other

Landlord Statement

Example: Proof of Residency

N/A

*Social Security

*Social Security Administration (SSA) Letter

Example: Proof of Disability Status

N/A

Veterans

DD -214 Form

N/A

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