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VIRGINIA DEPARTMENT EMPLOYMENT SERVICES PROGRAMS OF SOCIAL SERVICES COMMUNICATION FORM

10/24 VOLUME V, PART XXV, APPENDIX II PAGE 33

EMPLOYMENT SERVICES PROGRAMS COMMUNICATION FORM

FORM NUMBER - 032-02-0072

PURPOSE OF FORM - To exchange information about an employment services participant between the BPS and the employment services worker (ESW).

USE OF FORM - Either the BPS or the employment services may originate the form when circumstances change for the participant that require the exchange of information.

NUMBER OF COPIES - Two.

DISPOSITION OF FORM – The form consists of an BPS to ESW page and an ESW to BPS page. When the form is sent, both pages should be provided. A copy of the entire form should be retained in both the TANF/SNAP and VIEW/SNAP E&T files.

INSTRUCTIONS FOR PREPARATION OF FORM

The name of the BPS and the ESW, the date the form is sent, and the date the reply is needed must be entered in the upper right hand corner by the worker who originates the form.

Enter the identifying information for the case and participant.

The remainder of the form is completed when messages must be communicated between the eligibility staff and the employment services staff. The worker will check whichever block communicates the desired information, requests the desired information, or is applicable to the situation. If the worker needs to communicate information that is not listed on the form, check “Other” and enter the information.

TRANSMITTAL #35