georgia department of human services - georgia … · 2015-03-05 · georgia dhs refugee...

Georgia DHS Refugee Resettlement Program No DHS services are to be delivered without a fully executed contract in place. A fully executed contract is defined as a

contract that has been signed and dated by the DHS Commissioner and the Contractor.

Contract Deliverables/Service Provision Guidelines

of 55 Effective Dates: RSIG – August 15, 2014 SSG & TAG – September 30, 2014 CHP – September 30, 2014 SOR – September 30, 2014

Georgia Department of Human Services

Office of Strategic Planning and Execution

Refugee Programs Unit

Service Provision Guidelines

Effective Dates Refugee School Impact Grant (RSIG): August 15, 2014

Social Services Grant (SSG) & Targeted Assistance Grant (TAG): September 30, 2014

Cuban-Haitian Program (CHP): September 30, 2014 Services to Elderly Refugees (SOR): September 30, 2014





Table of Contents

All Services……………………………………………………………………………………………….3

• Agencies Providing Refugee Services (Chart)…………….…………………………………8 • Service Code Table (Chart)…………………………..……..…………………………………8

Billing and Funding Source Requirements…………………………………………………………9 English Language Instruction………………………………………..……………………………..11 Employability Services……………..………………………………….……………………………..14 Immigration Services………….……………………………………………..……………………….20 Information and Referral………………………………...………………..….………………………23 Refugee Youth Programs…………………………………..………………….……………………..25 Social Adjustment……………………..……………………...……………………………………….29 Domestic Violence Prevention…………………………..……………….…………………………34 Refugee School Impact Grant……………………………………………………………….………36 Cuban-Haitian Program …………………………………………………………………….…….….43 Services to Older Refugees……………………………………………………………….…………46 Database Line Item Transfer Request/Line Delete Form Instructions………….……….…...49 Database Line Item Transfer Request/Line Delete Form………………………….….….……..50 Database Line Item Transfer Request/Line Delete Form Example…………………..…….…51 Request for English Language Class at Alternate Site Instructions…………….…….…..…52 Request for English Language Class at Alternate Site Form ……………..……….…………53 RSIG Budget Adjustment Request Instructions……………………………………………,…...54 RSIG Budget Adjustment Request Form………………………………………………,…………55





All Services Performance Expectations/Outcomes:

100% Compliance with all elements (1-24)

For the purpose of this Contract, the term “refugee” includes individuals admitted as a refugee under section 207 of the Immigration and Nationality Act granted asylum under section 208 of the Act; paroled as a refugee or asylee under section 212(d)(5) of the Act; Cuban and Haitian Entrants; Iraqi and Afghani Special Immigrants (SIVs); certain Amerasians from Vietnam who are admitted as immigrants pursuant to Section 584 of the Foreign Operation export financing and related programs appropriation Act of 1988 are also eligible to receive ORR assistance and services; and Victims of Human Trafficking certified by the Office of Refugee Resettlement (ORR). It is the purpose of this program to assist and provide services that will aid in the effective resettlement of refugees and to assist them to achieve economic self-sufficiency as quickly as possible.

With diminishing federal resources to the States coupled with a diversifying refugee arrival population requires that local resettlement and other refugee service programs reexamine social service delivery and programs designed to mainstream refugees into existing local, state and federal social service programs. Building on prior efforts, these contract deliverables/service provision guidelines represent a continuing effort to streamline refugee service delivery, insure cost-effective programming, and expedite client self-sufficiency.

1. Services will be provided in the following order of priority (except in certain individual extreme cases): Social Services Grant (SSG) a. All newly arriving refugees during their first year in the United States (U.S.) b. Refugees who are receiving cash assistance. c. Unemployed refugees who are not receiving cash assistance. d. Employed refugees in need of services to retain employment or to attain economic

independence. Targeted Assistance Grant (TAG) a. Cash assistance recipients, particularly long-term recipients b. Unemployed refugees who are not receiving cash assistance c. Employed refugees in need of services to retain employment or to attain economic independence.

Refugee School Impact Grant (RSIG) a. All newly arriving refugee school aged children (5-18) who have been in the U.S. 1

years or less. b. Refugee school aged students in need of additional services in order to aid

adjustment into the American School System who have been in the U.S. 2-3 years or more with prior approval from State Refugee Coordinator or designee.

Cuban-Haitian Program (CHP) a. the newly arrived Cuban/Haitian refugee b. Cuban/Haitian refugees without family or voluntary agency support





c. the long-term unemployed and unintegrated Cuban/Haitian refugees who are unable

to access adequate services through mainstream assistance. Services to Older Refugees (SOR) a. All refugees age 60 and above regardless of length of time in the U.S. b. For naturalization services; special attention should be given to the newly-arrived older refugee and/or those who have lost, or are at risk of losing Supplemental Security Income and/or other Federal benefits.

2. The contractor will inform refugees of their rights and responsibilities as well as non-discrimination policies. Additionally, the contractor will document case records to ensure compliance.

3. Refugee women must have the same opportunities as men to participate in all services

provided with these funds. Services must be provided to the maximum extent feasible in a manner that includes the use of bilingual/bicultural women on service agency staffs to ensure adequate service access by refugee women. The Office of Refugee Resettlement (ORR) strongly encourages the inclusion of refugee women in management and board positions in agencies that serve refugees.

4. Services must be provided in ways that are culturally and linguistically appropriate to the

refugees being served. Service providers will be required to develop and implement a comprehensive written policy for assuring that the language needs of Limited English Proficient (LEP) refugees are met, so they will have meaningful access to services.

5. The contractor is required to communicate and share all information obtained in relation

to this project with the Department and take into account the reception and placement services provided by local resettlement agencies and other services provided by the Department. The sharing of information between DHS Refugee Resettlement Program contracted providers is required. This service element helps to ensure the provision of seamless, coordinated services to refugees that are not duplicative.

6. All clients must be asked if they are presently receiving or have received services in the

past from another DHS refugee contractor. The case record must be clearly documented with the client’s response.

7. Services shall encourage self-reliance to the point where the individual and/or family can

successfully handle similar situations independently. When a client receives the same service (such as the same medical service) for a third time, the case record must document the necessity for repeat services.

8. Service(s) will coordinate with other resettlement, refugee, and community education

agencies without duplication. 9. All clients must be informed about and assisted, if needed, to complete change of

address forms with the USCIS within 10 days of moving to new address.





10. The contractor will maintain a separate case record for every person/family served. It will include documentation of, but not be limited to, the following:

a. Immigration status (refugee, Cuban/Haitian entrant, asylee, Vietnamese Amerasian,

Iraqi and Afghani Special Immigrant Visa (SIV) or victim of human trafficking) b. Alien registration number c. Social security number

If no social security card: 1. The case record must be documented noting arrival date of client and date that

social security card application was made. 2. After 90 days the agency director must notify the State Refugee Coordinator as

to the circumstances and actions taken by the agency to resolve any barriers that have prevented the issuance of the social security card.

d. The Secure & Verifiable Document O.C.G.A § 50-36-2 (Completed in full and notarized) PENDING – to be implemented upon notification from DHS with effective dates.

e. Nationality/country of origin f. Date of birth g. Date of entry h. County of residence i. Gender. j. A legible photocopy (front and back) of the I-94, I-551 (Lawful Permanent Resident)

card, asylum approval verification, victim of human trafficking letter and social security card is required for each person served when appropriate.

k. The case record will note each contact with the client and include appropriate date and details of the service or services provided.

11. Case record must ‘stand alone’ and include documentation of all service elements. If

required information is maintained separately from the case record, the case record must clearly document where the information may be found.

12. Case records must be maintained for at least seven (7) years following the last day

service was provided. 13. The contractor will be required to maintain and submit the DHS Refugee Resettlement

Program developed database (with complete data, all required fields accurately completed) or required reports and paperwork for CHP, SOR and RSIG contractors that will include, but not be limited to the following:

• Monthly Invoice, Programmatic and Performance Expectations/Outcomes

Reports Due by the 10th calendar day of the following month with the exception of September. September’s invoice must be submitted on or before the 25th of the month to allow for final processing of the invoice for the end of the contract year. (Except for RSIG, SOR and CHP Grants) Contractors must be prepared to close out services for whatever time is needed to comply. Invoices (except for September) will not be processed until programmatic





reports (narrative) and performance expectations/outcomes reports are submitted. In the event that the automated report function(s) of the DHS Refugee Resettlement Program database fail to work or malfunction; the contractor will complete the report(s) manually. Information submitted to DHS is verification that the contents are correct and approved by the Agency Director or approved designee.

• Trimester Programmatic Narrative Reports (SSG & TAG) Due February 10, June 10 and October 10.

• Quarterly Reports (CHP, RSIG & SOR) Due within 15 calendar days of the end of the quarter. (CHP & RSIG) Due within 10 calendar days of the end of the quarter. (SOR)

• Semi-annual Reports (RSIG & SOR) Due by the 10th calendar day after the end of the period.

• Semi-Annual Reports (CHP) Due by 15th calendar day after the end of the period

• Final Project Report (CHP, SOR & RSIG)

Due by 20th calendar day after the close of the project period (CHP & SOR) Due by the 35th calendar day after the close of the project period (RSIG) Final Project Reports are due every 2 years for RSIG Program and every 3 years for CHP and SOR Programs.

14. The date in the database must always be the date of service, not the date of data entry. (Exception CHP, SOR and RSIG contractors) The date of service must not change.

15. The date of entry must always be the date of entry to U.S. (not date of entry in Georgia)

and the date of the asylum granted for the asylee and other beneficiaries. 16. The Performance Expectations/Outcomes Automated Reports require that all fields be

completed in the DHS Refugee Resettlement Program database for each client and household member. (Exception: CHP, SOR and RSIG contractors) Unless specifically noted, all other Performance Expectations/Outcomes Reports must be completed manually in accordance with the Contract Monitoring/Review Standards and Guidelines.

17. The Pandemic Plan and Inclement Weather Plan must be updated and provided to DHS

within 60 days of contract execution. Staff must be provided training on these plans.





18. When providing services, the contractor may incorporate the use of subcontractors to

ensure comprehensive provision of the service(s). The contractor must submit a proposal to the State Refugee Coordinator that will disclose all subcontractors, including organization name and address, telephone number, contact person, and a complete description of work to be subcontracted. In addition, the proposal must include a detailed description of the organizational capacity and structure of the subcontractor. Any subcontract must have the PRIOR approval of the State Refugee Coordinator before services are provided by the subcontractor.

19. The contractor must provide or refer for participation in any or all service(s) translation

and interpretation; transportation; childcare and/or follow-up with DFCS.

20. If the contractor does not have a contract with DHS Refugee Resettlement Program to provide a specific service, wherever possible the agency must refer client to an agency with a DHS Refugee Resettlement Program contract for that service.

21. All requests for training, technical assistance, database changes, line item transfers or

special requests are to be made via written correspondence (email, memo, letter, etc.) to the Business Operations Specialist assigned to the contract. For Database changes and line item transfer request, agencies must use the DATABASE Line Item Transfer Request/Line Item Delete Form (copy of form and instructions –pages 50-52). For Budget Amendment requests for RSIG Contractors, agencies must use the form on pages 55-56. Budget Amendment Requests should be for the following month that you submit it (i.e., if you submit an amendment request June 8, 2010; if approved, the changes will be effective for the invoice that is submitted in July.) No more than 3 budget amendment requests will be allowed per contract year.

22. Contractors are required to have at least one representative attend DHS Refugee Programs Unit sponsored meetings, training events, etc.

23. Contractors must provide training relevant to the provision of service contracted with

DHS Refugee Programs Unit to their staff at least semi-annually. 24. Agency agrees to use the following chart (page 8) to identify agencies and services

offered for referral when appropriate:





Agencies Providing Refugee Services

AGENCY

CODE AGENCY NAME CHP DV ELI ES IS I&R RSIG RYP SA SOR

Atlanta Technical College X

Catholic Charities X X X X X X

Center for Pan Asian

Community Services X X X X X X

Georgia Piedmont

Technical College X

Global Village Project X

International Rescue

Committee X X X X X

Jewish Family & Career

Services X

Lutheran Services of GA X X X X X X

New American Pathways

(formerly RRISA and RFS) X

Refugee Resettlement &

Immigration Services of

Atlanta

X X X X X X

Refugee Women’s Network X

Somali American Community

Center X

Tapestri X

World Relief X X X X

Service Code Table

CHP – Cuban Haitian Program DV – Domestic Violence ELI – English Language Instruction ES – Employability Service IS – Immigration Services I&R – Information & Referral RSIG – Refugee School Impact Grant Program** RYP – Refugee Youth Program SA – Social Adjustment SOR – Services to Older Refugees Program





Billing and Funding Source Requirements

Performance Expectations/Outcomes: 100% Compliance with all elements Refugee services are made possible thru funds made available to states by HHS/ORR. Each fund source in addition to the general or ‘All Services requirements may have more specific criteria. Contractors and agencies must assure that for each case in which refugee services are provided, the case record is documented and, if TAG, labeled as to the source of the funds in which DHS will be billed and that all criteria have been met. DHS must not be billed for any service until all criteria for the service have been met. Contractors and agencies should use the following chart to determine the correct fund source to bill for service:

HHS/ORR (DHS Sponsored Services)

Requirements ‘All Services’ specifications required; the

following are in addition Social Services Grant (SSG) – (Immigration; Employability; Information & Referral; Social Adjustment; and Other – Domestic Violence; and Refugee Youth Programs)

1. All newly arrived refugees during first year in the U.S. 2. Refugees who are receiving cash assistance. 3. Unemployed refugees who are not receiving cash assistance. 4. Employed refugees in need of services to retain employment or to attain economic independence.

For Employability Services, Social Adjustment, Youth Program, and Domestic Violence: In the U.S. 5 years or less (Exception: If DHS receives a waiver from ORR).

For Immigration Services, Information & Referral: All eligible refugees regardless of length of time in the U.S.

Targeted Assistance Grant (TAG) - (Employability; English Language Instruction; Information & Referral; and Social Adjustment) This fund is only for refugees that reside/live in DeKalb and Fulton counties.

1. Cash assistance recipients, particularly long-term recipients. 2. Unemployed refugees who are not receiving cash assistance. 3. Employed refugees in need of services to retain employment or to attain economic independence.

For Employability Services, Social Adjustment: In U.S. 5 years or less (Exception: If DHS receives a waiver from ORR).

For Information & Referral services: All eligible refugees regardless of length of time in the U.S.

Refugee School Impact Grant (RSIG) All services require proof of Refugee Status.

1. All newly arriving refugee parents with school aged children (5-18) and/or school aged children who have been in the U.S. 3 years or less.

2. Refugee school aged students and parents in need of additional services in order to aid adjustment into the American School System who have been in the U.S. 3 years or more with prior approval from State Refugee Coordinator or designee.

Cuban-Haitian Program (CHP) Cuban and Haitian entrants and refugees Services to Older Refugees (SOR) Refugees age 60 and above regardless of length of time in

the U.S.





Allowable/Not Allowable

Allowable Not Allowable

Services may be provided to individuals who have been in the U.S. up to 5 years or less. (Exception: RSIG (3 years or less). CHP, SOR, Immigration Services and Information & Referral have no time limit.

Services may not be provided to individuals who have become naturalized citizens.

Services are available for: Refugees, Asylees, Cuban and Haitian Entrants, Amerasians, Iraqi and Afghani SIV’s, and Certified Victims of Human Trafficking.

Services cannot be billed for asylum seekers – asylum must be granted.

Victim of Human Trafficking Certification Letter from the Department of Health and Human Services, Office of Refugee Resettlement.

Services cannot be billed for applicants for victims of human trafficking – must be “certified”.

Asylum Approval Letter from USCIS Asylum Officer. Recommendation for Approval of Asylum letter is not an acceptable document.

Federal funding is available for a State’s expenditures for assistance and services to a family unit which includes a refugee parent or two refugee parents and one or more of their children who are non-refugees, including children who are United States citizens. (CFR 400.208a)

Federal funding is not available for a State’s expenditures for assistance and services provided to a non-refugee adult member of a family unit or to a non-refugee child or children in a family unit if one parent in the family unit is a non-refugee. (CFR 400.208b).

Criminal records history investigation must be completed on those employees who will have direct contact/provide treatment/custodial responsibility to clients for services rendered under this contract (Contract Paragraph 137.a).

If agency does not have a contract with Refugee Resettlement Program to provide a specific service, the agency must either refer client to an agency that has contract with Refugee Resettlement Program for that service or arrange to subcontract with that agency.

Agency may not deny, without referral, client service because contract with DHS Refugee Resettlement Program does not include service needed by client.

Date of entry should always be the date of arrival on I-94 or date asylum was granted or certification date of Victim of Human Trafficking.

Date of entry should not be date of entry into Georgia.

Files can be developed and maintained per client/family – not necessary to create separate file per service.

Resettlement agencies may populate the Refugee Services Tracking Database with data from WRAPS.





English Language Instruction

This service must teach English to a level that will permit effective communication through listening, speaking, reading and writing -- with emphasis on obtaining self-sufficiency. Special attention must be given to the language needs of newly arrived, pre-literate, women and elderly refugees. This service may be provided to individuals who have been in the U.S. up to 5 years. Service Elements

• English Language Evaluation and Assessment: Includes testing and assessment of verbal, written and comprehension testing as it relates to English as a second language.

• Instruction Plan Development: To ensure proper placement of individuals in classes that will best meet their needs to accomplish verbal, written and comprehension skills in the English language.

• Instruction: Curriculum design and instruction must accommodate the needs of the client (refugee) to ensure continued and comprehensive instruction until the client (refugee) is able to communicate effectively in English or five (5) year from date of entry. Curriculum criteria should include lesson plans for pre-literates, beginners, intermediate English, and advanced English users. Classes shall be provided, as often as possible, so that refugees who are employed may participate; this may include classes in the evenings for those who work during the day and weekends.

• Service Administration: The contractor will maintain an attendance record for each student, documenting the daily hours attended, monthly notes documenting progress of English proficiency; and recommendation for alternative instruction, advancement and/or conclusion of instruction. Whenever necessary, for refugee students referred by county DFCS offices, information regarding the student(s) will be provided through monthly programmatic and statistical reports (using the appropriate DFCS forms) forwarded each month to the appropriate county DFCS office.

• Child-Care: Whenever necessary, either directly or through referral, for participation in any or all ELI

• Transportation: Whenever necessary, through referral, for participation in any or all ELI.

• ELI classes may be provided off-site of the Technical Colleges. The Technical Colleges will determine the feasibility of the site, number of students per class, hours of attendance, etc. Requesting contractors must use the outlined procedures – pages 53-54 - for requesting a class to be provided off-site.

• Client Registration: The colleges are prepared to accept clients for registration every day except for 12 legal holidays and the College is closed on Fridays.

• If a client needing mandatory ELI in order to receive cash assistance through DFCS

comes to register, and the client has form 162 when they arrive, the Technical Colleges

will complete the form and sign it. Otherwise, the client will be registered like any other

client without form 162. Clients requiring proof of attendance will be handled as follows:

1. Georgia Piedmont Technical College provides a data base on these clients

which is automatically sent to the Multi-County DFCS supervisor monthly.

Georgia Piedmont Technical College will share this with other contractors

upon request.





2. Atlanta Technical College will fill in the attendance dates and sign the

monthly forms brought in by clients.

• The Technical Colleges are prepared to provide whatever hours are needed for TANF

clients in order to keep these clients eligible for cash assistance through DFCS or a

mandated service by Child Welfare. All other cash assistance clients will have their

need met through existing classes.

• In the best interest of the clients we serve, if a contracted agency knows in advance that

a number of new clients will need to register for ELI services, it is requested that they

contact the Technical Colleges in advance, set a date and time for registration and

ensure to the best of their ability that the clients arrive at the date and time arranged for

them. Otherwise, the client will be registered like any other client and will not receive the

special treatment the colleges are willing to provide to other contractors.

• Contract agencies should make sure that clients are aware of registration dates, times,

sites and contact person at the different sites offering this service. Clients will not be

registered for classes if they do not have required personal information such as:

• What agency they are working with if any

• If they are receiving any cash assistance

• Their name

• Address

• Contact number

• Transportation/Childcare needs

• I 94, or other appropriate validation of legal residency

• SS# if available

• Date of birth

It is incumbent on the contractors to send clients with the information listed above. If the client needing ELI services is unable to provide this information, they will have to return at another time in order to be registered. Any emergency or problems should be directed to the Program Director or their designee. Monthly Reporting

• Submit by the 10th calendar day of the month following the month in which services were provided (exception September)

• Invoice • Data Base • Performance Outcome/Expectations Report(s) with an analysis which includes progress,

toward meeting the goals; explanation of any circumstance that prevents progress toward meeting goal and corrective action plan (if not on track to meet goals; numbers served for the month and cumulative numbers and where they exceed or fall short of goals; etc.

The Performance based data must be entered monthly.





Trimester Reporting

Submit by the 10th calendar day of the month following the end of the trimester. Months due are February, June, and October. Please include the following:

• Frequency, type, results (e.g. advance to next level, etc.) and pros/cons of testing used. • Successful and non-successful teaching strategies for multi-level classes. • Strategies used with pre-literate students, and types of results. • Successes or obstacles to service provision (activities undertaken during the trimester;

milestones achieved, actions taken to overcome obstacles, etc.) • Identify areas of technical assistance needed • Summary of the Monthly Narrative Reports • Performance Outcome/Expectations Report(s) with an analysis which includes progress,

or lack thereof, toward meeting the goals; explanation of any circumstance that prevents progress toward meeting goal and corrective action plan to address; numbers served for the trimester and cumulative numbers and where they exceed or fall short of goals; etc.

Unit Rate & Payment

Unit Rate Code Payment ELI- Technical Colleges All levels of ELI $6.00 40.29 Per Student Instructional Hour


Allowable Not Allowable Classes ranging from pre-literate to advanced, with specializations may be billed.

TOEFL classes may be billed.

Performance Expectations/Outcomes (report is automated – assure all information is included in DHS

data base for an accurate report):

1. 100% compliance with all elements of the ‘All Services’ and ‘Billing and Funding Source’ sections.

2. After determining the total number of participants, the contractor will be expected to

maintain a 55% Attendance Rate of refugees.

3. After determining the total number of attendees that complete the curriculum/lesson plan for the level, the contractor will be expected to have achieved the following: 60% of the participants will have completed and demonstrated competencies for the level of ELI enrolled.

4. The contractor will maintain and report by level the total number of participants that

complete the level but fail to demonstrate competencies; fail to complete due to employment; and fail to complete – reason unknown.





Employability Services

Employability Services must provide all the necessary support and preparation to ensure employment. Successful employment is defined as unsubsidized work at more than the minimum wage and preferably with access to group medical insurance. Social Service Grant (SSG) and Targeted Assistance Grant (TAG) funds may not be used for long-term training programs such as vocational training that lasts for more than a year or educational programs that are not intended to lead to employment within a year. This service may be provided to individuals who have been in the U.S. up to 5 years. Employability Services must tie early employment to planned employment upgrade to allow economic self-sufficiency. If an individual is in need of skills or professional refresher training and other recertification services in order to qualify to practice his or her profession in the United States, the training may consist of fulltime attendance in a college or professional training program, provided that such training is approved as part of the individuals employability plan by the State Refugee Coordinator or designee; does not exceed one year duration (including any time enrolled in such program in the United States prior to the refugees application for assistance); is specifically intended to assist the professional in becoming relicensed in his or her profession and if completed can realistically be expected to result in such relicensing and/or certification. Refugee TANF Recipients and Employability Services (RTRES): To enable self-sufficiency and self-reliance for refugees with the most significant barriers to employment, RTRES will provide intensive Employability Services to refugees receiving TANF benefits. RTRES will work in close coordination with the local DFCS office to provide needed elements for this population – ELI (preliterate @10 hours per week); VESL – specialized language instruction for workforce @ 8 hours weekly; computer lab – basic instruction and literacy component combined @ 8 hours weekly; job readiness skill class @ 4 hours weekly; mock worksite training @ 4 hours weekly; job placement activities and interviews; regular attendance reporting to DFCS office (at least every two weeks); MARTA card distribution and form completion; and troubleshooting on case management with TANF case workers. Service Elements

• Family Self-Sufficiency Plan (FSSP): An overall assessment of the family needs for the purpose of enabling the family to become self supporting through the employment of one or more family members. The Family Self-Sufficiency plan will assess each member’s ability to support each other to accommodate childcare, transportation, training, etc. The FSSP must include an in-depth face-to-face interview and review of the following elements for each person in the family unit (as applicable): family size; name(s) and number of employable people in the household; name(s) and number of employed people in the family unit and earnings; adult to child ratio in the family unit; childcare needs; previous work experience (both in country of origin and U.S.); education level; English language skill level; literacy in native language; other languages spoken; health/disability status (including substance abuse, mental and physical health); age; gender constraints; domestic violence issues; children with discipline problems/school concerns; transportation issues; unusual issues and barriers; aptitude and skills testing; determination of economic and/or social benefits (TANF, Match Grant,





etc.); evaluation of applicable documents (degrees, certificates, etc.); and review/verification of all pertinent information.

The DHS Refugee Program defines a family unit as one of the following: • an individual adult with or without children • Married individuals with or without children • Parents with adult children • Custodial relatives with minor children who may or may not be eligible for TANF,

who are a part of the same household (family) unit. When two adults reside together and have a child(ren) in common, the adults and their child(ren) are considered one family unit. When two or more adults reside together, are not married, and there is no child(ren) in common, then each adult and his/her child(ren) is considered a separate family unit. When two adults are married to one another and are residing in the same household, they are considered a family unit responsible for his/her/their child(ren), even if they do not have a child in common.

Only one FSSP will be completed per family unit per twelve month period. The sharing of the FSSP within and between DHS contracting agencies is required. DHS will make available to contractors a monthly list of all clients where the FSSP has been billed to DHS. The list will contain the client’s name, alien registration number, address, date FSSP billed to DHS; and name of contractor that completed the FSSP. The list will be drawn from the database submitted by the contractors to DHS monthly. Therefore, the information that will be provided will only reflect the information reported from the last billing/report period. (Household and family unit can be used interchangeably). When using the DHS developed FSSP that is available on the DHS Database; contractors must complete all information items and pull all related screens. When other family self sufficiency plans are used outside of the DHS developed FSSP; contractors must assure that all information is gathered; the needs of all persons living in the household are considered and this information is clearly identified as a FSSP. Updates to the FSSP should be made when significant changes occur.

• Individual Employability Plan and Management (IEP): An individualized written plan for a refugee registered for employability services that includes determination of needed services, referral and/or accommodation of such services, and tracking of participation and progress. Only one IEP will be completed per individual per twelve month period. The employability plan must take into consideration information gathered from the FSSP; be designed to lead to the earliest possible employment; not be structured in such a way as to discourage or delay employment or job-seeking; contain a definite employment goal consistent with the employability of the refugee in relation to job openings in the area; and allow for future employment development. The provision of refugee employability services will be coordinated with employment training programs including those funded by the Workforce Investment Act of 1998.

• Employment Preparation: Pre-employment services to assist the refugee with their job search and exploration of job/career options. Services provided to clients must be





determined based on the FSSP and Employability Plan and must be individualized according to client need. Allowable services include: Interviewing skills preparation; job counseling; job orientation; job search (application help, follow up with employers); job workshop; resume preparation; U.S. Employment Orientation; English Language Instruction (focus on obtaining and/or maintaining a job); employment related computer training; Drivers Test Training – for a refugee with previous driving experience (test workshop, driver’s orientation and enrollment into specialized services); Assistance with employer requirements (drug screening, orientation, transportation, interpretation, new hire paperwork including benefits explanation). In addition On-the Job Training either directly or through referral, provided at the employment site that is expected to result in full-time, unsubsidized employment at that site is allowable. Level 1 Employment Preparation is to be billed on a one time basis and includes all necessary services listed above (as determined by Individual Employability Plan) to assist the refugee with obtaining their first employment placement. Level 2 Employment Preparation services are designed to assist the refugee with obtaining another employment placement due to loss of job or to find a better employment placement.

• Job Placement: Client is employed in an unsubsidized full time position (part time work must be approved by your contract Business Operations Specialist in order to bill) at more than the minimum wage and preferably with access to group medical insurance.

• Job Retention: Obtain verification of employment 90 days after start date. If the client is working at the 90 day follow up (gaps and/or changes in Employment during the 90 days are allowable) a one year follow-up must be done. If the client is not working at the 90 day follow-up, the process of following the client for this placement ends, with no one year follow-up.

• Employability Workshops: Allowable services include: Financial aid counseling; Orientation to area educational institutions; Education related application counseling; GED Test Preparation; TOEFL (test of English as a foreign language) exam preparation; Academic Admission Test Preparation (SAT, GRE, LSAT, etc.); and Goal planning. Workshops are designed to be delivered effectively and efficiently in group settings, where participants are able not only to learn from skilled presenters, but also to learn from questions asked by fellow participants, and through discussions with fellow participants. Workshops must be at least 90 minutes and delivered to groups of 15 or more people. When possible, each workshop will be delivered in a single language to a group of participants of the same ethnicity or language group who have registered in advance.

• Specialized Employment Preparation: As necessary, either directly or through referral. Allowable services are: Driver’s Training – for a refugee with no previous driving experience (provided by licensed, certified provider); and Academic Credential Evaluation.

Service Administration Employability Services must include each contact with the client and document (with the date, name and address of the employer) each job referral and job placement. Job placements will also note the type of job, wage, and benefits. Follow-up contacts at the work place after 90-days and 365 days after placement must also be recorded. If a referral





does not result in placement, the reason must be recorded. The contractor will maintain the following information to document services provided: (1) A list of clients receiving cash assistance including name, social security number, Alien number, county of residence, date referred by DFCS, and disposition; (2) A list of employers contacted, including name and address, dates contacted and information obtained; (3) A list of job referrals, including the name of the client, name of the employer, date of referral, and result; (4) A list of job placements, including the name of the client, name of the employer, and date of employment. Whenever necessary, when employability services are provided to refugees referred by DFCS county offices, information regarding these clients will be exchanged with the county departments using the appropriate DFCS forms. Job placements/terminations must be reported within 10 calendar days to local DFCS office and copies of monthly statistical and trimester programmatic reports will be forwarded to the State office. Employable refugees are required to register for employability services as a condition of receiving RCA; they must, within 30 days of receipt of aid, participate in employment services. Certificate of completion of driver’s training sessions must be maintained in the case file. Copies of academic credentials and of evaluations must be maintained in case file.

Monthly Reporting Submit by the 10th calendar day of the month following the month in which services were provided. (Exception: September)

• Invoice • Data Base • Monthly Narrative (report to include information pertaining to the first four bullets

under Trimester Reporting • List of invited participants and actual attendees of Employability Workshops.

The Performance based data must be entered monthly. Trimester Reporting

Submit by the 10th calendar day of the month following the end of the trimester. Months due are February, June, and October. Please include the following:

• Patterns of types of jobs, job placement, hourly wages, benefits, noticeable increases or decreases in any area, etc.

• Employers who have been hiring high numbers refugees • Successes or obstacles to service provision (activities undertaken during the trimester;

milestones achieved, actions taken to overcome obstacles, etc.) • Identify areas of technical assistance needed • Summary of the Monthly Narrative Reports • Performance Outcomes/Expectations Report with an analysis which includes progress,






Unit Rate & Payment

Employability Services Unit Rate Code Payment

Family Self Sufficiency Plan $180 41.70 One Time Individual Employability Plan and Management $150 41.75 One Time Employment Preparation Level 1 $150 41.81 One Time Employment Preparation Level 2 $50 41.82 Per Occurrence Job Placement $250 41.21 Per Occurrence 90 day Follow Up (Job Retention) $50 41.30 Per Occurrence I Year Follow Up (Job Retention) $50 41.40 Per Occurrence Employability Workshop $400 41.90 Per Workshop Specialized Employment Preparation $350 41.95 One Time

Refugee TANF Recipients and Employability Services Unit Rate Code Payment

Vocational Training & Work $13 41.57 Per hour

Allowable/ Not Allowable – Employability Services

Allowable Not Allowable Job placement without assessing education

and/or employment skills, knowledge and experience in US and country of origin.

Billing Social Adjustment to provide employment service -- these clients should be referred to an employment program.

A second job placement can be billed to DHS if there has been 31 or more days between jobs.

A second job placement cannot be billed to DHS if there has been less than 31 days between jobs.

Part-time employment can be billed with prior approval by your contract BOS.

Performance Expectations/Outcomes – Employability Services (report is automated – assure all information is included in DHS data base for an accurate report): After determining the total number of participants served, the contractor will be expected to achieve the following:


2. 70% of the total number receiving employment preparation services will be placed in a job

3. 75% of the total number placed in a job will have TANF and/or RCA cases are closed due to wages/increased income

4. 70% of the total number placed in a job will remain employed for 90 days 5. 85% of the total number that remained on a job for 90 days will remain employed for

1 year





6. 90% of those who receive Specialized Employment Preparation services will complete the service

7. 80% of the total number provided employability workshops will demonstrate increased knowledge after the post test.





Immigration Services

This service must focus on helping refugees become self-sufficient and meet all their immigration obligations to ensure continued residence in the US. This service may be provided to individuals who have been in US for 5 years or more.

Service Elements

• Lawful Permanent Resident (LPR) Application Preparation and Orientation: Provide assistance to complete the application for LPR status for client (refugee) and must provide and document orientation relating to LPR rights and responsibilities and eventual US citizenship.

• Naturalization/Citizenship Application Preparation and Orientation: Provide assistance to complete the application for US citizenship status for client (refugee) including culturally and linguistically appropriate counseling to prepare for the US citizenship process and interview. As necessary, refer client to available ELI and/or Citizenship preparation classes. Information must be clearly documented in case file. Additionally, documentation is required in the case file if the client declined the instruction/class or instruction/class is not needed. Whenever necessary, either directly or through referral, assistance to disabled refugees in obtaining disability waivers from English and civics requirements for naturalization, and the provision of interpreter services for the citizenship interview.

• Other Immigration Services: Provide assistance with the completion of applications for services such as: Temporary Protection Status for Haitian Parolee, Replacement or renewal of EAD (Employment Authorization Document) and Replacement I-94 card for Client.

Service Administration: Includes each contact with the client and will document the orientation or referral for instruction (as applicable), preparation of application, all necessary waiver requests, supporting documents, etc., and outcome. This service should focus on helping refugees become self-sufficient and meet all their immigration obligations to ensure continued residence in the US.

Monthly Reporting Submit by the 10th calendar day of the month following the month in which the service was provided: (Exception: September)

• Invoice • Data Base • Monthly Narrative (report to include information pertaining to the first six bullets for

citizenship and naturalization under Trimester Reporting The Performance based data must be entered monthly.





Trimester Reporting Submit by the 10th calendar day of the month following the end of the trimester. Months due are February, June, and October. Please include the following:

• Length of time to process LPR applications • Length of time to process Citizenship applications • Successes or obstacles in obtaining waivers (activities undertaken during the trimester;

milestones achieved, actions taken to overcome obstacles, etc.) • Frequency and circumstances necessitating interpreter services at Department of

Homeland Security (DHS)- Immigration • Successes or obstacles in ELI classes for citizenship/Civics • Identify areas of technical assistance needed • Summary of Monthly Narrative Reports • Performance Outcomes/Expectations Report with an analysis which includes progress,


Unit Rate & Payment

Unit Rate Code Payment Citizenship and Naturalization-Application $200 51.20 One Time per Individual Citizenship and Naturalization-LPR/Application $200 51.30 One Time per Individual Other Immigration Services $50 51.60 One Time per Individual For unusual circumstances, contact the assigned Business Operations Specialist to your agency



Only Board of Immigration Appeals (BIA) accredited staff may complete immigration forms for the client.

Unless BIA accredited, agency staff should not complete immigration forms.

LPR orientation relating to explain rights and responsibilities to accommodate eventual US citizenship.

Assistance with Application for Replacement EAD and/or I-94 Cards

Corrected I-94 cards is not an allowable service.

Assistance must be provided to disabled refugees in obtaining waivers from English and civics requirements for naturalization.

Proof of mailing LPR a. Documentation in case file that the

agency mailed it. b. Copy of mail receipt if mailed by client





c. Letter of receipt of application from USCIS

Performance Expectations/Outcomes (report is automated – assure all information is included in DHS data

base for an accurate report): After determining the total number of participants, the contractor will be expected to achieve the following: Performance Expectations/Outcomes for Citizenship/LPR application (report is automated – assure all information is included in DHS data base for an accurate report)

1. 100% compliance with all elements of the ‘All Services’ and ‘Billing and Funding

Source’ sections. 2. 100% confirmation Citizenship/LPR application mailed to USCIS

Georgia DHS Refugee Resettlement Program No DHS services are to be delivered without a fully executed contract in place. A fully executed contract is defined as a contract that has

been signed and dated by the DHS Commissioner and the Contractor.



Information & Referral

Service must provide instruction and assistance in accessing federal/state/local-funded programs (i.e., Food Stamps, Medicaid, WIC, energy assistance, low-income housing, childcare assistance, etc.) and community services. This will include accompanying the client to the service provider, when appropriate and especially with new arrivals and those with limited English proficiency. Information & Referral services will help refugees assimilate into their new lives in the US and to encourage self-reliance to the point where the individual and/or family can successfully handle similar situations independently. Information & Referral is designed to mainstream refugees into existing local, state and federal social service programs and to expedite client self-sufficiency. This service may be provided to individuals who have been in US up to 5 years or more. Service Elements

• Assessment and referral to services needed • Assistance with completing eligibility applications / forms • Service administration must include each contact with the client, provision of service and

outcomes/follow-up. • Case record must include either a copy of completed eligibility applications/forms with

thorough documentation or the application confirmation sheet with tracking number.


• Invoice • Data Base • Monthly Narrative (report to include information pertaining to the first four bullets under

Trimester Reporting The Performance based data must be entered monthly. Trimester Reporting Submit by the 10th calendar day of the month following the end of the trimester. Months due are February, June and October. Please include the following:

• Patterns of services referred • Patterns of outcomes achieved • Successes or obstacles to service provision (activities undertaken during the trimester;

milestones achieved, actions taken to overcome obstacles, etc.) • Identify areas of technical assistance needed





• Summary of Monthly Narrative Reports

• Performance Outcomes/Expectations Report with an analysis which includes progress, or lack thereof, toward meeting the goals; explanation of any circumstance that prevents progress toward meeting goal and corrective action plan to address; numbers served for the trimester and cumulative numbers and where they exceed or fall short of goals; etc.

Unit Rate & Payment

Unit Rate Code Payment Information & Referral $125 52.10 Per Occurrence



Agency may not bill individual family members for I & R service when an entire family is applying for same benefit using one application. Example: Food Stamps.

Information & Referral (I & R) assistance should be billed only once for the entire family when applying for a program such as Food Stamps, Medicaid, TANF, Peach Care, School Lunch Applications (for children in U.S. greater than 3 years), etc.

Assistance with school issues for refugee youth ages 5-18 in the U.S. for 3 years or less; these issues should be referred to a Refugee School Impact Grant Provider.

Referral to health care provider. Assistance with medical/dental appointment.

Legal Resource referrals LPR and Form N400. Referrals to low-income housing, homelessness prevention, and/or emergency rent assistance programs.

Assistance with purchasing a home or vehicle, or providing monetary rent assistance

Referrals to Energy Assistance Program. Referrals to Social Security and Social Security Benefits Application Assistance

Employment services.

Community services allowed include libraries, community service boards, senior centers, Legal Aid, YMCA, YWCA, Boys and Girls Club, community action agencies, and utility companies.

Referral to agency’s own (in-house) program.


base for an accurate report): After determining the total number of participants, the contractor will be expected to achieve the following:


2. Maintain a 90% approval rate for referrals made to public, private and governmental

agencies.





Refugee Youth Programs

Programs that focus on the special needs of refugee youth and their families. Services may include after-school programs, summer youth programs and enrichment activities, and gang-prevention activities. Service administration will include each contact with the client and will document the provision of service and outcome. This service may be provided to individuals who have been in the U.S up to 5 years. Service Elements

• Service administration should include each contact with the client, provision of service and outcomes.

• The after-school and summer programs will operate based on the school year. The after-school program will begin the 2nd week in August and end the 3rd week of May. The summer program will begin the 1st week of June and will end the last week of July. The 1st week of August, and the last week of May (when students are not in the after-school and summer programs) the contractor will be allowed to use that time to make preparations for the incoming students. These dates may change depending on the school calendar year. Program dates will differ for RSIG providers.

• Facilities providing after-school and summer youth programs must be licensed or exempt through the Department of Early Care and Learning (DECAL): Bright from the Start. They must apply for licensure or exemption through DECAL.

• Attendance Record -- The contractor must maintain an attendance record for each student, documenting the daily hours attended, monthly notes documenting progress of English proficiency; and recommendation for alternative instruction, advancement and/or conclusion of instruction.

• Case Record must ‘stand alone and contain full and complete information. If attendance or testing information is maintained separately, the case record must be clearly documented as to where the information is located.

• Parental Authorization -- Permission slips will be filed in each case record. A signed permission slip must be on file for each child to participate in the after-school/summer youth program and permission for the program to provide emergency medical treatment. 1) Individual permission slips must be on file for each specific field trip. 2) Permission slips may be written in English. 3) If the participant’s parent does not read and/or write English, the form must be

interpreted verbally in the language of the program participant’s parent or legal guardian as well as initialed and dated by the interpreter.

• Health and Safety Standards -- The following is a list of requirements that constitute the minimum standards for all after-school/summer camp programs: 1) Fire Safety

a. The Fire Department must inspect all facilities with youth programs once a year. b. Each new program participant/staff member must receive orientation to all exits

and meeting location upon entering program. Evacuation plans must be posted. In addition, fire and evacuation drills must be performed once each semester.

c. Fire suppression hood system is required for all programs where meals are prepared on-site.

2) Sanitation -- Sites with meal preparation must meet day care standards or County health Department standards.

3) Vehicular Transportation of Youth Participants





a. Seat belts must be used at all times and only one person may use each seat belt. b. Children under 12 years of age are not allowed to ride in the front seat of vehicle. c. Maximum occupancy of vehicles must not be exceeded. d. Cell phones or beepers must be available on all vehicles used to transport youth. e. Maintenance logs (including, but not limited to inspection; oil change; tire

inspection and rotation every 3,000 to 5,000 miles; etc) must be kept on all vehicles used by the agency to transport youth. It is recommended that one staff person be responsible for coordinating and managing vehicle maintenance logs.

f. Each vehicle used to transport youth on trips (greater than 5 miles) must include at least one other adult (staff, volunteer, parent, etc.).

g. Copies of valid drivers’ licenses proof of insurance, and vehicle licenses must be kept in personnel files of each staff person and volunteer who transport youth.

h. A log must be kept documenting each trip. It must include the following: date of trip, destination, driver(s), youth who went on trip.

i. Staff and volunteers are prohibited from taking youth to places other than their destination, without prior approval from program manager.

4) Facility Safety a. All spaces (yards, floors, etc.) must be free of holes dents protrusions, sharp

objects, glass, etc. b. Toys, games and play equipment must be in good condition and safe to use.

5) Employed and Volunteer Staff a. Criminal background checks must be completed for all staff working with

children. b. Criminal background checks must be completed for all volunteers working with

children or that have access to sensitive information. c. Volunteer staff must not be left alone with any child(ren) and must be

accompanied by at least one employed staff person. d. Employed and volunteer staff should be prohibited from visiting youth away from

the program except with the knowledge and approval of the program manager. 6) First Aid & Cardiopulmonary Resuscitation (CPR)

a. First Aid kits must be available in all facilities and each vehicle used to transport youth.

b. All staff must be trained in CPR and First Aid, and the training must be up to date.

7) Incident Reports a. An incident report must be made on every accident or injury to a child. b. Incident reports must be kept on file until child reaches the age of 18.

8) Adequate Staff /Youth Ratios Must be Maintained -- Following are recommended for daily activities at the youth program sites:

Grade range # of Youth # of Adults 1st – 3rd 0 –20 2 4th – 6th 0 –25 2

Middle School 0 –25 2 High School 0 -30 2

9) Water Safety a. For swimming, only facilities with lifeguards should be used. b. The following staff/youth ratios are recommended:





# of Swimmers # of Lifeguards # of Watchers 1 - 7 1 1

7 - 14 1 2 15 – 26 1 3 27 - 35 2 4


• Invoice • Data Base • Monthly Narrative (report to include information pertaining to the first four bullets

under Trimester Reporting The Performance based data must be entered monthly. Trimester Reporting Submit by the 10th calendar day of the month following the end of the end of the trimester. Months due are February, June, and October. Please include the following:

• A description of each project activity for the month • Include mainstream activities with other youth programs • Successes or obstacles to service provision (activities undertaken during the trimester;

milestones achieved, actions taken to overcome obstacles, etc.) • Identify areas of technical assistance needed • Summary of Monthly Narrative Reports • Performance Outcomes/Expectations Report with an analysis which includes progress,


Unit Rate & Payment

Unit Rate Code Payment After-School $125 61.10 Per child, per month, for 10 months Summer Camp Program $300 61.20 Per child, per month for 2 months


Allowable Not Allowable Volunteers are not allowed to transport children

without staff member present. Permission slips may be written in English, with notation of interpretation provided.

Volunteers are not allowed to monitor children, without a staff member present.





American born children of refugee parents are eligible to attend youth programs.

Children are not allowed to swim in pools where there is no lifeguard.

Staff / Volunteers are not permitted to visit, meet or take child (children) outside the parameters of the youth program, without the expressed knowledge and consent of the agency director.



After School and Summer Youth Programs 1. 100% compliance with all elements of the ‘All Services’ and ‘Billing and Funding Source’ sections. After School Program 1. Maintain an 80% Attendance Rate of currently enrolled students

2. For youth that complete the after school program for the contract year, 60% must achieve an incremental improvement in English proficiency and/or have met the goals set at start of program Summer Youth Program 1. Maintain an 80% Attendance Rate 2. Maintain an 80% Retention Rate





Social Adjustment

Social adjustment services will help refugees assimilate into their new lives in the US and to encourage self-reliance to the point where the individual and/or family can successfully handle similar situations independently. This service may be provided to individuals who have been in the US up to 5 years.

Service Elements • Individual Assessment, Work plan Development and Management: Must include

determination of needed services, referral and/or accommodations of such services and tracking of participation and progress. The Individual Assessment should be updated each time a Refuge Client returns for a Social Adjustment service. If a Family Self Sufficiency Plan (FSSP) has previously been completed for any member of this family unit, worker should update the FSSP during the Individual Assessment and Workplan Development stage. If no FSSP has been completed, complete the next element.

• Family Self Sufficiency Plan: An overall assessment of the family unit relating to integration into life and economic self-sufficiency in the U.S. Assessment will include an in-depth face-to-face interview; consideration of physical and/or mental health issues; aptitude and skills testing; measurement of employability (education and/or employment skills, knowledge and experience in US and country of origin detailing at a minimum any jobs in the U.S. and in the country of origin, where the client and any other family members gained skills that may be marketable in the U.S.); determination of economic and/or social benefits (TANF, Match Grant, etc.); evaluation of applicable documents (degrees, certificates, etc.); and review/verification of all pertinent information.

The DHS Refugee Program defines a family unit as one of the following: • An individual adult with or without children • Married individuals with or without children • Parents with adult children • Custodial relatives with minor children who may or may not be eligible for TANF, who

are a part of the same household (family) unit.

When two adults reside together and have a child(ren) in common, the adults and their child(ren) are considered one family unit. When two or more adults reside together, are not married, and there is no child(ren) in common, then each adult and his/her child(ren) is considered a separate family unit. When two adults are married to one another and are residing in the same household, they are considered a family unit responsible for his/her/their child(ren), even if they do not have a child in common.

Only one FSSP will be completed per family unit per twelve month period. The sharing of the FSSP within and between DHS contracting agencies is required. DHS will make available to contractors a monthly list of all clients where the FSSP has been billed to DHS. The List will contain the client’s name, alien registration number, address, date FSSP billed to DHS Refugee Resettlement program and the name of contractor that completed the FSSP. The list will be drawn from the database submitted by the contractors to DHS monthly.





Therefore, the information that will be provided will only reflect the information reported from the last billing/report period. (Household and family unit can be used interchangeably). When using the DHS Refugee Resettlement Program developed FSSP that is available on the DHS Refugee Resettlement Program Database; contractors must complete all information items and pull all related screens. When other assessments are used outside of the DHS Refugee Resettlement Program developed FSSP, contractors must assure that all information is gathered and the needs of all persons living in the household are considered and this information is clearly identified as a FSSP.

• One or more of the following sub services should be provided in order to bill clients for social adjustment:

1) Home Management includes either formal or informal instruction to individuals

and/or families in management of household budgets, home maintenance, nutrition and health, housing standards, transportation (access to driver’s education), tenant’s rights, community services, school issues and other consumer education services.

2) Emergency/Crisis Intervention includes formal or informal instructions to individuals and/or families to provide emergency services assessment and short-term counseling to persons or families in a perceived crisis, referral to appropriate resources, and the making of arrangements for necessary services. This service also includes Child Welfare issues.

3) Health Related Services include formal or informal instructions to individuals and /or families to provide information, referral to appropriate resources, assistance in scheduling appointments and obtaining services, and counseling to individuals and families to help them understand and identify their physical and mental health needs and maintain or improve their physical and mental health (specifically culturally sensitive trauma counseling).

Service administration: Includes documentation of each contact with the client as well as documentation of Individual Assessment, FSSP, Work Plan, provision of service, and outcomes/follow-up. Social Adjustment Safety and Life Skills Workshops: This service includes group training and counseling designed to help refugees acquire skills and knowledge related to personal and family safety in the home, in their neighborhoods, on public transportation, and while driving. Workshops are designed to be delivered effectively and efficiently in group settings, where participants are able not only to learn from skilled presenters, but also to learn from questions asked by fellow participants, and through discussions with fellow participants. Workshops must be at least 90 minutes and delivered to groups of 15 or more people. When possible, each workshop will be delivered in a single language to a group of participants of the same ethnicity or language group who have registered in advance.





Service Administration: This service will include, but is not limited to, documentation of the participant’s eligibility (I-94 and Social Security card), as well as documentation of intake, of the participant’s attendance at the workshop, and of the participant’s test score. This information will be kept in the participant’s case file or in a special group file which contains the documentation for each client who attended the workshop. Class curriculum: For each workshop offered, the contractor will provide a curriculum. The curriculum will include: 1) a lesson plan with the objectives and key points covered in the session with supporting materials such as visual aids; 2) where applicable, a guide to conducting any practical exercises; and 3) the contents of the exit exam. Outreach: Agencies providing the Social Adjustment Safety and Life Skills Workshops will recruit participants through outreach to eligible clients, through flyers, interagency communication, ethnic radio programs, ethnic newspapers, and the like.


• Invoice • Data Base • Monthly Narrative (report to include information pertaining to the first six bullets

under Trimester Reporting • List of invited participants and actual attendees of Safety and Life Skills Workshops • Manual Reports

The Performance based data must be entered monthly. Trimester Reporting Submit by the 10th calendar day of the month following the end of the trimester. Months due are February, June and October. Narrative should include the following:

• Patterns of need regarding health care • Patterns of need regarding emotional / integration counseling • Patterns of need regarding crisis intervention • Patterns of need regarding home management instruction • Successes or obstacles to provision of service (activities undertaken during the

trimester; milestones achieved, actions taken to overcome obstacles, etc.) • Identify areas of technical assistance needed • Summary of Monthly Narrative Reports • Performance Outcomes/Expectations Report with an analysis which includes progress,






Unit Rate & Payment

Unit Rate Code Payment Family Self Sufficiency Plan $180 50.17 One-Time per 12 months Individual Work Plan $100 50.18 One time Social Adjustment Service Provision -Home Management

$100 50.71

1 or more must be performed to bill for client

Social Adjustment Service Provision - Emergency/Crisis Intervention

$100 50.72

Social Adjustment Service Provision – Health Related

$100 50.73

Social Adjustment Safety and Life Skills Workshops

$400 50.81 Per workshop

Allowable/Non Allowable

Allowable Not Allowable Formal or informal instruction and/or assistance with home management services related to the following: 1) Household Budgets 2) Banking and Financial Institutions 3) Nutrition and Health 4) Home Maintenance / Housing Standards 5) Home Purchase 6) Home Safety 7) Rental and Tenants Rights 8) Transportation 9) Car/Vehicle Purchase 10) Parenting/Childcare 11) School Issues – for Pre-kindergarten and

Head Start refugee children (less than 5 years of age) or for those refugee children who have been in the U.S. between 4 and 5 years. All other school issues should be referred to a RSIG (Refugee School Impact Grant) provider.

Any or all of the following should not be billed under home management Social Adjustment: 1) Employability Services. This should be

billed to Employability Services or client should be referred to an agency providing employability services or DOL.

2) Client with a non-emergent legal problem and is referred to Legal Services. This should be billed to Information and Referral.

3) Assisting client with school system to address delinquency, discipline, etc. All school issues, except those listed in the allowable column, should be referred to a RSIG provider.

4) Immigration issues.

Formal or informal instruction and/or assistance with emergency/crisis intervention services related to the following:

1) Emergency Medical Issues 2) Death/Funeral 3) Suicide Prevention 4) Arrest and/or Emergent Police Issues 5) Emergency Shelter 6) Emergency Necessities 7) Emergency Financial/Cash Assistance

Any or all of the following should not be billed under emergency/crisis intervention Social Adjustment: 1) Client has a medical emergency and case

manager meets client at hospital to interpret and/or translate.

2) Case manager meets client at traffic court to assist with a traffic ticket. This is not an emergency and is not billable as social adjustment.





8) Emergency School Related Issues 9) Domestic Violence 10) Crime Victimization 11) Accidents/Natural disasters

Formal or informal instruction and/or assistance with obtaining health related services related to the following: 1) Health, dental and/or mental health care

provider(s) 2) Health Education or Counseling 3) Medications and/or Medical Equipment 1) Nursing Home 2) Home Health Care 3) Wellness on Wheels

Any or all of the following should not be billed under obtaining health-related Social Adjustment: 1) Assistance in obtaining Medicaid,

Peachcare, WIC, or any other government benefits. This service would be billed to Information and Referral.

2) Meeting the client at a hospital only to act as an interpreter/translator.




2. Determine total number of participants served 3. Achieve 100% resolution of situation and/or understanding of steps to manage

situation Performance Expectations/Outcomes Social Adjustment Safety and Life Skills Workshops: (report is Manual): After determining the total number of participants, the contractor

will be expected to achieve the following:

1) 100% of participants will take an exit exam of the knowledge they gained in the

workshop. 2) 100% of participants will take a pre-test to determine their level of knowledge prior to

the workshop. 3) 80% of participants will show increased knowledge after their post test.





Domestic Violence Prevention

This service provides domestic violence prevention for the refugee community by combining both prevention and intervention, which includes, a) community education/orientation sessions on family violence, b) a support group composed of men who are potentially violent, and c) a support group for the female partners of these men. This service may be provided to individuals who have been in the U.S. up to 5 years. Service Elements

• Community education sessions (minimum 2 hours) on domestic violence prevention, including definition of family violence; types/cycles, effects and consequences of violence, effects of violence; consequences of child abuse; US laws; immigration consequences and resources.

• Therapy support group sessions (2 hours per week for 24 weeks) for male & female perpetrators of domestic violence who have been mandated by the court. The provider of Therapy Group Sessions must be a certified family violence intervention program. Sessions will include the same topics as the community education sessions and cultural norms, perceptions of masculinity, responsible parenthood, and communication and responsibility. Monthly contact will be made to partners of participants in therapy support group sessions to offer assistance and referrals as needed, as well as to invite them to attend the Women’s or Men’s Group Sessions

• Women’s and Men’s Group Sessions (2 hours per session for 4 sessions) for those at risk of domestic violence. This will include the same topics as the community education sessions and cultural norms, as well as parenthood, relationships in marriage, communication and responsibility. Classes should be divided based on gender.

• Coordination with probation departments, if applicable

Services Administration will include documentation of each contact with each client, provision of services, and outcome. Also include pre and post tests with scores for each participant and attendance. Monthly Reporting Submit by the 10th calendar day of the month following the month in which the service was provided: (Exception: September)

• Invoice • Data Base • Monthly Narrative (report to include information pertaining to the first three bullets

under Trimester Reporting The Performance based data must be entered monthly.





Trimester Reporting Submit by the 10th calendar day of the month following the end of the trimester. Months due are February, June, and October. Narratives should include the following:

• Document results of men’s and women’s support groups • Successes or obstacles to service provision (activities undertaken during the trimester;

milestones achieved, actions taken to overcome obstacles, etc.) • Identify areas of technical assistance needed • Summary of Monthly Narrative Reports • Performance Outcomes/Expectations Report with an analysis of performance

outcomes/expectations (include progress, or lack thereof, toward meeting the goals; explanation of any circumstance that prevents progress toward meeting goal and corrective action plan to address; numbers served for the trimester and cumulative numbers and where they exceed or fall short of goals; etc.)

Unit Rate & Payment

Unit Rate Code Payment Community Education Sessions $90 70.30 Per Person Men’s Support Group Sessions $90 70.35 Per Person Women’s Group Sessions $90 70.36 Per Person Therapy Support Group Sessions $90 70.37 Per Person


Allowable Not Allowable Individuals who have been in the U.S. up to 5 years.

Men’s support groups dealing with topics not related to family violence intervention

Performance Expectations/Outcomes (manual report – DHS database will not calculate report): After determining the total number of participants, the contractor will be expected to achieve the following:


2. 60% of Community Education Session participants will demonstrate increased knowledge of information provided during sessions.

3. Therapy Support Group Sessions • Maintain a 85% attendance rate • 60% of participants that complete the 24 weeks will demonstrate an

understanding of the information provided. 4. 85% of the initial contact with the partners will be provided information. 5. 60% of Women’s and Men’s Group Sessions participants will demonstrate increased

knowledge of information provided during sessions.





Refugee School Impact Grant

This service must assist refugee school aged children (5-18 years) to improve their academic performance and social adjustment to schools. Refugees older than 18 years are eligible provided that they are eligible full time High School students. The primary focus is to help newly arrived refugees that have been in the United States (U.S.) for one year or less. Those refugee children that have been in the U.S. three years or less but are continuing to face persistent challenges in schools are also eligible with approval from State Refugee Coordinator or designee. Agencies do not have to provide all services listed under Service Elements. Success in schools is measured by improved academic performance and English language proficiency, high classroom attendance rate, successful graduation and/or grade advancement rate, full school participation, development of leadership skills, and increased involvement of refugee parents in school activities. While funding is focused on activities that attribute to refugee children’s school success and that can be measured; Agencies must provide support to the parents of the student’s participating in agency programs that will promote increased involvement of refugee parents in school activities. Service Elements Assessment and Performance Level Measurement

• Needs Assessment: Each child must be administered a needs assessment that takes a holistic view of the child; taking into account their past experiences and current situation. Assessment must include family data (siblings, parents,), medical and mental health issues, academic information (current grade level, years of schooling, type of schooling, etc.), linguistic needs, interests, learning styles and other information that will ensure the programming meets their needs and that they achieve success in schools and the program. (Use assessment provided by DHS Refugee Programs Unit).

• Baseline Assessment: Each child in the program will be given an initial assessment that measures academic performance and levels in English Language, math, reading, and comprehension. There MUST be an initial assessment given to each child at the Start of the program. Assessment must be re-administered mid-way through and at the end of the program. (Use assessment(s) provided by DHS Refugee Programs Unit).

• Individualized Service Plan (ISP) and Goal Tracker: Based on information from the needs and baseline assessments; an IPP must be developed for each student that focus on educational, language and/or social/cultural adjustment goals for program duration. Individual goals must be set for each participant. The ISP and goals must be monitored and updated as needed at a minimum of every month.

Refugee School/After School Youth Programs: Refugee School/After School Youth Programs include the following: Classroom instruction, mentoring, after school and tutoring programs, The school youth programs will promote student school readiness, academic improvement and social adjustment in schools. Programs will provide homework assistance, tutoring, computer skill instruction, English Language Instruction, homework completion. Students will participate in academic enrichment activities designed to foster





excitement about learning. The school youth programs will focus on improving students’ reading, language arts, English and math skills. Students Individualized Service Plans (ISP) will be utilized in order make the program specific for each participants needs. In addition to individual student goals that are measured monthly the program must track school attendance and grades for each student participant and maintain copies of progress and report cards.

Refugee Summer Youth Program – The summer youth program is also designed to promote student school readiness, academic improvement and keep parents engaged and involved with their children’s educational activities throughout the summer months. Students will participate in various activities including cultural arts, health and wellness, service learning and field trips. Program should meet a minimum of 4 days per week during summer months. Student Orientation & Education Sessions – Youth orientation & education sessions are approved standardized workshops/classes with a defined curriculum and performance measurement tool (i.e. pre/posttest, etc.). Standard session topics should include: Initial School Orientation/Orientation to the American (Georgian) School System; Standardized Testing; Internet Safety; Higher Education; Behavior Management; Gang, Alcohol, Drug Prevention; Student Rights; The College Application Process; Bullying; After School/Summer Employment; and other topics with approval. Group Sessions should: be 2 hours in length, be culturally appropriate (included translation and interpretation as needed), and interactive. For each session, students should be given pre and post tests to determine knowledge. The sessions should be designed to address the needs of both the newly arrived refugee student as well as the refugee student who has been here a little longer but still needs assistance with navigating the school system. Refugee Parental Support: Refugee parental support involves activities that promote refugee student academic success and increased parental participation in school activities. Support activities can include but are not limited to: home visits and school related casework and case management services. School related casework consists of comprehensive, educationally-focused case management services to include: facilitation for critical parent/teacher conferences; assistance to refugee parents in attending school meetings; referrals for students and parents to vocational training, special education services, student/parent ELI classes, after-school and summer programs, and other academically related social service programs as needed. Each home visit must have a clearly defined goal and expected outcome.

School Based Assistance: This service should provide direct assistance to schools in order to meet the unique needs of the refugee population. School Based Assistance covers training sessions for teachers, administrators and other school personnel to provide information on Refugee cultures, experiences, needs and best practices. A pre and posttest must be administered to each attendee. For languages that are hard to find interpreters or languages that are minimally represented in the refugee community, this service can also assist with translating school related documents and interpretation services to make school meetings, conferences, assemblies, etc., accessible for the refugee population. Must receive prior approval.





Service Administration: The contractor will maintain a case record for each client/family. Case records should include all identifying information (see number 10 under the All Services section) and document services provided, program hours attended, client progress, pre/post test results (if applicable), needs assessment, Individualized Service Plans, referrals and any other relevant documentation. Case files should also include each contact with the client, provision of service, date(s) and outcomes. Case Record must ‘stand alone and contain full and complete information. If attendance or testing information is maintained separately, the case record must be clearly documented as to where the information is located. Parental support information can be kept in the file with student’s information. You must obtain I-94/proof of refugee status for parents as well as students.

• Translation and interpretation services must be provided as needed to each participant in order to convey technical information and to ensure that adequate and correct communication exists between the school, the parents and community.

• Facilities providing youth school and summer youth programs must be licensed or exempt through the Department of Early Care and Learning (DECAL): Bright from the Start. They must apply for licensure or exemption through DECAL.

• The contractor must maintain an attendance record, ISP and Goal Tracker for each participant Youth School/Summer Programs, and Student Orientation & Education Sessions); documenting the daily hours attended, monthly notes documenting progress of proficiency; and recommendation for alternative instruction, advancement and/or conclusion of instruction.

• Contractors will maintain a list of school trainings; including topic, list of participants/sign-in sheet, evaluation measures, and date of training. (School Based Assistance).

• Contractors will submit a monthly client report using the format provided by DHS Refugee Programs Unit.

• For Youth School and Summer Programs, permission slips will be filed in each case record. A signed permission slip must be on file for each child to participate in the after-school/summer youth program and permission for the program to provide emergency medical treatment. 1. Individual permission slips must be on file for each specific field trip. 2. Permission slips may be written in English. 3. If the participant’s parent does not read and/or write English, the form must be interpreted verbally in the language of the program participant’s parent or legal guardian as well as initialed and dated by the interpreter.

• The following is a list of requirements for health and safety standards that constitute the minimum standards for all youth-school/summer youth programs: 1. Fire Safety

a. The Fire Department must inspect all facilities with youth programs once a year. b. Each new program participant/staff member must receive orientation to all exits

and meeting location upon entering program. Evacuation plans must be posted. In addition, fire and evacuation drills must be performed once each semester.

c. Fire suppression hood system is required for all programs where meals are prepared on-site.

2) Sites with meal preparation must meet day care standards or County health Department standards.

3) Vehicular Transportation of Youth Participants a. Seat belts must be used at all times and only one person may use each seat belt.





b. Children under 12 years of age are not allowed to ride in the front seat of vehicle. c. Maximum occupancy of vehicles must not be exceeded. d. Cell phones or beepers must be available on all vehicles used to transport youth. e. Maintenance logs (including, but not limited to inspection; oil change; tire

inspection and rotation every 3,000 to 5,000 miles; etc.) must be kept on all vehicles used by the agency to transport youth. It is recommended that one staff person be responsible for coordinating and managing vehicle maintenance logs.

f. Each vehicle used to transport youth on trips (greater than 5 miles) must include at least one other adult (staff, volunteer, parent, etc.)

g. Copies of valid drivers’ licenses, proof of insurance, and vehicle licenses must be kept in personnel files of each staff person and volunteer who transport youth.

h. A log must be kept documenting each trip. It must include the following: date of trip, destination, driver(s), youth who went on trip.

i. Staff and volunteers are prohibited from taking youth to places other than their destination, without prior approval from program manager.

4) Facility Safety a. All spaces (yards, floors, etc.) must be free of holes dents protrusions, sharp

objects, glass, etc. b. Toys, games and play equipment must be in good condition and safe to use and

sanitized daily. 5) Employed and Volunteer Staff

a. Criminal background checks must be completed for all staff working with children. b. Criminal background checks must be completed for all volunteers working with

children or that have access to sensitive information. c. Volunteer staff must not be left alone with any child(ren) and must be

accompanied by a at least one employed staff person. d. Employed and volunteer staff should be prohibited from visiting youth away from

the program except with the knowledge and approval of the program manager. 6) First Aid & Cardiopulmonary Resuscitation (CPR)

a. First Aid kits must be available in all facilities and each vehicle used to transport youth.

b. All staff must be trained in CPR and First Aid, and the training must be up to date.

7) Incident Reports a. An incident report must be made on every accident or injury to a child. b. Incident reports must be kept on file until child reaches the age of 18.

8) Adequate Staff/Youth Rations Must Be Maintained – The following are recommended for daily activities at the youth program sites:

Grade range # of Youth # of Adults 1st – 3rd 0 –20 2 4th – 6th 0 –25 2

Middle School 0 –25 2 High School 0 -30 2

9) Water Safety a. For swimming, only facilities with lifeguards should be used. b. The following staff/youth ratios are recommended:

# of Swimmers # of Lifeguards # of Watchers 1 - 7 1 1





7 - 14 1 2 15 – 26 1 3 27 - 35 2 4

REPORTING Monthly Reports Submit by the 15th calendar day of the month following the month in which services were provided with the exception of the last invoice and report which must be submitted within 10 calendar days of the end of the contract. Supporting documentation (expense reports, time sheets, receipts, etc.) must accompany report until advised otherwise by State RSIG Program Manager and must be kept on file at agency for review by DHS Refugee Program Unit Staff:

• Invoice • Monthly Performance Expectations/Outcomes • Client report for all services (use template provided by DHS Refugee Programs Unit)

Quarterly Reports Submit within 10 calendar days of the end of the period. Quarterly reports are due November 24th and May 25th. On months where a Semi-Annual Report is to be submitted, a quarterly report is not required. Quarterly narrative reports should include the following information (Use report template provided by DHS Refugee Programs Unit):

• Major activities and accomplishments during this period. Use project task chart to document goals and actual results for each service area.

• Problems. Describe any deviations or departures from the original project plan. • Significant findings and events. • Performance Outcomes

Semi-Annual Reports Submit within 10 calendar days of the end of the period. Semi-annual reports are due February 24th and August 24th. Semi-Annual reports should include the following (Use report template provided by DHS Refugee Programs Unit):

• Major activities and accomplishments during this period, including performance outcomes. Use project task chart to document goals and actual results for each service area.

• Problems. Describe any deviations or departures from the original project plan. • Significant findings and events. • Dissemination activities. Describe project related inquiries and information

dissemination activities carried out over the reporting period. Include a copy of any newspaper, newsletter, magazine article or other published material considered relevant to project activities, or used for project information or public relations purposes.

• Other activities. • Activities planned for new reporting period.

Final Project Report Submit within 35 calendar days after the close of the 2 year project period using report template provided by DHS Refugee Programs Unit. Final Project Report is due September 19, 2016. Final Project Report should include the following information:





• Major activities and accomplishments during this period, including performance

outcomes. Use project task chart to document goals and actual results for each service area.

• Problems. Describe any deviations or departures from the original project plan. • Significant findings and events. • Dissemination activities. Describe project related inquiries and information

dissemination activities carried out over the reporting period. Include a copy of any newspaper, newsletter, magazine article or other published material considered relevant to project activities, or used for project information or public relations purposes.

• Other activities. • Activities planned for new reporting period.

Performance Expectations/Outcomes:

After determining the total number of participants, the contractor will be expected to achieve the following:

1. 100% compliance with all elements of the ‘All Services’ and ‘Billing and Funding

Source’ sections. 2. Assessment & Performance Level Measurement

• 100% of students will have a needs assessment completed. • 100% of students will have been administered an initial assessment that

determines baseline performance levels. • 100% of students completing program will have assessment re-administered

midway and at end of program to determine progress. • 100% of students will have an Individualized Service Plan with Goal tracker that

is managed and updated monthly.

3. Refugee School/After School Youth Programs • Maintain an 85% attendance rate in program. • Maintain a 75% retention rate in program. • Individual goals will be set for participants based on ISP. Individual goals must

be monitored monthly. 85% of youth will meet set individual goals. • 80% of students will increase their rate of homework completion. • 75% of refugee students that complete the program will demonstrate improved

English language proficiency and/or numeracy. • 80% of refugee youth who complete the program will advance to the next grade

level. • 75% of students will show improved academic performance

4. Refugee Summer Youth Program • Maintain an 80% attendance rate in summer youth program. • Maintain a 75% retention rate in summer youth program. • Individual goals will be set for participants. Individual goals must be monitored

monthly. 85% of youth will meet set individual goals.





5. Student Orientation and Education Sessions

• 75% of students will maintain or demonstrate an increased knowledge of the American School System and other subject matter as evidenced by administered Pre and Post tests at each session.

6. Refugee Parental Support

• 75% of parents will return to the school for at least one additional school-based engagement activity within the school year.

• 90% of parents will be connected to and utilize appropriate educational resources (i.e. home-school liaisons and other support services)

• 100% of refugee parents with students in the program will receive at least 1 home visit with clearly defined goals/objectives.

7. School Based Assistance (Trainings)

• 75% of school system personnel will demonstrate increased knowledge using pre/post test.



Must document proof of refugee status for all clients.

Services to students or refugees that are not refugees. Unaccompanied minors are not eligible for services under this grant.

Documentation/copies of all expenditures submitted with monthly invoice.

Submission of invoice without supporting documents. Equipment purchases (computers, printers, copiers) are not allowed.

Refugee students ages 5-18 who have been in the U.S. for one year or less (3 years or less with approval and demonstration of continued need). Also refugee students older than 18 years of age that are enrolled full time in high school.

Refugee students older than 18 years of age enrolled part-time in high school.





Cuban-Haitian Program

Service must assist the Cuban/Haitian refugees and entrants most in need of additional support; which includes the newly arrived, Cuban/Haitian refugees and entrants without family or voluntary agency support and/or the long-term unemployed and unintegrated Cuban/Haitian refugees and entrants who are unable to access adequate services through mainstream assistance. Services should assist Cuban/Haitian refugees and entrants in obtaining skills which are necessary for economic self sufficiency, including projects for job training, employment services, professional refresher training and other recertification services; to provide training in English when necessary; and provide social and other services where specific needs have been shown. Contracting agencies must provide comprehensive unduplicated services (see number 8 under All Services) to Cuban-Haitian refugees and entrants that are linguistically and culturally appropriate. Service Elements Employment Services: This service must focus on helping Cuban/Haitian refugee or entrant to become and remain financially self-sufficient. Employment should be unsubsidized and above minimum wage. Priority should be for full-time jobs, especially those that offer health insurance and other benefits. Women in the Cuban-Haitian Program must be extended the same opportunities as men. Employment services to the Cuban-Haitian refugees and entrants include assessment and pre-employment counseling; job development and placement; services aimed at placing two or more family members in jobs in order to achieve self-sufficiency; and supportive services, such as transportation and transitional child care to help Cuban/Haitian refugees maintain employment or participate in employment services.

• Pre-placement Services include needs assessment, job orientation, work plan, resume development, budgeting, and job readiness. These Services focus on assessing the individual needs, goals, skills of clients and preparing them for sustainable employment. Employment Specialists must teach clients how to fill out a job applications accurately, how to create a resume so that they will be more prepared for today’s online job applications, provide instructional materials in client’s own language, conduct mock interviews and work with clients to improve their interviewing skills, teach clients key words to remember during interviews, assist clients in addressing transportation and childcare issues, and any other barriers.

• Job Placement services include contacting potential employers on client’s behalf; scheduling appointments for and transporting clients to interview; assisting with completion of application forms and helping clients obtain appropriate clothing. Additional follow up with employers regarding application status; employee progress and performance checks upon hiring; arrange for and transport client to drug testing and provision of interpretation during job interview or on the job training are also allowable services. Successful job placement is an unsubsidized full time job or part time jobs at more than the minimum wage and preferably with access to group medical insurance. Utilization of Department of Labor (DOL) is required.





• Follow-Up Services include contacting client and/or employer at 90th day of

employment and again after one year to address questions and concerns and to make any additional referrals as needed.

Immigration Services: This service must be designed to assist Cuban/Haitian Refugees and entrants with their application to adjust to United States permanent residency and citizenship. Services also must be offered to assist disabled Cuban/Haitian refugees and entrants in obtaining disability waivers from English and civics requirements during the naturalization process. In addition, services can include assistance with applications for Employment Authorization Documents (EAD) and renewals; and assistance with Temporary Protection Status for Haitian parolee. All immigration programs must have attorneys and/or Board of Immigration Appeals (BIA) accredited representatives working cases.

Service Administration: Employment Services

• Case records must includes each contact with the client and document the date, name and address of the employer. Case file must include documentation of the type employment services that were provided to the clients (Pre-placement, Jobs placement, or Follow-Up services)

• Job placements must note the type of job, wage, and benefits. Follow-up contacts at the work place after 90-days and 1 year should also be recorded.

• The contractor will maintain the following information to document services provided: (1) A list of employers contacted, including name and address, dates contacted and information obtained; (2) A list of job referrals, including the name of the client, name of the employer, date of referral, and result; (3) A list of job placements, including the name of the client, name of the employer, and date of employment. Whenever necessary, when employment services are provided to the clients referred by DFCS county offices, information regarding these clients will be exchanged with the county departments using the appropriate DFCS forms. Case files for these clients should include: date referred by DFCS and disposition. Employable clients are required to register for employment services as a condition of receiving RCA; they must, within 30 days of receipt of aid, participate in employment services.


• Includes each contact with client and will document the service provided, orientation, preparation of application, outcomes and any necessary follow-up.

Quarterly Reporting Quarterly reports must be submitted on the following dates: January 15th, April 15th, July 15th and October 15th. Quarterly reports should include:

• Invoice • Quarterly Narrative Progress Report (use report template provided by DHS Refugee

Programs Unit)





• Client List • Performance Expectations/ Outcomes

Semi-Annual Reporting Semi-annual reports must be submitted by April 15th and October 15th. Semi-annual reports should include:

• Semi-Annual Narrative Progress Report (use report template provided by DHS Refugee Programs Unit)

• Client List • Performance Expectations/Outcomes

Final Project Reporting Within 20 calendar days of the close of the 3 year project period, a final project report is due. Final Project Report should include the following:

• Final Narrative Progress Report (use report template provided by DHS Refugee Programs Unit)

Performance Expectations/Outcomes: Performance Expectations/Outcomes are cumulative and must be submitted to DHS on a quarterly and semi-annual basis. Employment Services

• 100% compliance with all elements of the ‘All Services’ and ‘Billing and Funding Source’ sections.

• 100% of clients receiving Employment Services will receive pre-employment services. • 80% of clients are employed within 90 days of entering the employment program. • 85% of clients placed in a job are still employed 90 days after placement. • 80% of clients are still employed at the one-year follow up



• 100% of clients who request adjustment of status of LPR and N400 will receive assistance with applications

• 100% of clients who request services of Employment Authorization Document and renewal, parole renewals for parolees, and court hearings will receive assistance





Services to Older Refugees

The Services to Older Refugees Program must provide services that assists the older refugee population in achieving access to existing senior services and decrease barriers to participation in services. This service will provide a holistic and comprehensive service model that maximizes elderly independence. Agencies should establish and/or expand a working relationship with the State Agency on Aging and the local community Area Agency on Aging to ensure all older refugees in the community are linked to mainstream aging services in the community. This service must provide appropriate services to all older refugees who are not currently being provided for by the community; link older refugees with appropriate services in the community to increase independent living; create opportunities that enable older refugees to live independently as long as possible; and link older refugees to existing naturalization services, or, if services are non-existent or inadequate, develop such services with special attention to newly-arrived older refugees and those who have lost, or are at risk of losing Supplemental Security Income and/or other Federal benefits. Agencies do not have to provide all services identified in the Service Elements. Services may be provided to individuals who are 60 years of age and older, regardless of length of time in the U.S. Services must be provided in a culturally and linguistically appropriate manner. Service Elements Information & Referral: Services that will increase refugee seniors access to federal, state, local and community services, resources, supports and programs. Information & Referral is designed to mainstream older refugees into existing local, state and federal social service programs and to expedite client self-sufficiency. Services must include: intake and assessment; referrals to needed programs, activities and/or services and assistance with filling out public assistance forms (i.e. Social Security benefits, Supplemental Security Income, Medicare and Medicaid, subsidized senior rental housing, Food Stamps, Low Income Heating and Energy Assistance Program, etc.). Agencies must develop a referral system with the local aging services agencies.

Support Services/Other: Services that increase senior mobility and provide activities that are not readily available to senior refugees in the community Allowable services include transportation; public transportation training and assistance; recreational outings; day trips; tickets to community events; gift cards; access to adult day centers; and senior support groups. Service Administration: Case file includes each contact with the client and must include documentation of the type of services that were provided to the clients referrals, outcome, follow up, dates of classes, etc.. Case files must include clients name, social security number, alien number, county of residence and include case notes, needs assessments and other client documents. Case record must include either a copy of completed eligibility applications/forms with thorough documentation or the application confirmation sheet with tracking number. For Nutrition, Lifestyle and Health Management and citizenship classes must provide class format and maintain attendance records.





Quarterly Report Services to Older Refugees (SOR) Quarterly reports must be submitted on the following dates: January 10th, April 10th, July 10th and October 10th. Quarterly reports must include:

• Invoice • Quarterly Narrative Progress Report (use report template provided by DHS Refugee

Programs Unit) • Client List • Performance Expectations/ Outcomes

Semi-annual Report Services to Older Refugees (SOR) Semi-annual reports must be submitted by April 10th and October 10th using report template provided in contract. Semi-annual reports must include:

• Table with Summary of Services for the report period • Major activities and accomplishments (for each service activity) for the period • Performance Outcomes • Problems encountered • Significant findings and events • Dissemination activities • Other activities • Activities planned for next reporting period

Final Report

Due by 20th calendar day after the close of the project period using report template provided in contract. Final report must include:

• Table with Summary of Services for the report period • Major activities and accomplishments (for each service activity) for the period • Performance Outcomes • Problems encountered • Significant findings and events • Dissemination activities • Other activities • Any additional relevant information • Proposed activities that were not completed with explanation





Performance Expectations/Outcomes: Performance Expectations/Outcomes is cumulative and must be submitted to DHS on a quarterly basis; also a Semi-Annual Performance Expectations/Outcomes Report must be submitted. Performance Expectations/Outcomes Report must be completed manually in accordance with the Contract Monitoring /Review Standards and Guidelines. Information and Referral Services


• 90% approval rates for referrals made to public, private, and governmental agencies • 100% of senior refugees will be referred to mainstream aging services as requested • 100% of senior refugees will have individual needs assessments conducted

Decrease Barriers to Participation in Services

� 100% compliance with all elements of the ‘All Services’ and ‘Billing and Funding Source’ sections.

• 100% of senior refugees will be provided transportation as needed • 95% of senior refugees will be provided supportive services and/or recreational

activities. Allowable/Not Allowable


Older refugees (Asylees, Cuban and Haitian entrants and Victims of Trafficking) 60 years and older. There is no time limit in U.S. on eligibility of services.

Refugees, Asylees, Cuban and Haitian entrants and Victims of Trafficking who have become U.S. Citizens.





DATABASE Line Item Transfer Request/Line Delete Form

Instructions

1. Open MS Spreadsheet provided by DHS at beginning of Contract Year 2. Reference most recent submitted Invoice. 3. Looking at your most recent invoice, enter the number of Units you currently have in each Line Item in the “Current Units” column. 4. Enter the number of units you have already billed in the “Previously Billed Units” column. 5. Enter the number of units you are proposing to change to in the “Proposed Units” column. 6. Make sure that the total at the bottom of the “Proposed Total” equals your total contract amount. Do not attempt to change any other numbers as the spreadsheet is protected and Contractors can only make changes to the 3 columns list above. 7. Submit form to the State Refugee Coordinator for approval. All line item requests require approval and must be submitted directly to the State Refugee Coordinator using the provided template on page 50. Please Note: A TAG formula has been built into the spreadsheet. If TAG does not apply – do not use.

Line Delete Request

1. Enter Agency Number; Alien Number for client; Contract number; Service Code; Date of Service; and Date bill. 2. Submit form to State Refugee Coordinator for Approval.

Georgia DHS Refugee Resettlement Program No DHS services are to be delivered without a fully executed contract in place. A fully executed contract is defined as a contract that has been signed and dated by the DHS Commissioner

and the Contractor.



DATABASE Line Item Transfer Request/Line Delete Form Sta te :

Contracto r Name: DHS Con tracto r Agency:F isca l Yea r: 2014

Se rvi ce Rate To ta l C ost Cur re n t Units

Previously

B ille d Uni ts

Propos ed

Uni ts V ali d V ar iation Propos ed Tota l SSG TAG Employ abi lity

41 .2 1 - Job O rient ation & Placem ent $25 0.0 0 $ 0.0 0 -$ -$ -$ -$ 41 .3 0 - 9 0 d ays fo llow-u p $5 0.0 0 $ 0.0 0 -$ -$ -$ -$

41 .4 0 - 1 Y ear follo w-up $5 0.0 0 $ 0.0 0 -$ -$ -$ -$ 41 .7 0 - Family Se lf Su fficien cy P lan - Em p $18 0.0 0 $ 0.0 0 -$ -$ -$ -$

41 .7 5 - I ndiv id ual Emp lo yabi l ity P la n $15 0.0 0 $ 0.0 0 -$ -$ -$ -$ 41 .8 1 - Em ployment Pre p 1 $15 0.0 0 $ 0.0 0 -$ -$ -$ -$

41 .8 2 - Em ployment Pre p 2 $5 0.0 0 $ 0.0 0 -$ -$ -$ -$ 41 .9 0 - Em ployab il ity W o rksho p $40 0.0 0 $ 0.0 0 -$ -$ -$ -$

41 .9 5 - S pe c ial ize d Em ployment Pre p $35 0.0 0 $ 0.0 0 -$ -$ -$ -$ Socia l A djustm ent

50 .1 7 - Fam ily Se lf Su fficien cy Plan - SA $18 0.0 0 $ 0.0 0 -$ -$ -$ -$ 50 .1 8 - Ind iv id ua l W o rk Plan $10 0.0 0 $ 0.0 0 -$ -$ -$ -$ 50 .7 1 - Hom e Manag em en t $10 0.0 0 $ 0.0 0 -$ -$ -$ -$ 50 .7 2 - Em erg ency /Cris is $10 0.0 0 $ 0.0 0 -$ -$ -$ -$ 50 .7 3 - Hea lth Re la ted $10 0.0 0 $ 0.0 0 -$ -$ -$ -$ 50 .8 1 - So cial A djus tm ent W orkshop s $40 0.0 0 $ 0.0 0 -$ -$ -$ -$

In forma tion an d Re ferral52 .1 0 - I nfo rm a tio n a nd Re ferral $12 5.0 0 $ 0.0 0 -$ -$ -$ -$ Dom es tic V io l ence Servic es

70 .3 0 - C ommunity Ed uca tio n S erv ice s $9 0.0 0 $ 0.0 0 -$ -$ -$ -$ 70 .3 5 - M en s Su pp ort G ro up Se ssion $9 0.0 0 $ 0.0 0 -$ -$ -$ -$

70 .3 6 - W omens Supp ort G roup Sess io n $9 0.0 0 $ 0.0 0 -$ -$ -$ -$ Youth Servic es

61 .1 0 - A fte r Sch oo l $12 5.0 0 $ 0.0 0 -$ -$ -$ -$ 61 .2 0 - S umm er Cam p P rog ram $30 0.0 0 $ 0.0 0 -$ -$ -$ -$

TOTA L $0.0 0 -$ -$ -$ -$

T ota l Con tra ct: $302 ,255 .00 $0. 00

T o ta l SS G : $242 ,748 .12 $0. 00 0.3 4773925

T o tal T A G : $59 ,506 .88 $0. 00

A dju st the Pr o p o sed U n i ts to you r goal, u sing the Vali d and Va ria ti on co lum ns t o as s is t. T he Var iat io n c olum n w i ll s how how m uc h m ore m on ey yo u are a lloc ating to a se rv ice w ith y our prop os al. T he

to tal Va riat io n fie ld at th e bo ttom o f tha t c olum n w i ll help g et t he d ollar am oun ts c orre ct . If yo u ha ve propo se d les s uni ts tha n y ou h ave al re ady bi lled a red IN VA L ID w il l s ho w up in the V ali d c olu m n. T his

w i ll a ler t y ou t hat the p ro pos ed num ber o f un its fo r that s ervice are n ot a cc ep table. Yo u c ann ot g o un der th e P re vious ly B il led U n its a mo unt a s they h ave alre ady bee n inv oic ed and m u st be ac co unte d fo r. If

a l l L in e It ems a re va lid m ak e s ure that the su m of th e S p rea d sh eet T o tal c olum n e quals the T o ta l C o n trac t amo unt. Y our R e ques t Fo rm w i ll th en b e read y f or su bm is s ion .

S pread sheet S SG :

S pread sheet TAG :T o c om plete a L ine Ite m R eque st C han ge F o rm , f irs t retr ie ve the m o st rec ent paid invo ic e t o c om pare ch ange s wi th. E nter t he C u r ren t U n i ts (orange c olu mn ) s o that yo u ha ve a po in t of co mp ar is on (H int:

c opy /pa st e P ro pos ed U nits from mo st rec ent R eque s t F orm). En ter th e un its y ou hav e al read y b il led in the P revi o u sly B i lled U n its (g re en) c olum n . E nte r the uni ts yo u de sire to c hang e to in the Pro p o sed

U n its (b lue ) co lum n. Plea se not e tha t y ou w i ll no t ne ed t o en ter da ta into any ot her c olum n (only ora nge , green and blue c olum ns ).

Rate S chedu le & L ine Item Request Fo rm

Sp read sh e et T o ta l: 302 ,255 .00 T AG as a % o f M ixe d S SG /TA G

Georgia DHS Refugee Resettlement Program No DHS services are to be delivered without a fully executed contract in place. A fully executed contract is defined as a contract that has been signed and dated by the DHS Commissioner

and the Contractor.



DATABASE Line Item Transfer Request/Line Delete Form – Completed Example Sta te:

Con trac tor N ame : DHS C ont ractor Agency:Fisca l Yea r: 2014

Service Rate Total Cost Curren t Units

Previously

Billed Un its

Proposed

Units Valid Variation Proposed To tal SSG TAG

Employabi lity41 .21 - Job Orientation & Placement $250.00 $25 ,000.00 100.00 0.00 100.00 -$ 25,000.00$ 16 ,306.52$ 8,693 .48$

41 .30 - 90 days fo llow-up $50.00 $2 ,550.00 51 .00 0.00 51.00 -$ 2,550.00$ 1 ,663.26$ 8 86 .74$ 41 .40 - 1 Year follow-up $50.00 $2 ,500.00 50 .00 0.00 50.00 -$ 2,500.00$ 1 ,630.65$ 8 69 .35$

41 .70 - Family Se lf Su fficiency P lan - Emp $180.00 $18 ,000.00 100 .00 0.00 100.00 -$ 18,000.00$ 11 ,740.69$ 6,259 .31$ 41 .75 - Indiv idual Emp lo yabil ity P lan $150.00 $30 ,000.00 200 .00 0.00 200.00 -$ 30,000.00$ 19 ,567.82$ 1 0,432 .18$

41 .81 - Employment Prep 1 $150.00 $36 ,000.00 240 .00 0.00 240.00 -$ 36,000.00$ 23 ,481.39$ 1 2,518 .61$ 41 .82 - Employment Prep 2 $50.00 $5 ,950.00 119 .00 0.00 119.00 -$ 5,950.00$ 3 ,880.95$ 2,069 .05$

41 .90 - Employab il ity Wo rkshop $400.00 $20 ,000.00 50 .00 0.00 50.00 -$ 20,000.00$ 13 ,045.21$ 6,954 .79$ 41 .95 - Specialized Employment Prep $350.00 $7 ,000.00 20 .00 0.00 20.00 -$ 7,000.00$ 4 ,565.83$ 2,434 .17$

Socia l Adjustm ent50 .17 - Fam ily Se lf Su fficiency Plan - SA $180.00 $2 ,700.00 15 .00 0.00 15.00 -$ 2,700.00$ 1 ,761.10$ 9 38 .90$

50 .18 - Ind iv idua l Work Plan $100.00 $2 ,000.00 20 .00 0.00 20.00 -$ 2,000.00$ 1 ,304.52$ 6 95 .48$ 50 .71 - Home Managemen t $100.00 $3 ,100.00 31 .00 0.00 31.00 -$ 3,100.00$ 2 ,022.01$ 1,077 .99$

50 .72 - Emergency/Cris is $100.00 $600.00 6.00 0.00 6 .00 -$ 600.00$ 3 91.36$ 2 08 .64$ 50 .73 - Hea lth Re la ted $100.00 $3 ,000.00 30 .00 0.00 30.00 -$ 3,000.00$ 1 ,956.78$ 1,043 .22$ 50 .81 - Social Adjustment Workshops $400.00 $1 ,600.00 4.00 0.00 4 .00 -$ 1,600.00$ 1 ,043.62$ 5 56 .38$ Informa tion an d Re ferral52 .10 - Info rmation and Re ferral $125.00 $11 ,125.00 89 .00 0.00 89.00 -$ 11,125.00$ 7 ,256.40$ 3,868 .60$ Dom es tic V iolence Services70 .30 - C ommunity Educa tion Service s $90.00 $34 ,650.00 385 .00 0.00 385.00 -$ 34,650.00$ 34 ,650.00$ -$ 70 .35 - Mens Support Group Session $90.00 $34 ,470.00 383 .00 0.00 383.00 -$ 34,470.00$ 34 ,470.00$ -$ 70 .36 - Womens Support Group Session $90.00 $35 ,010.00 389 .00 0.00 389.00 -$ 35,010.00$ 35 ,010.00$ -$

Youth Services61 .10 - A fte r Schoo l $125.00 $13 ,500.00 108 .00 0.00 108.00 -$ 13,500.00$ 13 ,500.00$ -$

61 .20 - Summer Camp P rogram $300.00 $13 ,500.00 45 .00 0.00 45.00 -$ 13,500.00$ 13 ,500.00$ -$

TOTAL $302 ,255.00 -$ 3 02,255.00$ 242 ,748.12$ 5 9,506 .88$

Total Contract: $302 ,255 .00 $ 302, 255. 00

Total SS G: $242 ,748 .12 $ 242, 748. 12 0.34773925

Total TAG: $59 ,506 .88 $59, 506. 88

To com plete a L ine Ite m R eque st Chan ge Fo rm , f irs t retr ie ve the mo st recent paid invo ice t o com pare ch ange s with. E nter t he Current Uni ts (orange colu mn ) so that yo u ha ve a po in t of co mp arison (H int:

copy /pa st e P ro posed Units from mo st recent Reque s t Form). En ter th e un its you have alread y b il led in the P revi ously Bi lled Units (g re en) column . E nte r the units yo u de sire to chang e to in the Proposed

Units (b lue ) co lum n. Plea se not e tha t you w i ll no t ne ed t o en ter da ta into any ot her column (only ora nge , green and blue colum ns).

A dju st the Proposed Uni ts to you r goal, u sing the Vali d and Va ria ti on co lum ns t o ass is t. The Var iation colum n will show how m uch m ore m on ey yo u are a llocating to a se rv ice with your prop osal. The

to tal Va riation fie ld at th e bo ttom o f tha t colum n will help g et t he d ollar am oun ts corre ct . If yo u ha ve propo se d less units tha n you h ave alre ady bi lled a red INVALID w il l sho w up in the V ali d colu mn. This

w i ll alert you t hat the p ro posed num ber o f un its fo r that service are n ot a ccep table. Yo u cann ot g o un der th e P re vious ly B il led Un its a mo unt a s they h ave alre ady bee n invoiced and mu st be acco unte d fo r. If

al l Lin e Items a re va lid m ake sure that the su m of th e S prea dsheet Total colum n e quals the Tota l Contrac t amo unt. Y our Re ques t Fo rm will th en b e read y f or su bm iss ion .

Rate Schedule & L ine Item Requ est F orm

Spreadsheet Total:

S preadsheet S SG:

S preadsheet TAG:

TAG as a % o f M ixed S SG/TAG0.00





Request for English Language Class at Alternate Site Instructions

1. Insert name of Technical College that the request will be sent. 2. Insert the name of the potential site location. (Ex: Clarkston City Hall.)

3. Insert the address of the site location. (Ex: 210 City Hall Lane; Clarkston , Georgia;

30381)

4. Insert name of Contact Person. (Ex: Ms. Mayor Assistant)

5. If space is available to accommodate the number of people expected to attend the class place an ‘X’ before ‘Yes’. If there is not available space – place an ‘X’ before ‘NO’. The Technical Colleges will be unable to conduct a class if there is no free space available.

6. Insert the name of the person making the request.

7. Insert the name of the organization that the person making the request is employed.

8. Insert the date that the request was faxed or emailed to the Technical College.

9. Anticipated Roster of participants – insert the name; sex; language spoken; alien

number and social security number (SSN) for each person that may attend the class. Note: a minimum of 10 persons must be expected to attend the class.

10. For Technical Colleges Only – The Technical College will complete the information.

Insert the date the site is approved; date the class will begin; and the date the requesting organization is notified. If the site is not approved – place an ‘X’ and document the reason that the class cannot be held at this site. Sign and date the form and fax to the requesting organization with a copy to the State Refugee Coordinator at 404-463-8046.

11. The requesting organization will notify prospective students of the dates, times, and

location of the class. Continuation of the class will be totally dependent upon adequate attendance of the refugee students to fund the class.





Request for English Language Class at Alternate Site

To: __________________________________________________________________________________ Potential Site Location Name: ____________________________________________________________ Potential Site Address: _________________________________________________________________ _________________________________________________________________ Name of Contact Person: _______________________________________________________________ Is space available to hold class? _________ YES _________NO (If there is no free space to accommodate the class, the Technical Colleges will not be able to conduct class at proposed site)

Name of Person Making Request: _________________________________________________________ Organization: _________________________________________________________________________ Date Faxed/Sent to Technical College: ____________________________________________________

Anticipated Roster of Participants (Minimum of 10 documented refugee participants required; if more use additional sheet; Alien Number and SSN will be

collected after class is approved)

Name Sex Language Spoken

Alien Number SSN

For Technical Colleges Only (Minimum of Two (2) weeks required before a response is given): Site Approved: __________ Date: Class to Begin: ____________ Organization Notified: ________________ Site Not Approved: ______ Reason: ____________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________ Signature: ___________________________________________________________ Date: _________________





RSIG BUDGET AMENDMENT REQUEST

Instructions

1. Complete the heading by entering contractor name, contract number, name and title of person requesting adjustment, and date of request.

2. Please provide a detailed justification for requested amendment. If more space

is needed, you may attach a letter justifying the request.

3. Complete the transfer information for all budget categories, including those with

no change requested.

a. Latest Approved: Enter the current approved amount for that budget category

b. Request: Enter the amount of change requested (+/-). If you are adding

money to this budget category, enter as a regular number (600). If you are subtracting money from this category, enter as a negative number (-2,500).

c. Adjusted amount: Do not enter anything into this field; it will calculate

automatically. d. Totals: Do not enter anything into these fields; they will calculate

automatically. Note: The total of requested changes must add up to $0.00. For example, you request to add $300.00 to Regular Operating and deduct $300.00 from Travel. These two adjustments total $0.00 so that the total grant award amount is not altered.





Contractor Name:

DHS Contract Number:

Requested by:

Title:

Date:

REQUEST

(+ OR -)

Personnel Services $0.00

Regular Operating $0.00

Travel $0.00

Consultant/ Contractual $0.00

Total $0.00 $0.00 $0.00

BUDGET CATEGORIES

Justification

RSIG BUDGET AMENDMENT REQUEST

GRANT FUNDS

LATEST

APPROVEDADJUSTED AMOUNT