WIOA YOUTH ADMINISTRATIVE BULLETIN No. 4 Attachment 1
List of Acceptable Eligibility/Barrier;
Documents for items below must be submitted in the order listed
A. Eligibility Item
Acceptable Documentation
(Only one of the following is required.)

Age


Out of School Youth age 16-24
In School Youth age 14-21
Low-Income
Income based on Family Size –
use Income Guidelines Bulletin
No. 4


All In-school Youth
Out of School youth with below
barriers:
1. A recipient of a secondary school
diploma or its recognized
equivalent,
2. individual who requires additional
assistance to enter or complete
an educational program or to
secure or hold employment
Driver’s License;
Baptismal record; Birth certificate; DD-214;
Report of Transfer or Discharge paper;
Federal, state or local ID card;
Passport;
Hospital record of birth;
Public assistance/social service records;
School records or ID cards;
Work permit;
Cross match with Department of Vital Statistics (Department of
Health’s Center for Health Statistics); or
Tribal records;
Alimony Agreement;
Applicant statement;
Award letter from veteran’s administration;
Bank statements;
Compensation award letter;
Court award letter;
Pension statement;
Employer statement/contact;
Family or business financial records;
Free Lunch Certification from school (In-School only)
Housing authority verification;
Pay stubs;
Public assistance records/including authorization to receive public
assistance/copy of recent public assistance check/refugee assistance
records
Quarterly estimated tax for self-employed persons;
Social Security benefits;
UI documents (WIOA001 Report)
Include all income on WIOA Application Supplement form
Citizen / Legally Entitled to Work in the U.S.
Accepted I-9 Documentation, such as: driver’s license / ID card along
with Social Security card, refer to Section B.
Selective Service Registration
Selective Service acknowledgement letter;
Form DD-214 “Report of Separation”; Screen printout of the Selective
Service Verification site;
Selective Service Registration Card; Selective Service Verification
(Form 3A);
Release Date – July 1, 2015
WIOA YOUTH ADMINISTRATIVE BULLETIN No. 4 Attachment 1
Eligibility Barriers:
School Dropout -
**Age 18-24 Applicant Self-Attestation;
Age 16 – 17 Document from School and Self-Attestation
A youth who is within the age of compulsory
Applies only to age 16 and 17 : see “School Dropout”
school attendance, but has not attended
school for at least the most recent complete
school quarter (quarter based on the individual
school schedule)
(Low income youth) Deficient in Basic Literacy
Skills and/or English language learner-(InSchool Only)
CASAS Diagnostic Test(s)
TABE (can be used for in-school youth only)
TABE (for all youth Language Level)
Pregnant or Parenting
** Applicant Self-Attestation (if details provided on self-attestation form); or
Child’s Birth Certificate; or
Telephone verification form, verified by TANF;
Homeless
** Applicant Self-Attestation (if details provided on self-attestation form); or
Document from an individual or social service agency providing residence;
Runaway
** Applicant Self-Attestation (if details provided on self-attestation form); or
Document from an individual or social service agency providing residence;
Foster Child or has aged out of foster care
system
Written confirmation from social services agency or legal foster parent,
An out-of home placement; court mandated or
foster care
Written confirmation from social services agency or legal foster parent;
Child Eligible for assistance under section 477
of the Social Security Act (foster care)
Written confirmation from social services agency or legal foster parent ,
Out of school age 16 – 21 who is subject to
the juvenile or adult justice system
** Applicant Self-Attestation (if details provided on self-attestation form)
Document from criminal justice system, adult or juvenile
Documented phone call with court or probation, include name and date
Offender- In-school / age 14-21:
** Applicant Self-Attestation (if details provided on self-attestation form)
Document from criminal justice system, adult or juvenile
Documented phone call with court or probation, include name and date
An individual with a disability
Document from Dr. or other medical professional
(Low-income youth) who requires additional
Income verification as listed above AND;
assistance to enter or complete an educational Documentation as to the specific life circumstance reason including
appropriate source document and Applicant Self-Attestation;
program or to secure or hold employment.
(Different criteria for In and Out of School)
Use Attachment 2 for Self-Attestation
Release Date – July 1, 2015
WIOA YOUTH ADMINISTRATIVE BULLETIN No. 4 Attachment 1
B. Legal to Work in the U.S.A
LISTS OF ACCEPTABLE DOCUMENTS - All documents must be UNEXPIRED
Employees may present on selection from List A
Or a combination of one selection from List B and one selection from List C.
LIST A
Documents that Establish Both Identity and
Employment Authorization
LIST B
Documents that Establish
Identity
OR
1. U.S. Passport or U.S Passport Card
2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)
LIST C
Documents that Establish Employment
Authorization
AND1. A Social Security Account Number card,
1. Driver’s license or ID card issued by a
unless the card includes on the following
State or outlying possession of the
restrictions:
United States provided it contains a
(1) NOT VALID FOR EMPLOYMENT
photograph or information such as
(2) VALID FOR WORK ONLY WITH
name, date of birth, gender, height, eye
INS AUTHORIZSTION
color and address
(3) VALID FOR WORK ONLY WITH
DHS AUTHORIZSTION
2. ID card issued by federal, state, or
local government agencies or entities,
provided it contains a photograph or
information such as name, date of
birth, gender, height, eye color and
address
2. Certification of Birth Abroad issued by
the Department of State (Form Fs-545)
3. Certification of Report of Birth issued by
the Department of State (Form FS-1350)
3. Foreign passport that contains a temporary
I-551 stamp or temporary I-551 printed
notation on a machine-readable immigrant
visa
3. School ID card with photograph
4. Original or certified copy of birth
certificate issued by a State, county,
municipal authority, or territory of the
United States bearing official seal
5. Employment Authorization Document that
contains a photograph (Form I-766)
4. Voter’s registration card
5. Native American tribal document
5. U.S. Military card or draft record
6. U.S. Citizen ID Card for use of Resident
Citizen in the United States (Form 1-179)
5. For a nonimmigrant alien authorized to
work for a specific employer because of his
or her status:
6. Military dependent’s ID card
a. Foreign passport; and
7. U.S. Coast Guard Merchant Mariner
Card
b. Form I-94 or Form I-94A that has the
following:
8. Native American tribal document
(1) The same name as the passport; and
(2) An endorsement of the alien’s
nonimmigrant status as long as that
period of endorsement has not yet
expired and the proposed
employment is not in conflict with
any restrictions or limitations
identified on the form.
9. Driver’s license issued by a Canadian
government authority
7. Identification Card for Use of Resident
Citizen in the United States (Form I-179)
8. Employment Authorization document
issued by the Department of Homeland
Security
For persons under 18 who are unable to
present a document listed above:
10. School record or report card
11. Clinic, doctor, or hospital record
6. Passport from the Federated States of
Micronesia (FSM) or the Republic of the
Marshall Islands (RMI) with Form I-94 or
Form I-94A indicating nonimmigrant
admission under the Compact of Free
Association Between the United State and
the FSM or RMI.
12. Day-care or nursery school record
Release Date – July 1, 2015