The instructions for Form 9061 lists those documents and/or contact information the employer is requested to provide Job Service North Dakota in order to substantiate the new hire's "yes" responses on Form 9061. Job Service uses the information the employer submits to verify whether or not the new hire is eligible for the target group(s) indicated on the form. The following chart is to be used by employers to determine the documentation and/or contact information they should obtain from the new hire and submit to Job Service.
|If a “yes” response was indicated on Form 9061 to this question:||…then this target group is indicated:||The employer must obtain the documentation listed below from the new hire and either mail it along with the 8850 and 9061 forms or indicate it will be mailed separately:|
|14||Supplemental Nutritional Assistance Program (SNAP) (Food Stamps) Benefit Recipient||The employer needs to make sure the new hire listed the primary recipient and city and state.|
|15||Vocational Rehabilitation Benefit Recipient||
NOTE: If the new hire has a signed statement from an authorized individual that outlines the benefits that were received, the employer should send a copy of that statement along with the completed Disclosure form as noted above.
|16||Temporary Assistance for Needy Families (TANF) Benefit Recipient||The employer needs to make sure the new hire listed the primary recipient and city and state.|
The employer needs to make sure the new hire completed all the blanks.
The employer needs to acquire one of the following from the new hire: 1) the parole officer’s name and phone number and write this on Form 9061 (this item is most helpful); 2) the parole officer’s statement; 3) correction institution records; or 4) court records extracts.
|18||Designated Community Resident – Rural Renewal County||Documents to verify age and residence. See the Designated Community Resident – Rural Renewal Counties section below for detailed information on those items that must be submitted.|
|19||Supplemental Security Income (SSI) Benefit Recipient||Have the new hire complete the Consent for Release of Information by the Social Security Administration Form.|
|20||Unemployed Veteran||A copy of the DD214 form that shows dates of entry and discharge (used to verify over 180 days of active duty in the Armed Forces of the U.S.).|
|21||Disconnected Youth||If the new hire indicated “yes” responses to the first two questions, have the new hire complete ETA 9154 (Youth Self-Attestation Form).|