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COMMONWEALTH OF VIRGINIA

To___________________________________, BPS DEPARTMENT OF SOCIAL SERVICES

From_________________________________, ESW EMPLOYMENT SERVICES PROGRAMS

Date_______/_______/_______ COMMUNICATION FORM- From ESW to BPS Reply Needed By _______/_______/_______

 Copy Sent to Child Care Worker ====================================================================================== Name of Participant_______________________ Participant’s Client ID # ______________________ Case Name ______________________________  SNAP E&T  TANF  TANF-UP Case Number ____________________________

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 Volunteer signed APR on __________________. Please update AEGNFS screen and run ED/BC.  Reevaluation of non-exempt/mandatory status is requested. Reason: _____________________________ _______________________________________________________________________________________.  Volunteer no longer wishes to participate. Please update AEGNFS screen and run ED/BC. ======================================================================================

 Individual will enter education or training activity on _______/_______/_______.  Individual will be a participant in work experience. Please provide the SNAP amount for the month of ______________________. ======================================================================================

 Individual will enter/entered employment on_______/_______/_______. Employer_____________________________ Scheduled # of Hours/week: _____________. Rate of pay: $____________ per __________. Frequency of pay: _____________________. Date of First Pay: _______/_______/_______.  Please send verification of employment.

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 Individual has failed to comply with program requirements of ___________________________________ _________________________________________________________________. Good cause does not exist.  Notify ESW if aware of good cause reason.  Sanction TANF for (check appropriate answer)

 1 month and compliance  3 months and compliance  6 months and compliance  SNAP E&T case will close effective_______/_______/_______.  Please provide the dollar amount of SNAP reduction due to employment or sanction.  Please notify when suspended TANF case has been reinstated. ======================================================================================

 VIEW Transitional Payment enrollment opened effective_______/_______/_______.  VIEW Transitional Payment enrollment closed effective _______/_______/_______. Reason: ______________________________________________________________________________. ======================================================================================

 Hardship denied on_______/_______/_______.  Hardship granted from _______/_______/_______to_______/_______/_______.  Hardship terminated on_______/_______/_______. ======================================================================================

 Other ________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

032-02-0072-13-eng (09/2024)