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EMPLOYEES' MANUAL I - F- Appendi x

I owa Depar t ment of Human Ser vi ces Febr uar y 11, 1986

VOLUNTEER SERVICES

APPENDIX

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EMPLOYEES' MANUAL 1- F- Appendi x

VOLUNTEER SERVI CES

APPENDI X

CONTENTS

Page

I owa Depar t ment of Human Ser vi ces Revi sed Febr uar y 2, 1988

VOLUNTEER APPLI CATI ON, SS- 1628 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

VOLUNTEER GROUP APPLI CATI ON AND REGI STRATI ON, 470- 2071 . . . . . . . . . . . . . . . . . . . 2

QUESTI ONNAI RE FOR TRANSPORTATI ON VOLUNTEER, 470- 2253 . . . . . . . . . . . . . . . . . . . . . 2a

VOLUNTEER REGI STRATI ON, 470- 2347 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b

REQUEST FOR VOLUNTEER, SS- 1103 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

MONTHLY VOLUNTEER REPORT, SS- 1711 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ANNUAL VOLUNTEER REPORTS, 470- 2074 and 470- 2075 . . . . . . . . . . . . . . . . . . . . . . . . . . 7

ADMI NI STRATI VE SUPPORT CONTRACT FOR VOLUNTEER SERVI CES, 470- 2072 . . . . . . . . . 8

AMENDMENT TO ADMI NI STRATI VE SUPPORT CONTRACT FOR VOLUNTEER

SERVI CES, 470- 2073 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

VOLUNTEER RECOGNI TI ON CERTI FI CATES, 470- 2097 and 470- 1912 . . . . . . . . . . . . . . . 11

VOLUNTEER SERVI CES HANDBOOK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

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EMPLOYEES' MANUAL I - F- Appendi x- 1

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VOLUNTEER APPLICATION, SS-1628

The Vol unt eer Appl i cat i on gi ves t he cont r act or and t he prospect i ve vol unteer

per t i nent i nf or mat i on.

When Pr epar ed

When a person i s seeki ng vol unt eer work.

By Whom Pr epared

Pr ospect i ve vol unt eer .

Number of Copi es

Two.

Speci f i c I nstr ucti ons

The f or m i s sel f - expl anat or y.

Di sposi t i on

The cont r act or or t he vol unteer ser vi ces di r ect or keeps t he or i gi nal i n

t he vol unt eer ' s f i l e and sends t he copy to t he st af f r equest i ng t he

vol unt eer .
http://www.dhs.state.ia.us/sites/default/files/470-0649.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-0649.pdf

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VOLUNTEER GROUP APPLICATION AND REGISTRATION, 470-2071

The Vol unt eer Gr oup Appl i cat i on and Regi st r at i on gi ves t he cont r act or and

st af f per son i nf or mat i on about t he gr oup, as wel l as t he si gnat ur e of t he

gr oup repr esent at i ve.

When Pr epar ed

When a gr oup i s seeki ng vol unt eer work.

By Whom Pr epared

Gr oup r epr esent at i ve.

Number of Copi es

Two


The group r epresent at i ve must make sur e t hat al l members of t he group hear

and agr ee t o t he conf i dent i al i t y r ul es. The f or m i s si gned by a

desi gnat ed gr oup r epr esent at i ve.

Di sposi t i on

The or i gi nal i s kept by t he cont r act or .

Af t er t he gr oup repr esent at i ve compl et es t he regi st r at i on f or m, t he

cont r act or assi gns an appr opr i at e j ob to t he gr oup.

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EMPLOYEES' MANUAL I - F- Appendi x- 2a

VOLUNTEER SERVI CES


QUESTIONNAIRE FOR TRANSPORTATION VOLUNTEER, 470-2253

For m 470- 2253 i s used t o gat her i nf ormat i on needed t o see i f a pr ospect i ve

vol unt eer i s qual i f i ed t o pr ovi de t r anspor t at i on f or cl i ent s.

When Pr epar ed

Thi s f or m i s prepar ed when a prospect i ve vol unteer i s bei ng consi dered f or

a j ob t r anspor t i ng cl i ent s.

By Whom Pr epared

The f or m i s prepar ed by t he prospect i ve vol unteer .

Number of Copi es

One.


The f or m i s sel f expl anat or y. Thi s f or m i s not avai l abl e f r om Anamosa.

Copi es shal l be made f r om t he sampl e i n t he manual .

Di sposi t i on

The f or m shal l be at t ached t o t he or i gi nal of t he Vol unteer Appl i cat i on,

f or m SS- 1628.

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VOLUNTEER REGISTRATION, 470-2347

The Vol unt eer Regi st r at i on i s t he of f i ci al agreement between t he Depar t ment

and a vol unt eer appl i cant accept i ng the appl i cant as a DHS vol unt eer.

When Pr epar ed

The f or m i s compl et ed af t er t he vol unt eer has compl et ed t he Vol unteer

Appl i cat i on, f or m SS- 1628, and staf f has had an oppor t uni t y t o check

r ef er ences and det er mi ne sui t abi l i t y of t he pr ospect i ve vol unt eer t o the

posi t i on, but pr i or t o the per son' s begi nni ng ser vi ce as a vol unt eer .

By Whom Pr epared

Vol unt eer and st af f per son

Number of Copi es

Two


The si gnat ures of t he vol unteer and a st af f person must be on t he f or m.

Di sposi t i on

St af f r et ai ns t he yel l ow copy and sends t he ori gi nal t o t he cont r act or, i nt he di str i cts, or t he vol unt eer ser vi ces di rect or, i n t he i nsti t ut i ons, t o

be pl aced i n vol unt eer ' s f i l e.

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VOLUNTEER SERVI CES


REQUEST FOR VOLUNTEER, SS-1103

The Request f or Vol unt eer i s t he wr i t t en r ecor d of a r equest f or a vol unteer

f r om a st af f member t o t he cont r act or ( i n t he di st r i ct ) or t o t he vol unt eer

servi ces di rect or ( i n t he i nst i t ut i on) . I t i s a t ool t o assi st i n t he

r ecrui t ment of pr ospect i ve vol unt eer s. The vol unt eer j ob descr i pt i on gi ves

t he cont r act or or vol unt eer ser vi ces di r ect or i nf or mat i on necessar y needed i n

r ecrui t i ng pr ospect i ve vol unt eer s.

When Pr epar ed

When a st af f person det ermi nes t hat a vol unt eer i s needed.

By Whom Pr epared

By t he staf f per son r equest i ng a vol unt eer .

Number of Copi es

Two- part NCR.


The J ob Descr i pt i on ( page 2) must be at t ached. Pl ease note: Cl i ent

i nf or mat i on i s not appl i cabl e f or a r equest f or of f i ce suppor t vol unt eer s.

Di sposi t i on

The or i gi nal i s sent t o t he cont r act or or t he vol unteer ser vi ces di r ect or .

The st af f person maki ng t he r equest keeps t he copy.

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MONTHLY VOLUNTEER REPORT, SS-1711

The Monthl y Vol unt eer Report i s used f or t r acki ng each di st r i ct and i nst i t u-

t i on vol unt eer pr ogr am. I t i s al so used t o comput e t he Depar t ment ' s mont hl y,

quar t er l y, and annual vol unt eer pr ogr am r epor t s. The f or m i s order ed f r om

Anamosa.

When Pr epar ed

At t he end of each month.

By Whom Pr epared

1. For di st r i cts, t he r epor t i s pr epar ed:

a. By t he cont r act or . The cont r act or or der s t he mont hl y r epor t f or m

f r om Anamosa.

b. By t he cont act per son. A compi l at i on of cont r act or s' r epor t s i s

submi t t ed as a di st r i ct r epor t .

2. For i nst i t ut i ons, t he r epor t i s pr epar ed by t he vol unt eer ser vi ces

di rect or .

Dat e Due

A compl et ed mont hl y r eport shal l be sent t o t he st at e vol unt eer pr ogr am

di r ector no l ater t han t he 10t h day of t he mont h f ol l owi ng t he mont h t he

r epor t cover s. The r epor t f r om t he cont r act or s i s due i n t he di st r i ctof f i ce by the 5t h of t he mont h.

Number of Copi es

Two


1. "Regi st ered DHS i ndi vi dual vol unteer " means a vol unteer who has

compl et ed the r egi st r at i on f or m and has been act i ve dur i ng the pr i or

or cur r ent f i scal year . Any vol unt eer who has not been act i ve si nce

t he begi nni ng of t he pr i or f i scal year i s no l onger consi der ed

r egi st er ed.

2. "Regi st ered DHS vol unt eer group" means a group whi ch has compl et ed t he

gr oup regi st r at i on f orm and i t s members have been act i ve dur i ng the

pr i or or curr ent f i scal year. Any gr oup whi ch has not been act i ve

si nce t he begi nni ng of t he pr i or f i scal year i s no l onger consi der ed

r egi st er ed.

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VOLUNTEER SERVI CES


MONTHLY VOLUNTEER REPORT, SS-1711 ( Cont d)

Speci f i c I nstr ucti ons ( Cont d)

3. Cat egor i es

a. "I ndi vi dual di r ect ser vi ce vol unt eer s" means vol unt eer s, act i ng as

i ndi vi dual s, who pr ovi de ser vi ce di r ectl y t o cl i ent s.

b. "I ndi vi dual i ndi r ect ser vi ce vol unt eer s" means vol unt eer s, act i ng

as i ndi vi dual s, who pr ovi de i ndi r ect ser vi ce, t hat i s t hey do not

wor k wi t h cl i ent s. Exampl es of wor k coul d i ncl ude cl er i cal ,

ser vi ng on boards, and mai ntenance.

c. "I ndi vi dual vol unt eer s i n gr oups - - di r ect servi ce" means vol un-

t eer s who ser ve as member s of a gr oup, whet her or not t hey ar e

wi t h t he gr oup when t hey serve; a gr oup r egi st r at i on f orm has been

compl eted and a group r epr esent at i ve has been desi gnat ed. They

wor k di r ectl y wi t h cl i ent s.

d. "I ndi vi dual vol unt eer s i n gr oups - - i ndi r ect servi ce" means vol un-

t eer s who ser ve as member s of a gr oup, whet her or not t hey ar e

wi t h t he gr oup when t hey serve; a gr oup r egi st r at i on f orm has been

compl eted and a group r epr esent at i ve has been desi gnat ed. They

do not work wi t h cl i ent s.

e. "St i pend vol unt eer s" ar e f ost er gr andpar ent s and seni or com-

pani ons. I f ot her vol unt eer s r ecei ve a smal l cont r i but i on f orservi ce, t hey may be count ed i n t hi s category.

4. Tot al # vol unt eer s act i ve t hi s mont h. Sel f - expl anat or y.

5. Tot al # hour s act i ve t hi s mont h. Sel f - expl anat or y.

6. Cumul at i ve hour s t o dat e. Thi s f i gur e r epr esent s t he sum of t he

cur r ent mont h wi t h the pr i or mont hs i n the f i scal year begi nni ng J ul y

1. The J une r epor t shoul d r ef l ect a t ot al f or t he year .

7. # Cl i ent s Served. Count each cl i ent onl y one t i me, no mat t er how many

t i mes t he cl i ent r ecei ves vol unt eer ser vi ces dur i ng the mont h.I nst i t ut i ons may report t he census f or t he mont h under t hi s headi ng.

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VOLUNTEER SERVI CES


MONTHLY VOLUNTEER REPORT, SS-1711 ( Cont d)


8. Dol l ar val ue of mat er i al donat i ons and cash donat i ons. Sel f -

expl anat or y.

9. Number of vol unt eers t er mi nat ed. Sel f - expl anat ory.

10. Opt i onal . Some of t hese st or i es wi l l be sel ect ed f or use i n t he

vol unt eer newsl et t er .

11. Name of person compl et i ng r eport .

Di sposi t i on

From t he cont r act or , one copy i s sent t o the cont act per son i n the

di str i ct of f i ce and one i s ret ai ned i n t he l ocal of f i ce.

Fromt he di st r i ct , one copy i s sent t o t he st at e vol unt eer pr ogr am di r ec-

t or and one i s ret ai ned i n t he di st r i ct of f i ce.

Fromt he i nst i t ut i on, one copy i s sent t o the st at e vol unt eer pr ogr am

di r ector and one i s r et ai ned f or t he vol unt eer ser vi ces di r ector' s f i l es.

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ANNUAL VOLUNTEER REPORTS, 470-2074AND 470-2075

The Annual Vol unteer Report i s used t o compi l e t he Depar t ment ' s st at i st i cs f or

t he annual r eport . The r epor t i s compl et ed at t he end of t he st at e f i scal

year and i s due t o t he st at e vol unt eer pr ogr am di r ect or by August 31 each

year .

A. Annual Vol unt eer Report : I nst i t ut i ons, 470- 2074

Thi s f or m f or t he i nst i t ut i ons i s not avai l abl e at Anamosa. Copi es may be

made f r om t he manual .

By Whom Pr epared

Vol unt eer ser vi ces di r ect or

Number of Copi es

Two or mor e, dependi ng on i nst i t ut i on pol i ci es.

Di sposi t i on

The vol unt eer ser vi ces di r ect or sends t he r eport t o t he st at e vol unt eer

pr ogr am di r ector, wi t h a copy ret ai ned f or t he vol unt eer of f i ce f i l es.

B. Annual Vol unt eer Report : Di st r i ct s, 470- 2075

By Whom Pr epared

Cont r act or s

Number of Copi es

Three- part NCR.

Di sposi t i on

The cont act person sends t he f or ms t o t he cont r act or s, one f or m f or each

count y served. Upon compl et i on, t he cont r actor sends t wo copi es of t hef orms t o t he cont act per son. The cont act per son does not compi l e t he

r epor t s. Al l r epor t s ar e sent t o t he st at e vol unt eer pr ogr am di r ect or ,

wi t h a copy of each r et ai ned i n t he di st r i ct of f i ce.
http://www.dhs.state.ia.us/sites/default/files/470-2074.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-2075.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-2075.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-2074.pdf

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ADMINISTRATIVE SUPPORT CONTRACT FOR VOLUNTEER SERVICES, 470-2072

For m 470- 2072 i s t he pur chase of servi ce cont r act between t he Depart ment and

ei t her an i ndi vi dual cont r act or or a cont r act or agency pr ovi di ng ser vi ces

r el ated t o vol unt eer pr ogr ammi ng.

When Pr epar ed

Cont r act s whi ch wi l l pr ovi de servi ces f or 12 mont hs shal l be sent t o t he

st at e vol unt eer pr ogr am di r ect or by May 31 f or a J ul y 1 ef f ect i ve dat e.

Cont r act s whi ch wi l l pr ovi de ser vi ces f or onl y a por t i on of t he f i scal

year may be submi t t ed at any t i me. The ef f ect i ve dat e of t he cont r act i s

t he f i r st day of an agr eed- upon mont h f ol l owi ng si gnat ur e by t he cont r ac-

t or , t he count y di r ect or , t he di st r i ct admi ni st r at or and t he st at e

vol unt eer pr ogr am di r ect or .

By Whom Pr epared

The cont r act i s compl et ed by t he proj ect manager wi t h t he cont r act or .

Number of Copi es

Four .


The cover page must i ncl ude t he name, compl et e addr ess, phone and soci al

secur i t y number of an i ndi vi dual cont r act or . I f t he cont r act or i s an

agency, t he f ederal I . D. number and t he agency repr esent at i ve' s name must

be pr ovi ded.

The proposed begi nni ng and t er mi nat i on dates of t he cont r act per i od must

be pr ovi ded.

The annual cost s must be compl et ed both on t he cover page and t he budget

page.

1. Fee means t he amount pai d t o t he cont r actor provi di ng servi ces r el atedt o vol unt eer progr ammi ng.

2. Expenses means expenses i ncur r ed by t he cont r act or . The cont r act may

or may not speci f y an amount of money f or t hi s pur pose.

3. Vol unt eer expenses means expenses i ncur r ed by t he vol unt eer s. The

cont r act may or may not speci f y an amount of money f or t hi s pur pose.

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ADMINISTRATIVE SUPPORT CONTRACT FOR VOLUNTEER SERVICES, 470-2072 ( Cont d)


Si gnat ur es must be on al l f our copi es of t he cont r act .

For cont r act r enewal s, t he annual r evi ew page must be at t ached t o t he

cont r act . I t shal l descri be t he achi evement l evel of t he cont r act or i n

meet i ng t he cont r act r esponsi bi l i t i es dur i ng t he f i scal year .

I f t he cont r act or i s not submi t t i ng a cont r act f or t he comi ng f i scal year ,

t he annual r evi ew at t achment shoul d be submi t t ed by J ul y 31.

Di sposi t i on

Four copi es si gned by t he cont r act or, t he di st r i ct admi ni st r at or , and t he

count y di r ect or ar e sent t o the st at e vol unt eer pr ogr am di r ect or .

Af t er si gni ng t he cont r act , t he st at e vol unt eer pr ogr am di r ect or sends one

copy t o the Bureau of Fi nance, keeps one copy, and sends t wo copi es t o the

di st r i ct of f i ce, whi ch t hen sends one copy t o t he cont r act or .

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AMENDMENT TO ADMINISTRATIVE SUPPORT CONTRACT FOR VOLUNTEER SERVICES, 470-2073

The Amendment t o Admi ni st r at i ve Support Cont r act f or Vol unteer Servi ces i s t o

be submi t t ed when t here i s a change i n t he cont r actor ' s f ee, expenses,

vol unt eer expenses or r esponsi bi l i t i es.

By Whom Pr epared

The proj ect manager.

Number of copi es

Four .


Do not or der t hi s f or m f r omAnamosa. Make copi es f r om t he f or m i n t he

manual .

The amount of t he or i gi nal cont r act , any previ ous amendments, t he proposed

amendment and t he new cont r act t ot al must be entered on the f orm on the

l i nes f or f ee expenses and vol unt eer expenses, dependi ng on what t he

amendment i s f or .

The change i n r esponsi bi l i t i es i s submi t t ed i n case of a maj or change i n

t he pr ogr amobj ect i ves. The changes shoul d be descr i bed on an at t achment .

Di sposi t i on

Four copi es si gned by t he cont r act or and t he di st r i ct admi ni st r at or ar e

sent t o t he st at e vol unt eer pr ogr am di r ect or .

Af t er si gni ng t he cont r act , t he st at e vol unt eer pr ogr am di r ect or sends one

copy t o t he Bureau of Fi nance, keeps one copy, sends one copy t o t he

di st r i ct of f i ce, and sends one copy to t he cont r act or .

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VOLUNTEER RECOGNITION CERTIFICATES, 470-2097AND 470-1912

Cer t i f i cat es ar e avai l abl e f or use by t he di st r i cts and i nst i t ut i ons f or

honor i ng vol unt eer s on t he l ocal l evel .

By Whom Or dered and Pr epared

1. The I nst i t ut i on Vol unt eer Recogni t i on Cer t i f i cat e, f or m 470- 2097, i s

pr epar ed by t he vol unt eer ser vi ces di r ect or .

2. The Di st r i ct Vol unt eer Recogni t i on Cer t i f i cat e, f or m 470- 1912, i s pr e-

pared by t he cont act per son.

Or der Dat e

The cer t i f i cat e shoul d be or dered at l east 2 months bef or e i nt ended use

dat e.

Number of Copi es

One f or each vol unt eer r ecei vi ng r ecogni t i on.


There are t wo vol unt eer r ecogni t i on cer t i f i cat es, one f or t he i nst i t u-

t i ons, one f or t he di st r i ct s. The per son r esponsi bl e f or prepar i ng t he

cer t i f i cat e shal l obt ai n t he necessar y si gnat ur es.

Di sposi t i on

Gi ven t o a vol unt eer at an awards ceremony.
http://www.dhs.state.ia.us/sites/default/files/470-2097.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-1912.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-1912.pdfhttp://www.dhs.state.ia.us/sites/default/files/470-2097.pdf

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VOLUNTEER SERVICES HANDBOOK

The Vol unt eer Servi ces Handbook i s i ncl uded i n t he appendi x t o provi de gui de-

l i nes and suggest i ons f or vol unt eer di r ect ors, pr oj ect manager s, cont act per -

sons and cont r act ors I t cover s t he basi c el ement s of a vol unt eer pr ogr am,

such as recor d- keepi ng, i nt er vi ewi ng, or i ent at i on and t r ai ni ng, st af f r el a-

t i ons wi t h vol unt eer s, j ob descri pt i ons, and eval uat i ons.

Di st r i ct and i nst i t ut i on st af f shal l use t he i nf or mat i on i n t hi s handbook as a

basi s f or devel opi ng a handbook speci f i c t o t hei r oper at i ons, as r equi r ed i n

I - F, Vol unt eer Handbook.
http://www.dhs.state.ia.us/sites/default/files/VolHnbk.pdfhttp://www.dhs.state.ia.us/sites/default/files/VolHnbk.pdf

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1-F-App