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THE VIRGINIA INITIATIVE FOR EDUCATION AND WORK PROGRAM (VIEW) TANF

APPENDIX F

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Virginia Department of Social Services Temporary Assistance for Needy Families (TANF) Displacement Grievance Form Virginia Initiative for Education and Work (VIEW) Date

Name of Employee Home Phone #

Address _City State Zip Code

Work Phone # Best Time To Call A.M. P.M

Name of Employer

(Whom grievance is filed against) Phone #

Employer's Address Apt. #

Supervisor's Name

City _State Zip

Brief description of grievance, include dates.

________________________________________________________________________________________ ________________________________________________________________________________________

Employee Signature_______ All of the above information is correct to the best of my knowledge.

Date______________ Displacement means employing or assigning a Temporary Assistance to Needy Families (TANF) Community Work Experience Placement (CWEP), Full Employment Program (FEP) or other subsidized employment participant when: 1) The employer has terminated the employment of an employee, or the employee's current position, or otherwise caused an involuntary reduction in its work force in order to fill the vacancy with a subsidized participant, 2 ) An individual is hired while another person is on layoff, including seasonal layoff, from the same or substantially equivalent position; 3) The employer has reduced the hours of an employee in the same or substantially equivalent position to less than full time in order to employ or assign a subsidized participant: or; 4) The employment or assignment results in the impairment of an existing contract for services.* The Virginia Department of Social Services will act as a mediator to assist in resolving the grievance. Any suggestions made by the Department of Social Services are not binding to either party. This form must be received by the Virginia Department of Social Services no later than sixty days after the alleged incident of Displacement.

Mail to: Virginia Department of Social Services

Economic Assistance and Employment Unit (TANF/VIEW) 5600 Cox Road Glen Allen, VA 23060 * 45 CFR 261.70 (a)

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