Common use of Contract Compliance Clause in Contracts

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation Annual Reporting with supporting documentation (if updated from time of contract renewal) Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at mid-year and annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation Annual Reporting with supporting documentation (if updated from time of contract renewal) Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan Plan of correction Correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required. When a Contractor is alleged to have violated ethical standards according to the Code of Professional Ethics for Certified Rehabilitation Counselors identified in this contract and/or legal standards applicable to the treatment of individuals and claims for payments of public funds, the Contractor will be placed on temporary suspension pending the outcome of an investigation. Depending on the severity of the allegation(s) (i.e., Involving the individual(s) welfare), DRS will suspend new referrals and remove all individuals currently receiving services. For allegations not involving the welfare of the individual(s), DRS will suspend new referrals and individuals in current service status will remain with the Contractor, pending the outcome of the investigation. If the allegation(s) involves a Contractor’s staff, DRS requires the Contractor to take immediate and appropriate action and notify the ESS TA of action taken in writing. If appropriate action is not taken, the Contractor is subject to contract suspension. In the event of contract suspension, the DRS will send written notice transmitted via certified mail to the Contractor and suspend the contract effective upon receipt of notice or at 5:00 PM on the fifth (5th) calendar day from the date DRS mailed the notice, whichever occurs first.

Contract Compliance. The ESS TA will review the documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within the time frames stated in the contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation submitted by January 31st Annual Reporting with supporting documentation (if updated from the time of contract renewal) submitted by July 31st Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan Plan of action Action is necessary. When required, the Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If the Contractor fails to follow through with their plan of action, the Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, the Contractor will be placed on probation, and all new referrals will be suspended. The Contractor is required to submit a monthly progress report while on probation. When the Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required. When a Contractor is alleged to have violated ethical standards according to the Code of Professional Ethics for Certified Rehabilitation Counselors identified in this contract and/or legal standards applicable to the treatment of individuals and claims for payments of public funds, the Contractor will be placed on temporary suspension pending the outcome of an investigation. Depending on the severity of the allegation(s) (i.e., Involving the individual(s) welfare), DRS will suspend new referrals and remove all individuals currently receiving services. For allegations not involving the welfare of the individual(s), DRS will suspend new referrals and individuals in current service status will remain with the Contractor, pending the outcome of the investigation. If the allegation(s) involves a Contractor’s staff, DRS requires the Contractor to take immediate and appropriate action and notify the ESS TA of the action taken in writing. If appropriate action is not taken, the Contractor is subject to contract suspension. In the event of contract suspension, the DRS will send written notice transmitted via certified mail to the Contractor and suspend the contract effective upon receipt of notice or at 5:00 PM on the fifth (5th) calendar day from the date DRS mailed the notice, whichever occurs first.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation submitted by January 31st Annual Reporting with supporting documentation (if updated from time of contract renewal) submitted by July 31st Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at mid-year and annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required.

Contract Compliance. The ESS TA will review the documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within the time frames stated in the contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation Annual Reporting with supporting documentation (if updated from the time of contract renewal) Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan Plan of action Action is necessary. When required, the Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If the Contractor fails to follow through with their plan of action, the Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, the Contractor will be placed on probation, and all new referrals will be suspended. The Contractor is required to submit a monthly progress report while on probation. When the Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required. When a Contractor is alleged to have violated ethical standards according to the Code of Professional Ethics for Certified Rehabilitation Counselors identified in this contract and/or legal standards applicable to the treatment of individuals and claims for payments of public funds, the Contractor will be placed on temporary suspension pending the outcome of an investigation. Depending on the severity of the allegation(s) (i.e., Involving the individual(s) welfare), DRS will suspend new referrals and remove all individuals currently receiving services. For allegations not involving the welfare of the individual(s), DRS will suspend new referrals and individuals in current service status will remain with the Contractor, pending the outcome of the investigation. If the allegation(s) involves a Contractor’s staff, DRS requires the Contractor to take immediate and appropriate action and notify the ESS TA of the action taken in writing. If appropriate action is not taken, the Contractor is subject to contract suspension. In the event of contract suspension, the DRS will send written notice transmitted via certified mail to the Contractor and suspend the contract effective upon receipt of notice or at 5:00 PM on the fifth (5th) calendar day from the date DRS mailed the notice, whichever occurs first.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation Annual Reporting with supporting documentation (if updated from time of contract renewal) Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction will be reviewed by the ESS Unit at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward achieving contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation Annual Reporting with supporting documentation (if updated from time of contract renewal) Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation Annual Reporting with supporting documentation (if updated from time of contract renewal) Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. The Contractor is required to submit a monthly progress report while on probation. When the Contractor demonstrates progress toward achieving contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required. When a Contractor is alleged to have violated ethical standards according to the Code of Professional Ethics for Certified Rehabilitation Counselors identified in this contract and/or legal standards applicable to the treatment of individuals and claims for payments of public funds, the Contractor will be placed on temporary suspension pending the outcome of an investigation. Depending on the severity of the allegation(s) (i.e., Involving the individual(s) welfare), DRS will suspend new referrals and remove all individuals currently receiving services. For allegations not involving the welfare of the individual(s), DRS will suspend new referrals and individuals in current service status will remain with the Contractor, pending the outcome of the investigation. If the allegation(s) involves a Contractor’s staff, DRS requires the Contractor to take immediate and appropriate action and notify the ESS TA of action taken in writing. If appropriate action is not taken, the Contractor is subject to contract suspension. In the event of contract suspension, the DRS will send written notice transmitted via certified mail to the Contractor and suspend the contract effective upon receipt of notice or at 5:00 PM on the fifth (5th) calendar day from the date DRS mailed the notice, whichever occurs first.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation submitted by January 31st Annual Reporting with supporting documentation (if updated from time of contract renewal) submitted by July 31st Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan of correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required. When a Contractor is alleged to have violated ethical standards according to the Code of Professional Ethics for Certified Rehabilitation Counselors identified in this contract and/or legal standards applicable to the treatment of individuals and claims for payments of public funds, the Contractor will be placed on temporary suspension pending the outcome of an investigation. Depending on the severity of the allegation(s) (i.e., Involving the individual(s) welfare), DRS will suspend new referrals and remove all individuals currently receiving services. For allegations not involving the welfare of the individual(s), DRS will suspend new referrals and individuals in current service status will remain with the Contractor, pending the outcome of the investigation. If the allegation(s) involves a Contractor’s staff, DRS requires the Contractor to take immediate and appropriate action and notify the ESS TA of action taken in writing. If appropriate action is not taken, the Contractor is subject to contract suspension. In the event of contract suspension, the DRS will send written notice transmitted via certified mail to the Contractor and suspend the contract effective upon receipt of notice or at 5:00 PM on the 5th calendar day from the date DRS mailed the notice, whichever occurs first.

Contract Compliance. The ESS TA will review documentation and information below to determine if Contractor is following the contract: Attendance at all Project Director Meetings Obtaining required training within time frames stated in contract (unless extensions are approved by ESS TA) Completion of at least 6 hours of continuing education each contract year – related to field, by project director and employment consultants Mid-Year Reporting with supporting documentation submitted by January 31st Annual Reporting with supporting documentation (if updated from time of contract renewal) submitted by July 31st Timely notification to ESS TA by email when staff changes occur. (Include: Name; Background Check Completion Date; Salary; Start Date, and Termination Date) Quality Assurance Reviews (average of case reviews completed at midMid-year Year and annual Annual Reporting) ESS-A-080 Monthly Contractor Production Report submitted by the 10th of each month Pre-Placement Reports Other contract requirements Procedures: The ESS TA will send an ESS-A-035 Contract Compliance Review to notify Contractor of their compliance status. If a Contractor is found to be out-of-compliance, the ESS TA will determine if a plan of action is necessary. When required, Contractor will write a plan of action outlining the steps to be implemented to meet contract compliance within the next six (6) months. The plan of action will be submitted to the ESS TA within thirty (30) days of receiving the ESS-A-035 Contract Compliance Review. The ESS TA will review contract compliance again in six (6) months. Upon review, the ESS TA will contact Contractor to discuss their progress and determine if an updated plan of action is required. If Contractor fails to follow through with their plan of action, Contractor must meet with the ESS Unit and develop a six (6) month plan of correction. The ESS Unit will review the plan Plan of correction Correction at the end of six (6) months. If no progress has been made at that time, Contractor will be placed on probation, and all new referrals will be suspended. Contractor is required to submit a monthly progress report while on probation. When Contractor demonstrates progress toward contract compliance, probation will be lifted. Once Contractor is complying, the ESS TA will document this in writing and no further action is required. When a Contractor is alleged to have violated ethical standards according to the Code of Professional Ethics for Certified Rehabilitation Counselors identified in this contract and/or legal standards applicable to the treatment of individuals and claims for payments of public funds, the Contractor will be placed on temporary suspension pending the outcome of an investigation. Depending on the severity of the allegation(s) (i.e., Involving the individual(s) welfare), DRS will suspend new referrals and remove all individuals currently receiving services. For allegations not involving the welfare of the individual(s), DRS will suspend new referrals and individuals in current service status will remain with the Contractor, pending the outcome of the investigation. If the allegation(s) involves a Contractor’s staff, DRS requires the Contractor to take immediate and appropriate action and notify the ESS TA of action taken in writing. If appropriate action is not taken, the Contractor is subject to contract suspension. In the event of contract suspension, the DRS will send written notice transmitted via certified mail to the Contractor and suspend the contract effective upon receipt of notice or at 5:00 PM on the fifth (5th) calendar day from the date DRS mailed the notice, whichever occurs first. Based on availability of DRS funds, one (1) special incentive payment may be earned per case if the following conditions are met, and proper documentation is provided as described below: The Contractor may receive an incentive of five hundred dollars ($500.00) per individual for a one (1) time payment upon completion of the SE EM Milestone: Successful Employment, before DRS case closure, for difficult-to-serve individuals in these categories: individuals who have felony convictions, high school students who are classified by the school as severely emotionally disturbed (SED), individuals with HIV/AIDS, individuals who are legally blind, individuals who are deaf with primary communication of sign language, or individuals who are deaf/blind. For payment, Contractors must submit the following information to their ESS TA before submitting Required Case Documentation for Payment of SE EM Milestone to the DRS Counselor: ESS-A-020 Incentive Payment Request Form, The Contractor may receive an incentive of five hundred dollars ($500.00) per individual for a one (1) time payment, upon completion of the SE EM Milestone: Successful Employment, before successful closure by DRS Counselor, when the individual earns more than $24.49 per hour. This amount is based on the average hourly wage for Oklahoma at the time this contract was written. For payment, Contractors must submit the following information to their ESS TA before submitting Required Case Documentation for Payment of SE EM Milestone to the DRS Counselor: ESS-A-020 Incentive Payment Request Form, and, One of the following: A copy of the most current paystub/earnings statement including the individual’s name, address, payroll period, date issued and check amount or, A wage verification letter on the employer’s letterhead which indicates a breakdown of monthly wages and hours worked. The verification letter should also include the name of a contact person and telephone number or, Most recent Payroll Report from the employer which documents the individual’s name, social security number, paycheck date, and breakdown of monthly payments, including a contact person and telephone number of the employer.