Check the box next to the activity, which best describes the specific activity you are performing at the selected moment. For example, you may be able to relate the activity to a specific program (i.e., training related to the Food Stamp program, the TANF program, referral for a photo ID for the Food Stamp program, etc.). Also, if you are gathering/collaborating/verifying information (e.g., address, birth dates, etc.) common to more than one program under the activity code 200 or 201, program code 109 in Section I should be checked off. Do not use a general activity code if one of the specific activity codes better describes that moment's action.
200 Interview/Intake: Activities include conducting interviews, facilitating group interviews and video presentations and providing applicant with appropriate forms, in the office, field, by mail or telephone. Also includes review of application forms and verification documents, data entry, in the office, field, by mail or telephone.
201 Eligibility Determinations/Re-determinations: Activities include case file review, document verification, preparing calculation entries and computations, entering data for eligibility purposes, completing necessary forms, referral for photo ID and researching any policy specific to a case. Also includes activities associated with obtaining, verifying and updating information for re- determining eligibility.
202 Case Management/Continuing Services: Activities include all case
management activities related to the development of a case plan. Activities include basic orientation and assessment, developing initial work development plans, arranging for supportive services (child care, transportation, etc.), eliminating barriers to employment, and administering the reconciliation and sanction process. For TANF, this activity also includes completion of the assessment form, the jobs referral form, referrals to the Jobs Club, and the
Instructions for the Random Moment Sample – Revised 9/25/10 Page 5
generating/providing referrals to employment and training programs for members of food stamp households not receiving TANF. Also includes conducting interviews, explanation of work registration activities, job
readiness assessment and referral services and receive and process sanctions.
204 Program Explanation: Activities include time spent in explaining the benefits, limitations and options available, rights and responsibilities of applicant and recipient households, and answering specific questions either in person or via telephone. The program being explained to the client should be identified in Section I.
205 Outreach: Activities include preparing and compiling information on food stamps, TANF and medical assistance for distribution to public and private entities and conducting off-site briefings to community groups and senior citizen organizations.
206 Preliminary Assessment/Referral: Activities include the initial assessment of program eligibility. As such the specific program being applied for in Section I should be indicated. Activities also include notification and referrals of clients or potential clients to other specific programs, e.g., child support enforcement, social services, TANF Work Related Screening and Assessment, etc. This also includes time spent in completing any required forms, inputting information to the ACEDS system and/or providing any other required information to the General Councils Office relating to Child Support
Enforcement. The program in which the client is being referred to should be identified in Section I. Also includes referring customers to domestic violence vendor and preparing referrals to the Social Security Administration and the Department of Employment Services.
Under the TANF program, all non-exempt applicants are required to
participate in work activities as a condition of eligibility. Activities include program explanation, sanction activity, referrals, preparing/processing exemption requests, fair hearings, determining work program and exemption status. Provides employment planning services to single parents and two parent families who are unemployed or underemployed. Also provides preliminary job assessment and referral services to these clients.
207 Conduct/Participate in Staff Training, Conferences and Meetings Relating to a Specific Program: Activities include time in training situations, conferences or meetings relating to a specific program as well as actually participating or leading the training/conference either at an on-site or off-site location. [Note: When the training is off-site, the Sample Coordinator should identify the program the training is related to in Section I, identify the nature of the training
Check the box next to the activity, which best describes the "general" activity you are performing at the selected moment. Codes 300-306 should only be checked when the activity being performed cannot be identified to a specific program/case.
300 Administrative Functions - Not Case Related: Activities include all other non- case related activity such as organizing desk, attending to general clerical matters, etc.
301 Conduct/Participate in Staff Training, Conferences and Meetings of a General Nature: Activities include time in training situations, conferences or meetings of a general nature or relating to more than one program as well as actually participating or leading the training/conference either at an on-site or off-site location. [Note: When the training is off-site, the Sample Coordinator should identify the program the training is related to in Section I, identify the nature of the training in Section III (name of training session) and sign the Observation Form.]
302 Travel - Including Conference or Training Travel: includes all job-related travel. This does not include routine between the office and one's home.
303 Lunch, Breaks, Personal Business: includes activity of a personal nature.
304 Employee on Leave/Not Scheduled to Work: (FOR SAMPLE
COORDINATOR USE ONLY) use for approved leave (e.g., annual leave, sick leave, etc.) or otherwise not scheduled to be at work at the time of sample (i.e., flex-time).
305 Any Other Activity: includes any other activity not described by the codes in Section II. Please specify the nature of this activity in the space provided on the observation form.
306 Invalid Sample Moment: (FOR SAMPLE COORDINATOR USE ONLY) should be used when a valid response can not be obtained for the moment selected as, for example, the employee selected is no longer working as an employment counselor or is no longer working for the Department. Only the RMTS Sample Coordinator will make selection of this category.
SECTION IV – Additional Information
Please provide any additional information that will either assist in the proper coding of a specific sampled moment or in the documentation supporting the rational used in