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MEMO: AP 00-16 Change 3

Last Updated: June 25, 2018

DATE: November 17, 2003

TO: WIB Directors; WIB Chairpersons; Grant Recipients; DOL Job Center Directors

FROM:  Lorna Joseph, Director of Program Support

SUBJECT:  WIA 5 Completion; DOL Staff Requirements; Use of MD20

America's Workforce Network

Background: On August 7, 2000, AP 00-16 was issued regarding dislocated worker eligibility to bring more clarity and consistency to the process of certifying dislocated workers under the Workforce Investment Act. This supplemental policy includes additional information which will assist the certification process. Included with this policy is a revised Eligibility and Certification for Dislocated Workers Form, WIA 5, the form used in determining WIA Title IB eligibility for dislocated workers. This policy augments earlier policies addressing the process and documentation for certification.

Policy: The revised WIA 5 form is very similar to the original form. It lists the legislation and the choices of requirements for certification as a dislocated worker. There are some formatting changes which make the form easier to use. The lines for noting documentation are directly below each of the eligibility conditions instead of at the bottom of the form.

This form also replaces the need for the DOL 37, the Unemployment Insurance Records Release  form. The content of that form is now at the bottom of the WIA 5. In addition, there is a box at the bottom of the form, before the signatures, to check if the person is eligible for certification or not. An additional piece of information requested on this updated form is an explanation of the circumstances if someone is not eligible for certification. The reason for this additional information is to give staff  information on the circumstances of certification in case a participant grieves the certification decision.

On the back of the WIA 5 there is a listing of the documentation needed to certify people in any one of the four categories. The required documentation is the same as previously listed in AP 00-21; December 21, 2000; AP 00-21, (Clarification 1; November 1, 2002) and AP 00-21; Change 3 - January 21, 2003. The only change is that the MD 20 may now be used in Number 1 and/or Number 2 of Box A for documentation. You will not be able to click on MD20 as an option in CTWBS for Box A (Dislocated worker terminated/laid off) for several more weeks due to some changes that must be made to the CTWBS.  Until the MD20 is added as an option for Box A, you can select "Applicant's UC‑61" for Box A (Dislocated worker terminated/laid off) and simply write in "MD20" as the verification used on the WIA‑5 form.  The MD20 must be printed and dated the day of the certification.

Copies of this form may be downloaded from the DOL Intranet site, under Program Support, Quality Program Review, WIA Administration.  It is best to use original copies of the form for certification. Please assure that documentation is attached for each of the categories needed under each block. A copy of the completed and signed WIA 5, and the accompanying documentation, must be given to the local One-Stop operator, or the Board (depending on the local agreement) upon completion for inclusion in the participant=s file. The original WIA 5 and documentation should  be retained in the DOL offices. In situations where someone is not certified all records stay in the DOL offices.

Further specifics of the process such as how and when the certification is competed, data entry, flow of processing etc. are determined locally by the Regional Board, the Department of Labor and the partners. 

200 Folly Brook Boulevard, Wethersfield, CT 06109 / Phone: 860-263-6000

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