Form 2.4 "Dislocated Worker Eligibility Determination for Dislocated Worker Program - Workforce Innovation and Opportunity Act (Wioa)" - Arkansas

What Is Form 2.4?

This is a legal form that was released by the Arkansas Department of Labor and Licensing - Division of Workforce Services - a government authority operating within Arkansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 24, 2021;
  • The latest edition provided by the Arkansas Department of Labor and Licensing - Division of Workforce Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 2.4 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Labor and Licensing - Division of Workforce Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form 2.4 "Dislocated Worker Eligibility Determination for Dislocated Worker Program - Workforce Innovation and Opportunity Act (Wioa)" - Arkansas

Download PDF

Fill PDF online

Rate (4.8 / 5) 5 votes
Dislocated Worker Eligibility Determination
Workforce Innovation and Opportunity Act (WIOA)
FORM WIOA I-B – 2.4 (Updated 6/24/21)
For Dislocated Worker Program
Name:
Participant No.:
DLW Category
Documentation
Documentation must support information being
Applicant must meet:
documented
Age and common eligibility requirements
Check appropriate documentation used
One DLW Category
Unless otherwise indicated, only one document
Employment Status requirements
required per eligibility criterion
Must maintain copies of all documents used
Date of Birth on FORM WIOA I-B – 2.1 (Common
At least 18 years old
Eligibility Documentation)
FORM WIOA I-B – 2.1 (Common Eligibility
Meet common eligibility requirements
Documentation)
Verification from Employer
Date of actual dislocation – date of last day of
Rapid Response List
employment at the dislocation job
Notice of Layoff
(mm/dd/yyyy): __________________
Public Announcement with Follow-Up Cross-
Match with UI Database
PIRL # 410 Programs: A/D/DWG
Self- Attestation
Unemployment Claim Status
PIRL #401 - Programs: A/D/DWG
Documentation
Cross-Match to State UI Database
1. Filed a claim, determined eligible, eligibility
Cross-Match to State MIS Database
has not ended, and referred by Reemployment
Referral Transmittal by RESEA or WPRS
Services and Eligibility Assessment (RESEA)
Self-Attestation for Code Values 3 and 4 only
2. Filed a claim, determined eligible, eligibility
has not ended, and referred by the state
Worker Profiling and Reemployment Services
(WPRS) system
3. Filed a claim, determined eligible, eligibility
has not ended, and NOT referred by RESEA or
WPRS
Filed a claim, determined eligible, and
eligibility has exhausted
Receiving benefits, but is exempt from the
normal work search activities
Dislocated Worker Eligibility Determination
Form 2.4 (Updated 6/24/21)
Page 1
A proud partner of the American Job Center network
Dislocated Worker Eligibility Determination
Workforce Innovation and Opportunity Act (WIOA)
FORM WIOA I-B – 2.4 (Updated 6/24/21)
For Dislocated Worker Program
Name:
Participant No.:
DLW Category
Documentation
Documentation must support information being
Applicant must meet:
documented
Age and common eligibility requirements
Check appropriate documentation used
One DLW Category
Unless otherwise indicated, only one document
Employment Status requirements
required per eligibility criterion
Must maintain copies of all documents used
Date of Birth on FORM WIOA I-B – 2.1 (Common
At least 18 years old
Eligibility Documentation)
FORM WIOA I-B – 2.1 (Common Eligibility
Meet common eligibility requirements
Documentation)
Verification from Employer
Date of actual dislocation – date of last day of
Rapid Response List
employment at the dislocation job
Notice of Layoff
(mm/dd/yyyy): __________________
Public Announcement with Follow-Up Cross-
Match with UI Database
PIRL # 410 Programs: A/D/DWG
Self- Attestation
Unemployment Claim Status
PIRL #401 - Programs: A/D/DWG
Documentation
Cross-Match to State UI Database
1. Filed a claim, determined eligible, eligibility
Cross-Match to State MIS Database
has not ended, and referred by Reemployment
Referral Transmittal by RESEA or WPRS
Services and Eligibility Assessment (RESEA)
Self-Attestation for Code Values 3 and 4 only
2. Filed a claim, determined eligible, eligibility
has not ended, and referred by the state
Worker Profiling and Reemployment Services
(WPRS) system
3. Filed a claim, determined eligible, eligibility
has not ended, and NOT referred by RESEA or
WPRS
Filed a claim, determined eligible, and
eligibility has exhausted
Receiving benefits, but is exempt from the
normal work search activities
Dislocated Worker Eligibility Determination
Form 2.4 (Updated 6/24/21)
Page 1
A proud partner of the American Job Center network
Dislocated Worker Categories
Category A – Individual Layoff. The applicant must meet all three of the numbered criteria OR the special
veteran’s criteria
1. Has been terminated or laid off or
Layoff notice or termination notice from employer
has received a notice of termination
Telephone verification by last employer (with name, position,
or layoff, from employment
and date of contact, and signed by person making verification
(applicant did not quit or retire.)
contact)
Letter from employer confirming layoff or termination status
Self-attestation supported by UI statement, document, or form
showing receipt of UI benefits after leaving employment
2. Meets one of the following
2.a. Eligible for or has exhausted entitlement to UI compensation:
conditions concerning
Documentation that applicant has been determined monetarily and
unemployment compensation
non-monetarily eligible for benefits, has received benefit payments,
has exhausted benefit, OR is still receiving benefit payments. These
a. Is eligible for or has exhausted
may include:
entitlement to unemployment
UI payment record
compensation
Monetary determination document PLUS layoff notice or
document
Telephone verification by ADWS local office of both
monetary and non-monetary eligibility determination (with
name, position, and date of contact, and signed by person
(See next page)
making verification contact)
Other:
2.b.(1) Any document that applicant has worked during at least 1
quarter in the last year immediately prior to eligibility
b. (1) Has been employed long
determination. These may include:
enough to demonstrate
attachment to the workforce (has
Paycheck stub
worked in 1 quarter in the last
Written verification by last employer
year immediately preceding
Phone verification by last employer (with name, position,
eligibility determination), AND
and date of contact, and signed by person making
(2) is not eligible for
verification contact)
unemployment compensation
UI wage records
due to insufficient earnings or
Other:
having performed services for an
employer not covered under a
2.b.(2) Any form or statement from ADWS documenting that denial
state unemployment
was due to insufficient earnings or that employment was not
compensation law
covered under UI wages, such as:
Monetary determination record
Written statement by ADWS local office
Telephone verification by ADWS local office (with name,
position, and date of contact, and signed by person
making verification contact)
Written statement from or telephone verification with
employer that employment was not covered under UI
Other:
Note: if self-employed, applicant is not eligible for this category. Go
to Category C.
Dislocated Worker Eligibility Determination
Form 2.4 (Updated 6/24/21)
Page 2
A proud partner of the American Job Center network
Choose A or B
3. Is unlikely to return to a previous
A. The industry or occupation shows no growth or a decline in
industry or occupation
available job opportunities, as determined by ADWS or the
(Note: Local area must define “unlikely
LWDB:
to return to a previous industry or
Labor Market Information
occupation.” Documents are given as
ADWS labor analysis
guidelines to document local definition,
LWDB list of in-demand occupations
and local areas may adjust the
Other:
documentation, if needed, to comply
with their definition.)
B. The applicant has been seeking employment since
termination, but is unable to find employment in his/her
previous industry or occupation due to economic conditions,
skill limitations, or physical limitations:
Application in AJL and has not refused to accept a
reasonable job offer
Lack of job offers or rejection letters from employers in
the local area
Documentation that the applicant is insufficiently
educated and/or does not have the necessary skills for
reentry into the former industry/occupation:
Statement from doctor, ARS, or DSB indicating that the
applicant’s inability to return to previous
industry/occupation is due to physical limitations
Other:
Special Veteran’s Criterion: A separating service member qualifies as a dislocated worker under Category A if
the separation is anything other than dishonorable. A DD-214 from the Department of Defense or other
appropriate documentation that shows a separation or imminent separation from the Armed Forces qualifies
as the notice of termination or layoff to meet the dislocated worker definition. ETA policy mandates that a
separating service member meets the Dislocated Worker requirement that an individual is unlikely to return
to his or her previous industry or occupation [TEGL 19-16].
Document :______________________________________________________________________
Category B – Business Closure or Substantial Layoff. The applicant must meet both closure/layoff and
employed-at-business criteria
Closure/Layoff
Any document verifying or announcing the specific situation to
(select 1)
be verified, including:
Has been terminated or laid off or has
Letter or statement from employer
received notice of termination or layoff
Newspaper article
permanent closure or substantial layoff
News media printed article
(50 employees or 33% of workforce,
Document from Governor’s Dislocated Worker Task
whichever is less - not including
Force
employees who have worked less than 6
WARN notice
months in the last 12 months and those
Business’ Internet web site report
who work an average of less than 20
Correspondence from a Union or Elected Official
hours a week)
Eligibility certificate to receive TAA
Rapid response list of affected employees from layoff
Employer has made a general
Phone verification by last employer (with name,
announcement that facility will close
position, and date of contact, and signed by person
within 180 days
making verification contact)
Other:
Dislocated Worker Eligibility Determination
Form 2.4 (Updated 6/24/21)
Page 3
A proud partner of the American Job Center network
Employer has made a general
announcement that a facility will close
in more than 180 days or with no
specific date (Employee may receive
services other than training described in
described in WIOA § 134(c)(3), career
services described in WIOA §
134(c)(2)(A)(xii), or supportive services.
The person may qualify for these
services when one of the above other
criteria is met.)
Employed at Business
Any document that verifies that the applicant is/was employed
at the facility, including:
Applicant is/was employed at the facility
Current employee list from employer
Employer list of laid-off employees
Most current check stub from employer
Wage file for UI claimants
Layoff/closure letter to employee from employer or
union representative
Phone verification by last employer (with name, position,
and date of contact, and signed by person making
verification contact)
Eligibility certificate to receive TAA
Rapid response list of affected employees from layoff
Other:
Category C – Self-employed. The applicant must meet both self-employed and reason-for-closure criteria
Self-employed
Tax Return with business name and applicant’s name
Business license with applicant’s name
Statement from bank linking applicant to business
Other document showing applicant as owner of business:
Reason for closure:
Natural Disaster
Natural Disaster
Self-attestation of reason for closing, including how the
natural disaster caused the business to close, supported with
documentation of the disaster, such as:
Newspaper article discussing the disaster
Government information concerning the disaster
Information from local Chamber of Commerce, Economic
Development organization, or other such entity
concerning the disaster
Other:
Economic conditions in the
Economic Conditions within the community
community. Self-attest to what the
Must document with self-attestation how the economic
economic conditions were, how they
conditions caused the business to close, supported with
impacted the business closure, and
documentation of the economic conditions. Economic
document the economic conditions
conditions could be:
Dislocated Worker Eligibility Determination
Form 2.4 (Updated 6/24/21)
Page 4
A proud partner of the American Job Center network
Depressed prices or markets for the articles produced or
services rendered by the self-employed individual
(Note: Local area must define “unemployed
Failure of one or more businesses to which the self-
as result of general economic conditions in
employed individual supplied a substantial portion of
the community in which an individual resides
products or services
or because of natural disasters.” Documents
Failure of one or more businesses from which the self-
are given as guidelines to document local
employed individual obtained a substantial proportion of
definition, and local areas may adjust the
products and services
documentation, if needed, to comply with
Substantial layoff(s) from or permanent closures of
their definition.)
plants, facilities or enterprises that support a significant
portion of the state or local economy
Reduction in number of residents in local community for
other reason.
Other:
Appropriate Supporting documentation of the economic
conditions:
Labor market information
Documentation of drop in market price of goods and
services produced
U.S. Census population or demographics data
Honored checks from applicant’s business to failed
business
Copies of cancelled orders or invoices
Signed letter or statement from purchaser of services
Other documentation of closure or layoff of applicable
business supplying or receiving services or supporting
local economy
Newspaper articles
Information from local Chamber of Commerce, Economic
Development organization, or other such entity
concerning economic conditions
Other:
Category D – Displaced homemaker. The applicant must meet all three of the numbered criteria
1. Has been providing unpaid services
Most recent tax return showing family members
to family members in the home
Applicant statement
Other:
2. Meets one of the following criteria
Applicant statement (self-attestation) concerning situation
concerning losing income of another
AND
family member:
At least one(1) document to support the statement:
Death certificate
Has been dependent on the
Divorce papers
income of another family member,
Legal separation document
but is no longer supported by that
Insurance records
income
Bank records
OR
Court records
Dependent spouse of member of
Disability declaration
armed forces on active duty, and
Layoff or termination notice of family member
the family income is significantly
Military Document
changed because of a deployment,
Written statement from supporting family member
a call or order to active duty, a
stating that he/she no longer supports applicant and
permanent change of state, or the
reason why the support has been withdrawn
service-connected death or
Other:
disability of the member
Dislocated Worker Eligibility Determination
Form 2.4 (Updated 6/24/21)
Page 5
A proud partner of the American Job Center network
Page of 7