PM 02-09-00

revised textComplete the Responsibility and Services Plan using the the Work Verification System (WVS), or the manual Form 4003 series.

The Responsibility and Services Plan (Form 4003) series includes:

  • Responsibility and Services Plan - Activities to Meet Goal (Form 4003)
  • Work Experience/Work First/Community Service (Form 4003 A)
  • Job Search/Job Readiness (Form 4003 B)
  • Vocational Training/Bachelor or Associate Degree Program (Form 4003 C)
  • High School/GED Program for Teen Parents (Form 4003 D) 
  • Job Skills Training/Education Related Directly to Employment (Form 4003 E) 
  • Vocational Rehabilitation Services (Form 4003 F)
  • Alcohol/Substance Abuse Services (Form 4003 K)
  • Mental Health Services (Form 4003 J)
  • Medical/Family Care Services (Form 4003 G)
  • Family Violence Services (Form 4003 H)
  • Child Support/Financial Resouces (Form 4003 L)
  • Child Safety (Form 4003 M)
  • Basic Needs (Form 4003 N)
  • Health (Form 4003 T).

Complete Referral Form (Form 2151) to refer the applicant to any resources in the community which may be of help to them.

Applicant not included in TANF request

If an RPY requires child care due to employment, complete Form 2151 to refer them to the CCR&R. Give the RPY a copy to present to the CCR&R as proof of RPY status so they can determine child care eligibility.