Application for Trade Out-of-Area Job Search Allowance

Instructions

A separate form should be completed for each Out-of-Area Job Search to be made by the customer.

Customer Information

This form is a combined form to be used for TAA and TGAAA and TAARA Programs.
Check the appropriate Trade Program petition requirements that apply for this individual.
1. / LWIA#/ETC / Enter the LWIA # and ETC where the customer is being served.
2. / Customer SSN / Enter the last four digits of the customer’s SSN.
3. / Application Date / Enter the date of customer application.
4. / Name / Enter the customer's last name, first name and middle initial.
5. / Street Address (Residence) / Enter the customer's current street address of residence.
6. / City / Enter the customer's city of residence.
7. / State / Enter the customer's state of residence.
8. / Zip / Enter the customer's corresponding five or nine digit zip code.
TradeOut-of-Area Job Search Information
9. / Trade Petition Number / Enter the 5 digit (and letter if applicable) Petition Number from the certified petition covering the worker group from which the customer was laid off.
10. / Interview Date / Enter the date of customer's interview.
11. / Name of Company / Enter the name of the company interviewing customer.
12. / Title Applied For / Enter the job title for which customer will interview.
13. / Contact Name / Enter the name of contact at interviewing company.
14. / Phone Number / Enter phone number for contact provided in # 13. Include relevant extensions.
15. / Street Address / Enter the street address of the location of the interview.
16. / City / Enter the city of the location of the interview.
17. / State / Enter the State of the location of the interview.
18. / Zip / Enter the five or nine digit zip code of the location of the interview.
Trade Out-of-Area Job Search Allowance Determination
(To Be Completed by LWIA CareerPlanner)
19.-24. / Yes – No / Respond to each question with a Yes or No selection. In order to gain approval, items #19 - 24 must be answered Yes or #20 must apply.
19. / Application filed in a timely manner / Check yes or no to indicate if customer meets the criteria for having filed the application in a timely manner. To be considered to have been filed in a timely manner, an application must be filed within a year of total separation or certification or within 182 days after the concluding date of training approved, unless the customer received a waiver. Receipt of a waiver eliminates the 182 day extension at the conclusion of the training program. Also, if the customer ceases participation in training without justifiable cause, Out-of-Area Job Search is not allowed.
20. / Equitable Tolling Date
and Justification
/ All conditions of TEGL 8-11 must be met to apply Equitable Tolling. Equitable Tolling of this deadline may only apply in egregious situations where the customer acted with due diligence to meet the deadline. The definition of Egregious is extraordinary in some bad way; glaring; flagrant. Please describe why and how Equitable Tolling is documented. Attach additional sheets as necessary.
21. / Total Separation / Check yes or no to indicate if the customer will be totally separated from the Trade certified employment at the time of the current job search.
22. / Trade Registration / Check yes or no to indicate if the customer has been registered for Trade Adjustment Assistance with the local workforce investment area.
23. / No Evidence of Suitable Employment / Check yes to indicate No suitable employment in the customer's commuting area. Check no to indicate there is suitable employment in the customer's commuting area.
24. / Reasonable Expectation of Obtaining Suitable Long-Term Employment Outside Commuting Area / Check yes or no to indicate if the customer can reasonably be expected to secure suitable long-term employment outside the commuting area in which the worker resides and in the area where the job search is being conducted.
25. / Approved/Denied / Indicate Approval or Denial as appropriate. If Yes is answered to #19, 21, 22, 23 and 24 above, Out-of-Area Job Search Allowance shall be approved. If #19 is no, does Equitable Tolling apply – if yes fill out #20. If approval is denied for reason other than those discussed in items #19-24, describe the reason. If approval is denied for any reason, skip to Item #47.
TradeOut-of-Area Job Search Allowance History
26. / Previous Allowance Payments / Indicate previous Allowance Payments in items a-d. Indicate the sum of these payments in item e.
27. / Available Allowance Calculation / Note: The maximum allowable Out-of-Area Job Search Allowance is $1250 for TAA andTAARA and $1,500 for TGAAA. The customer may conduct multiple Job Searches to reach the full benefit amount. The customer is only eligible to receive an Out-of-Area Job Search Allowance up to the total of Item #27c. If the total in #27c is $ 0, the customer is not eligible to receive further Out-of-Area Job Search Allowances. Skip to Item # 47.
Trade Estimate of Out-of-Area Job Search Allowance
These are the anticipated expenses of the Out-of-Area Job Search. The LWIA CareerPlanner should complete this with the customer.
Transportation Request:
28. / Date / Indicate the date of the out-of-area job search event.
29. / Departed From / Indicate the place and time of customer departure.
30. / Arrived At / Indicate the place and time of customer arrival.
31. / Transportation / Calculate the auto reimbursement compensation by multiplying miles driven and the current mileage rate. For current mileage rate, go to to calculate other mode, enter the cost of round trip travel by the most economical public transportation the customer reasonably can be expected to take from the customer’s residence to the area of job search. Indicate the most cost effective mode of transportation. The most cost effective mode is the option the participant should take.
32. / Other Travel Expenses / Indicate the sum total of all other applicable travel expenses such as tolls, parking, etc.
33. / Line Totals / Provide the sum total of items #31 (most cost effective mode) & #32 for each line.
34. / Total / Provide the sum total of all prior line totals from Item #33.
*Note: If applicable, describe the Other Mode of Transportation and "Other" Travel Expenses anticipated to be incurred.
Lodging and Meals Request:
35.
36. / Travel for Out-of-Area
Job Search More than
12 hrs
Date / Check Yes or No to indicate whether the travel associated with the Out-of-Area Job Search was for more than 12 hours. If No, the customer is not eligible for Subsistence Assistance. (Skip to Item #40.)
Indicate the applicable date of each event requiring lodging and meals assistance.
GSA M&IE Schedule
When Travel Is: / The Allowance Is:
More than 12 Hours, but Less than 24 Hours / 75% of the Applicable M&IE Rate
24 Hours or More: / The Day of Departure / 75% of the Applicable M&IE Rate
Full Day(s) in Travel / 100% of the Applicable M&IE Rate
The Last Day of Travel / 75% of the Applicable M&IE Rate
37. / GSA Per Diem Rate / GSA Per Diem Rate: go to to obtain current maximum per diem rate. Record these amounts in columns 37a. Record 50% of these amounts in column 37b.
38. / Total allowable Lodging and Meals / Add the total of item #37b.
39. / Lodging Information / Provide name, address, city, state, zip, phone & ext., and fax of the lodging facility used for estimating travel expense. Include any relevant additional lodging information on a separate sheet.
40. / Subtotal of Anticipated Out-of-Area Job Search Allowance / Add items #34 & #38 to calculate a subtotal of Anticipated Out-of-Area Job Search Allowance.
41. / Out-of-Area Job Search Allowance / If TAA or TAARA: Calculate the total Out-of-Area Job Search Allowance Amount by multiplying Item #40 by 90%. If TGAAA: Calculate the total Out-of-Area Job Search Allowance Amount by multiplying Item #40 by 100%.
42. / Calculated Out-of-Area Job Search Allowance / Compare Item #41 (out-of-area job search allowance) with item 27c (remaining job search allowance) – the calculated out-of-area job search allowance cannot exceed the remaining job search allowance.
43. / Advanced Payment / Check yes or no to indicate if customer has requested an advance payment of their out-of-area job search allowance.
NOTE: A Job Search Allowance Advance is available to the customer. The advance must be issued within 5 days of the request. The advance can equal 60% of the total estimated Job Search Allowance, not to exceed $360. The careerplanner must enter this information in case notes including the calculation for the advance. A reason the customer is requesting an advance is required and must be included in the case notes on IWDS.
44. / Advance Payment Request Amount / If yes to #43, provide the advance payment request amount. Advance payment shall be equal to 60% of item #42, and no more than $360.
45. / Approval/Denial of Advanced Payment / Indicate approval/denial of the Advanced Payment as applicable to customer. If denied, state the reason.
46. / Customer Acknowledgement for Advanced Payment / Customer must acknowledge awareness of either eligibility or ineligibility for the Advanced Payment. Check box as appropriate for customer. The customer must sign and date this form.
47. / Customer Acknowledgement for Out-of-Area Job Search / Customer must acknowledge awareness of either eligibility or ineligibility for out-of-area job search assistance. Check box as appropriate for customer. The customer must sign and date this form and provide documentation as appropriate.
48. / CareerPlanner Signature / Careerplanner must sign and date this form.
49. / LWIA Director Signature / The LWIA Director or designee must sign and date this form.
NOTE: Make sure the Customer receives a copy of this form and keep the original in the Customer's file. Also, provide a copy to the fiscal staff to enter as obligations and accruals.

January 20, 2016Page 1 of 4Instructions: Commerce/Trade Form #012