Index of data files

UY BAN NHAN D A N CQNG H O AX A HOICHU NGHIA V I E T NAM TINH SON L A Doc lap - Tu - Hanh phiic S6: 1947/QD-UBND San La, ngdy 15 thdng nam 2017 Q U Y E T DINH Ve viec cong bo thu tuc hanh chinh thupc tham quyen giai quyet cua So Lao dpng - Thuong binh va Xa hpi C H U T I C H U Y BAN NHAN DAN T I N H Can cu Luat To chuc Chinh quyen dia phuong ; Can cu Nghi dinh s6 63/2010/ND-CP 08 thang nam 2010 cua Chinh Phu ve Kiem soat thu tuc hanh chinh; Can cu Nghi dinh s6 48/2013/ND-CP 14 thang nam 2013 ciia Chinh phu sua d6i, b6 sung mot s6 dieu cua cac nghi dinh lien quan den kiem soat thu tuc hanh chinh; Can cu Thong t u so 05/2014/TT-BTP 07 thang 02 nam 2014 cua Bp truong Bp T u phap huong dan cong bo, niem yet thu tuc hanh chinh va bao cao ve tinh hinh, ket qua thuc hien kiem soat thu tuc hanh chinh; Xet de nghi ciia Giam doc Sd Lao dpng - Thuong binh va Xa hpi va Giam doc Sd T u Phap, Q U Y E T DINH: Dieu Cong bo kem theo Quydt dinh 04 thii tuc hanh chinh moi ban hanh; 04 thii tuc hanh chinh dugc sua ddi, bd sung, thay the; 02 thu tuc hanh chinh hi bai bd thupc pham vi chuc nang quan iy ciia Sd Lao dpng - Thuong binh va Xa hpi (cd danh muc va noi dung cu the kem theo) Dieu 2, Quyet dinh cd hieu iuc ke tu ky han hanh Dieu Chanh Van phdng Uy ban nhan dan tinh, Giam doc Sd Tu phap, Giam doc Sd Lao dpng - Thuong binh va Xa hpi; Thii trudng cac sd, ban, nganh; Uy ban nhan dan cac huyen, thanli ph6, Uy ban nhan dan cac xa, phuong, thi tran va cac t6 chuc, ca nhan co lien quan chiu trach nhiem thi hanh Quyet dinh nky.l.iLf- Noi nhan: - Thuong true Tinh uy (b/c); - Thuong true H D N D tinh (b/c); - Chu tich U B N D tinh; - Cac D/c Pho Chu tich U B N D tinh; - Cue Ki6m soat TTHC- V P Chinh phu; - VP Chinh phu (b/c) - N h u dieu 3; - So T u phap; - Trung tarn Cong bao tinh; - Cong T T Dien tu Tinh; - L u u : V T , N C (270b) Cam Ngoc Minh THU T U C HANH CHINH THUOC T E A M QUYEN GIAI Q U Y E T CUA SO LAO DONG - THlTONG B I N H VA XA H Q I (Ban hanh Kem theo Quyit dinh sd 1947/QD-UBND ngdy 15/7/2017 cua Chu tich Uy ban nhan dan tinh San La) Vhkn I DANH M U C T H U T U C H A N H C H I N H I Danh mnc thu tuc hanh chinh moi ban hanh STT LINHVUC TEN T H U T U C HANH CHINH Cao Giav chune nhan dii dieu kien hoat dpng huan luyen an toan ve sinh lao dpng hang A (ddi v d i td chuc, doanh nghiep CO quan cd tham quyen cap tinh, true thupc Trung uong quyet dinh lap; doanh nghiep, don v i dia phuong quan ly) Gin Vinn Ginv rViiVno nVinn di'i diPll lao dpng kipn hoat dpng huan luyen an toan ve sinh lao dpng hang A (ddi vdi td chuc, doanh nghiep co quan cd tham quyen cap tinh, true thupc Trung uong quyet dinh lap; doanh nghiep, don v i dia phuong quan ly) A n toan Cap lai Giay chung nhan du dieu kien hoat dpng huan luyen an toan ve sinh lao dpng hang A (ddi v d i td chuc, doanh nghiep CO quan cd tham quyen cap tinh, true thupc Trung uong quyet dinh lap; doanh nghiep, don v i dia phuong quan ly) Thdng bao doanh nghiep du dieu kien tu huan luyen an toan, ve sinh lao dpng hang A (ddi vdi td chuc, doanh nghiep co quan cd t h i m quySn c4p tinh, phd true thupc Trung uong quyet dinh lap; doanh nghiep, don v i dia phuong quan ly) A n toan lao dpng A n toan lao dpng A n toan lao dpng CO QUAN THirC HIEN Sd Lao dpng Thuong binh va Xa hpi Sd Lao done Thuong hinh va Xa hpi Sd Lao dong Thuong hinh va Xa hpi Sd Lao dpng Thuong hinh va Xa hpi 11 Danh muc thu tuc hauh chi'uh duoc sua doi, bo sung, thay the ST T Ten thu tuc hanh chiuh Thu tuc Tiep nhan doi tuong bao Nghi dinh sd 136/2013/ND-CP trg xa hpi c6 hoan canh dac biet 21/10/2013 ciia Chinh phii; kho khan vao co sd bao trg xa hpi, Thong tu 29/20 MATTLT-BLDTBXH-BTC nha xa hpi ngav 24/10/2014 Thu tuc Tiep nhan ddi tugng can Ten V B Q P P L quy dinh upi dung sua doi, bo sung, thay the su bao ve khan cap vao co sd bao Nghi dinh sd 136/2013/ND-CP 21/10/2013 ciia Chinh phii; Thdng tu 29/2014/nLT-BLDTBXH-BTC trg xa hpi 24/10/2014 Nghi dinh 221/2013/ND-CP 30/12/2013 Thu tuc Che dp tham gap ddi vdi hoc vien tai Trung tam Chua benh - Giao due - Lao dpng - Xa hpi ciia Chinh phii ve quy dinh che dp ap dung hien phap x i i ly hanh chinh dua vao CO sd bat huge; Thdng tu 14/2014/11'BLDTBXH 12/6/2014 ciia Bp Lao dpng Thuong binh va Xa hpi Nghi dinh 221/2013/ND-CP 30/12/2013 Thu tuc nghi chiu tang ciia hgc vien tai Trung tam Chua henh Giao due - Lao dpng - Xa hpi ciia Chinh phii ve quy dinh che dp ap dung hien phap xu ly hanh chinli dua vao CO sd bat huge; Thdng tu 14/2014/11B L D I B X H 12/6/2014 ciia Bp Lao dpng Thuong binh va Xa hpi I I I Danh muc thu tuc hanh chiuh bi bai bo • ST T • Ten thu tuc hauh chinh • • Ten V B Q P P L quy dinh vice bai bo, buy bo thu tuc hanh chiuh Luat sd 46/2014/QH13 13/6/2014; Nghi dinh sd 105/2014/ND-CP Thii tuc mua bao hiem y te ddi v d i 15/11/2014; ngudi cd cong va than nhan 41/2014/TTLT/BYT-BTC Thdng tu lien tich sd hudug din 44/2016/ND-CP thuc hien bao hiem y te C4p giay chiing nhan dii dieu kien Nahi dinh sd hoat dpng dich vu huan luyen an 15/5/2016cuar Chinh phu quy dinh chi toan lao dpng, ve sinh lao dpng tiet mot so dieu cua Luat An toan, ve sinh thupc tham quyen cua Sd Lao lao dpng ve hoat dpng kiem dinh ky thuat dpng - Thuong binh va Xa hpi an toan lao dpng, huan luyen an toan, ve sinh lao dpng va quan trac moi trudng lao dpng Phin n NOI D U N G C U T H E T H U T U C H A N H C H I N H T H U O C T H A M Q U Y U N GlAi Q U Y E T C U A S O L A O D O N G - T B X H I THU TUC HANH CfflNH MOT BAN HANH (LINH VUC AN TOAN LAO DONG) Cap Giay chung du dieu kien hoat dpng huan luyen an toan, ve sinh lao dpng hang A cua to chiic, doanh nghiep co' quan co tham quyen cap tinh, true thupc Trung uong quyet dinh lap; doanh nghiep, don vi dia phuong quan ly - Trinh tur thuc hien: Buac To chuc, doanh nghiep co nhu cau cap Giay chung nhan dii dieu kien hoat dpng huan luyen an toan, ve sinh lao dpng hang A gui 01 bp ho so ve Sd Lao dpng - Thuong binh va Xa hpi tinh Son La Buoo Sd Lao dpng - Thuong binh va Xa hpi tiep nhan xem xet phan va tinh hop le cua ho so , Budc Sd Lao dpng - Thuong binh va Xa hpi xem xet, tham dinh ho so va dieu kien thuc hien cua to chiic, doanh nghiep de nghi Neu chua dam bao theo quy dinh, thi thdng bao cho td chiic, doanh nghiep Budc Khong qua 30 lam viec tu nhan dugc hd so day dii, hop le, Giam doc Sd Lao dpng - Thuong binh va Xa hpi cap giay chung nhan dii dieu kien huan luyen hang A Trudng hop khong cap Giay chiing nhan, Giam doc So Lao dpng - Thuong binh va Xa hpi ky Thong bao khong cap giay chiing nhan va neu ro ly cho td chiic, doanh nghiep - Cach thuc thuc hien: Giii true tiep hoac qua dudng buu dien ve Trung tam Hanh chmh cong tinh Son La - Thanh phan ho so: + Don de nghi cap Giay chiing nhan dii dieu kien boat dpng hoac cong van de nghi tham dinh dieu kien tu huan luyen (neu la doanh nghiep chiing minh du dieu kien tu huan luyen); + Ban thuyet minh ve quy mo huan luyen va cac dieu kien, giai phap thuc hien; + Ban Quyet dinh lap hoac Giay chiing nhan dau tu dong thdi la Giay chiing nhan dang ky doanh nghiep ddi vdi doanh nghiep lap tnidc 01 thang nam 2015; + Ban Quyet dinh bd nhiem hoac giao nhiem vu ngudi diing dau, ngudi phu trach cong tac huln luyen; + Danh muc vd ca so vat chit; danh sach nguoi quan ly, ngudi huan luyen kem theo hd so, tai lieu sau day: • Ban co chung thuc hd so, giay td chung minh du dieu kien huan luyen cua ngudi huan luyen; • Ban cd chung thuc hd so, giay td ve co sd vat chat lien quan gdm quyet dinh giao co sd vat chat cua co quan cd tham quyen, hop dong, hda don mua, giiy td cho, tang, sang nhugng, mugn hgp phap; hop dong thue hoac lien k i t vdi co sd khac de dam bao dieu kien ve may, thiet hi huan luyen theo quy dinh; • Chuoug trinh chi tiet, tai lieu huan luyen an toan, ve sinh lao dong - Sd lugng hd so: 01 bp r ^ ^ > - Thdi han giai quyet: 30 lam viec (ke tu nhan dugc hd so day du, hgple) - Bdi tugng thuc hien TTHC: Td chuc, doanh nghiep cd nhu cau tham gia boat dpng huan luyen an toan, ve sinh lao dpng - C o quan thuc hien T T H C : Sd Lao dpng - Thuong binh va Xa hpi - Ket qua thuc hien T T H C : Giiy chung nhan du dieu kien boat dpng huan luyen an toan ve sinh lao dpng, hoac Thdng bao khong cap Giay chung nhan du dieu kien boat dpng (trong neu ro ly do) - Le phi: Theo quy dinh tai Thdng tu sd 245/2016/TT-BTC 11/11/2016 cua Bp Tai chmh - Ten man don, man td khai: + Mau don dd nghi c4p Giiy chung nhan boat dpng huan luyen an toan, ve sinh lao dpng quy dinh tai Phu luc I I ban hanh kem theo Nghi dinh so 44/2016/ND-CP 15/5/2016 cua Chinh phu; + Mau Ban thuydt minh vd quy md huan luyen va cac dieu kien, giai phap thuc hien quy dinh tai Phu luc I I ban hanh kem theo Nghi dinh sd 44/2016/NDCP 15/5/2016 cua Chinh phu - Yeu cau, dieu kien thuc hien thu tuc hanh chinh: Dap ung cac dieu kien quy dinh tai Didu 26, Nghi dinh sd 44/2016/ND-CP 15/5/2016 cua Chinh phu - Can CU' phap ly: + Luat A n toan, ve sinh lao dpng 25/6/2015; + Nghi dinh sd 44/2016/ND-CP 15/5/2016 cua Chinh phu quy dinh chi tiet mot sd didu cua Luat an toan, ve sinh lao dpng vd boat dpng kidm dinh ky thuat an toan lao dpng, huin luyen an toan, ve sinh lao dpng va quan trac mdi truong lao dpng./ , Miu 01: Dan de nghi cdp Gily chdng nhan du didu kien hoat dong hudn luyen an toan, ve sinh lao dpng ca QUAN CHU QUAN (neu c6) Ten t6 chLFc/doanh nghiep CONG HOA XA HOI CHU NGHIA VIET NAM Doc lap - Tg - Hanh phuc , thang nam DONDE NGH! d p Gily chung nhan du didu kien hoat dpng huan luyen an toan, ve sinh lao dpng Kinh gui: Tdn to chuc/doanh nghiep dang ky: Dia chi try sd chinh: Dien thoal: Fax: Email: Dia chi chi nhanh/ ca sd huan luyen khac (neu c6): Quyet dinh lap, gidy chung nhan ddu tu hoac giay phep kinh doanh (kem ban GO chdng thuc): So: Ngay thang nam cap: Co quan d p : Hp va tdn ngudi dung ddu to chuc/doanh nghiep: Dia chi: So chung minh nhan dan/can cudc cong dan/hp chieu: Dang ky hoat dpng huan iuydn/tu huan iuyen an toan, vd sinh iao dpng ITnh VUG, cong vide chu ydu sau (cd ban thuyet minh dieu kien boat dong huan luyen an toan, ve sinh lao dong kem theo): Chung to! xin cam ket thuc hien dung quy dinh phap luat ve hoat dpng huan iuyen an toan, vd sinh iao dpng va quy dinh cua phap luat c6 ildn quan./ NGU'O'I D I J N G D A U (Ky, ghi ro ho ten va dong dau) Mau 02: Ban thuydt minh ve quy mo hudn luyen va cac dieu kien, giai phap thuc hien c a QUAN CHU QUAN C O N G HOA XA HOI C H U NGHTA VIET NAM (ngu CO) D p c l a p - T y d o - H a n h phuc Ten to chLPc/doanh nghiep , thang nam 20 BAN THUYET MINH Vd quy mo huln luyen va cac didu kien, giai phap thyc hien I Co" sd vat chit va thidt bj chung cua td chuc/doanh nghiep ) Tong quan ve ca sa vat chit chung cua to chiic/doanh nghiep - Cong trinh va tong dien tich su dung cua tung cong trinh cua tru so chinh: - Cong trinh va tong dien tich su dung cua tung cong trinh cua chi nhanh/co sd huan luyen khac (neu co): (kem theo ban cac giay phep xay dang cd chCmg thac) Cong trinh, phdng hoc su dung chung: - Phdng hgc duoc su dung chung: - Phdng thi nghidm/thuc nghidm, xudng thuc hanh: - Cong trinh phu trq (hoi trudng; thu vien; khu the thao; ky tuc xa ): Cac thiet bi huan luyen sd dung chung S o lirong T e n t h i l t bi TT Nam s a n x u l t II Can bp quan ly, ngudi huln luyen cu huu STT Ho ten 11.1 Can bd quan ly N a m sinh So n a m lam c o n g viec v d an toan, v e Trinh dp sinh iao dpng chuyen m o n 11.2 Ngucyi huan luyen hCru cc NGUai DLFNG D A U (Ky ten, dong diu, ghi ro ho ten) Ghi chu: Thac hien bao cao chi tiet theo cac noi dung a tdng muc 10 Mau so l a (Ban hanh kem theo Thong tu lien tich sp 29/2014/TTLT-BLDTBXH-BTC ngdy 24 thdng 10 nam 2014) CONG H O A X A H0\ C H U N G H I A V I E T NAM Dpc lap - T y - Hanh phiic T O K H A I D E NGHI T R O GHJP X A HOI (Ap dung doi vol ddi tugng quy dinh tai Khoan vd Khoan Dieu Nghi dinh so 136/2013/ND-CP) Phan T H O N G T I N CUA DOT TlTONG Kg va ten (Viet chit in hoa): Ngay/thang/nam sinh: / / Gidi tinh: Dan tpc: Giiy CMND s6 d p / / Noi cap: Hp khau thudng tru: Hien dang d vdi va dia chi noi d? • • • Tinh trang di hgc Chua di hgc (Ly do: Da nghi hgc {Ly do: Dang di hgc (Chi cu thi): • Co Co the B H Y T khong? • Khong Dang hudng che dp nao sau day: Trg cdp BHXH hdng thdng: ddng Hudng tic thdng / Trg cdp bao trgxd hpi hdng thdng: ddng Huang tu thdng / Trg cap im ddi ngudi cd cdng hdng thdng: ddng Hudng tu thdng Trg cdp, phu cdp hdng thdng khdc: ddng Hudng tu thdng / Thupc hp ngheo khdng? • Khong • Cd Cd khuydt tat khdng? • Khdng • Cd (Dang tat ^ Muc dp khuyet tat Thdng tin ve me cua ddi tugng Thdng tin ve cha cua ddi tugng Tdi xin cam doan nliuiig Idi khai tren la dung su thuc, neu cd dieu gi khai khdng dung, tdi xin chiu trach nhiem hoan toan Thdng tin ngu'di khai thay Cidy CMND sd: Ngdy cdp: Nai cdp: Quan he vdi ddi tuong: Dia chi: Ngay thdng nam 20 Ngudi khai (Ky, ghi ro ho ten Trudng hgp khai thay phdi ghi day du thdng tin ngudi khai thay) 34 Phln K E T L U A N C U A UOl DONG X E T D U Y E T T R O GIUP X A H O I Hoi ddng xet duyet trg giup xa hpi xa/phudng/thi tran: da xem xet hd so, xac minh thdng tin ca nhan cua va hgp thang nam thdng nhjat ket luan nhu sau (Ghi cu the dien chinh sach, che dp hudng, thdi gian): , De nghi co quan cd tham quyen xem xet giai quyet che dp chinh sach cho ddi tugng theo quy dinh./ Ngdy THl/KY (Ky, ghi ro ho ten) thdng nam 20 CHU TICH (Ky, dong dau) 35 Mau so lb (Ban hanh kem theo Thong tu lien tich s6 29/2014/TTLT-BLDTBXH-BTC ngdy 24 thdng 10 nam 2014) C O N G HOA X A H O l C H U NGHIA V I E T NAM Dpc lap - Tu- - Hanh phiic T O K H A I D E NGHI T R O GIUP X A H Q l (Ap dung doi voi doi tugng quy dinh tai Khoan Dieu Nghi dinh sd 136/2013/ND-CP) Phin T H O N G T I N CUA D O I TlTONG Ho va ten (Viet chu in hoa): Ngay/thang/nam sinh: / / Gioi tinli: Dan tpc: Giay CMND so Cap / / Noi cap: Hp khau thuo-ng tru: Hien dang voi va dia chi noi d? • • • Tinli trang di hoc Chua di hoc (Ly do: Da nghi hoc (Ly do: Dang di hgc (Chi cu the: • Cd Cd the B H Y T khdng? • Khdng Dang hudng che dp nao sau day: Trg cdp BHXH hdng thdng: ddng Huang tic thdng / Tro' cap bao trgxd hpi hdng thdng: ddng Huang tu thdng / Trg cdp uu ddi nguai cd cdng hdng thdng: ddng Huang tic thdng Trg cdp, phu cdp hdng thdng khdc: ddng Huang tic thdng .I Thupc hp ngheo khdng? • Khdng • Cd Thdi diem phat hien nhiem H I V Cd khuydt tat khdng? • Khdng • Cd (Dang tat Muc dp khuyet tat Kha nang tham gia lao ddng (Chi cu thi) Tdi xin cam doan nhung Idi khai trdn la dung su thuc, ndu cd didu gi khai khdng dung, tdi xin chiu trach nhiem hoan toan 36 Ngdy Thong tin nguoi khai thay Gidy CMND s6: Ngdy cdp: Nai cdp: Quan he vai doi tugng: Dia chi: thdng nam 20 Nguoi khai (Ky, ghi ro ho ten Truang hgp khai ^ thay phdi ghi day du thong tin nguai khai thay) Phan K E T L U A N CUA H O I DONG X E T D U Y E T T R O GIUP X A UOl Hpi dong xet duyet trg giup xa hpi xa/phudng/thj tran: da xem xet ho so, xac minh thdng tin ca nhan cua va hop thang nam thdng nhat ket luan nhu sau (Chi cu the dien chinh sdch, che dp huang, thdi gian): | De nghj co quan cd tham quyen xem xet gjai quyet che dp chinh sach cho ddi tugng theo quy djnh./ Ngdy THl/KY (Ky, ghi ro ho ten) thdng nam 20 CHU TICH (Ky dong dau) 37 Mau so I c (Ban hanh kem theo Thong tu lien tich sP 29/2014/TTLT-BLDTBXH-BTC ngdy 24 thdng 10 nam 2014) \ CONG H O A XA UOl C H U N G H I A V I E T NAM Dpc lap - Tu - Hanh phiic T O K H A I D E NGHI T R O G I U P X A HOI (Ap dung dot vai dot tugng quy dinh tai Khoan Dieu Nghi dinh so 136/2013/ND-CP) Phan T H O N G T I N C U A D O I T l / O N G Ho va ten (Viet chit in hoa): Ngay/thang/nam sinh: Giay CMND so Hp khau thudng tru: / / Gioi tinh: Dan tpc: d p J I Noi cIp: Hien dang d vdi va dia chi noi d? Cd the B H Y T khdng? • IGiong • C6 Thupc hp ngheo khong? • Khong • Co Tinh trang hdn nhan? (Ghi ro: Khong cd chdng/vg; cd chdng/vg dd chet hoac mat tich heo quy dinh) So dang nudi ngudi Trong dudi 16 tudi ngudi; tu 16 den 22 tudi dang hoc phd thdng, hoc nghe, trung cap chuyen nghiep, cao dang, dai hoc ngudi Thdng tin ve thu nhat (Chi cu thdho ten, ngdy thdng nam sinh, nai a, tinh trang di hoc, che dp chinh sach dang huang) Thdng tin thu hai trd di {Khai day ^u thdng tin nhu thii nhat) 38 Toi xin cam doan nliu'ng loi khai tren la dung su thuc, neu co dieu gi khai khong dung, toi xin chiu trach nhiem hoan toan Thong tin ngudi khai thay Ngdy thdng nam 20 Nguoi khai Gidy CMND sS: Ngdy cdp: (Ky, ghi ro ho ten Trudng hop khai Noi cdp: Quan he voi ddi tugng: ^^'^y P^^' S^i ^Hy du thdng tin ngudi khai thay) Dia chi: ^ Phan K E T L U A N C U A UOl DONG X E T D U Y E T T R O GIUP X A H O I Hpi ddng xet duyet trg giup xa hpi xa/phudng/thi tran: da xem xet hd so, xac minh thong tin ca nhan cua va hop thang nam thong nhat ket luan nhu sau {Chi cu the dien chinh sdch, che dp hudng, thdi gian): De nghi co quan cd tham quyen xem xet giai quyet che dp chinh sach cho ddi tugng theo quy dinh./ Ngdy THl/KY (Ky, ghi ro ho ten) thdng nam 20 CHU TICH (Ky, ddng dau) 39 Mau so I d (Ban hanh kem theo Thong tu lien tich s6 29/2014/TTLT-BLDTBXH-BTC 24 thdng (O nam 2014) C O N G HOA X A H O I C H U N G H I A V I E T NAM • • • Dpc lap - Tu-do - Hanh phuc > • I T C I K H A I D E NGHI I^RO G I U P X A H O I (Ap dung doi vol ddi tuang qhy dinh tai Khoan Dieu Nghi dinh sd 136,'2013/ND-CP) PhSn T H O N G T I N C U A D O I TlTONG Ho va ten (Viet chu in hoa): [ Ngay/thang/nam sinh: / / Gioi tinh: Dan too: / / N o i cap: Giay CMND s6 d p Hp khau thudng tru: Hien dang d vdi va dia chi noi d? Co the BHYT khong? • Khong • C6 Dang hudng che dp nao sau day: Luang huu/Trg cdp BHXH hdng thdng: ddng Huang tu thdng / ddng Hudng tic thdng Trg cdp bao trgxd hpi hdng thdng: Trg cdp uu ddi ngudi cd cdng hdng thdng: ddng Hudng tic thdng ! r r y Trg cdp, phu cdp hang thdng khdc:: I ddng Hudng tic thdng / Thupc hp ngheo khong? • Khong • Cd Co Idiuyet tat Idiong? • Khong • Co (Dang tat Mice dp khuyet tat Tinh trang hdn nhan? {Chi ro: Khdng cd chdng/vg; cd chdng/vg dd chet hoac mat tich theo quy dinh) , Ngudi cd nghia vu va quyen phung dupng (Neu cd, ghi cu the ho ten, tudi, nghe nghiep, nai a, viec iam, thu nhqp): Qua trinh hoat dpng cua ban than (Khdng bat bupc): Tdi xin cam doan nhung idi khai tren la pung su thuc, neu cd dieu gi khai khdng dung, tdi xin chiu trach nhiem hoan toan Thdng tin ngudi khai thay Cidy CMND sd: Ngdy cdp: Noi cap: Quan he vdi ddi tugng: Dia chi: P h i n Ngdy thdng nam 20 Ngudi khai Ky, ghi ro ho ten Trudng hgp khai thay phdi ghi day dii thdng tin ngudi khai thay) K E T LUAN C U AHOIDONG X E T DUYET T R OGIUP xA HOI /in Hpi dong xet duyet trg giup xa hpi xa/phud|ng/thi tran: da xem xet ho so, xac minh thong tin ca nhan cua va hgp thang nam thong nhat ket luan nhu sau (Ghi cu the dien chinh sdch, che dp huang, thai gian): i De nghi co quan co tham quyen xemlxet giai quyet che dp chinh sach cho doi tugng theo quy dinh./ THl/KY (Ky, ghi ro ho ten) Ngdy thdng nam 20 CUV T I C H (Ky, ddng ddu) Mau so I d (Ban hanh kem theo Thong tu lien tich sP 29/2014/TTLT-BLDTBXH-BTC ngdy 24 thdng 10 nam 2014) CONG H O A X A VOI C H U N C H I A V I E T NAM Dpc lap - Tu - Hanh phiic T O K H A I D E N C H I T i o C I U P X A VOI (Ap dung doi v&i ddi tuong quy dinh tai Khoqn Dieu Nghi dinh sd 136/2013/NDCP) P h l n T H O N C T I N C U A DOI TlTONC Ho va ten (Viet chu in hoa): Ngay/thang/nam sinh: / / Gioi tinh: Oily CMND s6 d p ql l Hp khau thuong tru: Dan tpc: Noi cap: Hien dang d vdi va dia chi noi d? • • • Tinh trang di hoc Chua di hoc {Ly do: j •) Da nghi hoc {Ly do: ) Dang di hoc (Chi cu the: ) Cd the BHYT khdng? • Khong • Co Dang hudng che dp nao sau day: Luang huu/Trg cdp BHXH hdng thdng: ddng Huang tu thdng / Trg cdp bao trg xd hdi hdng thdng : ddng Huang tu thdng / Trg cdp im ddi ngudi cd cdng hdng thpng: ddng Huang tu thdng / Trg cdp, phu cdp hdng thdng khdc: ddng Huang tic thdng / Thupc hp ngheo khong? • Khong D I C O Dang khuyet tat: Muc dp khuyet tat: Cd tham gia lam viec kliong? • Khdng • Cd a) Neu cd thi dang iam gi , thu nhqp hang thdng ddng b) Neu khdng thi ghi iy do: Tinh trang hdn nhan : i 10 Sd {Neu cd): ngudi Trong do, dudi 36 thang tuoi: ngudi 11 Kha nang tu phuc vu? 12 Ca nhan/hp gia dinh dang true tiep cham soc, nudi dudng: 42 Toi xin cam doan nhQ'ng Idi khai trdn la dung su thuc, neu cd dieu gi khai khdng dung, toi xin chiu trach nhiem hoan toan Thong tin ngu'di khai thay Gidy CMND sS: Ngdy cdp: Nai cap: Quan he vdi dot tugng:, Dia chi: Phan K E T LUAN CUA VOI Ngdy thdng nam 20 Ngudi kh a i I (Ky, ghi ro ho ten Truang hgp khai thay phdi ghi day du thong tin nguai khai thay) DONG X E T DUYET T R O GIUP XA VOI Hpi dong xet duyet trg giup xa hpi xa/phudug/thi tran: da xem xet hd so, xac minh thdng tin ca phan cua va hop thang nam thdng nhat ket luan nhu sau {Ghi cu the dien chinh sdch, che dp hudng, thdi gian): De nghi co quan cd tham quyen xem xet giai quyet che dp chinh sach cho ddi tugng theo quy dinh./ Ngdy THir K Y (Ky, ghi ro hg ten) thdng CHU nam 20 TICH (Ky, dong ddu) 43 k Mau so 29/2014/TTLT-BLDTBXH-BTC (Ban hanh kem theo Thong tu lien tich so ngdy 24 thdng to nam 2014) C O N G H O A X A H O I : H U NGHIA V I E T NAM Dpc lap - Tu - Hanh phuc DON D E N C H I Tiep nhan vao co' so' bao tro xa hoi, nha xa hoi Kinh gui: Chu tich Uy b a i nhan dan Ten toi la: Sinh .thang nam Hien dang cu tru tai r Toi lam don trinh bay hoan cand (Neu cu the hoan cdnh ddi tuang, gia dinh) Vay toi lam don de nghi co qpan co tham quyen xem xet, tiep nhan hoac trinh co quan co tham quyen tiep nhan vao chain soc, nuoi duong tai co sd bao trg xa hpi riia xa hpi theo quy dinh./ Ngdy thdng nam 20 Nguoi lam don (Ky, ghi ro ho ten) I I L I N H VirC P H O N G , CHONQ T E NAN X A VOl Che dp tham gap than nhan doi voi hoc vien tai Co' so' Dien tri nghien ma - Trinh ty thyc hien: Buoc 1: K h i toi tham gap hoc vien, than nhan hgc vien xuat trinh Giay chung minh nlian dan va trinh S6 tham gap than nlian hgc vien Co sd dieu tri nghien ma cap Budc 2: Td tham gap ghi s6, tu van, hudng dan than nhan hgc vien tham gap, giai dap nhung thac mac cua than rhan va hgc vien ve che dp tham gap, cd quydn dinh chi vide tham gap ndu vi phan ngi quy cua Co sd che dp tham gap va cap nhat thong tin theo ddi hoat dpng tham gap vao So tham gap hgc vien, vao Sd giam sat hoat dpng tham gap - Cach thu'c thyc hien: True tiep tai Co sd Dieu tri nghien ma - Thanh phan, so luong ho so': 01 quyen so tham gap than nhan hgc vien theo m i u s6 13 ( ban hanh kem theo Thdng tu s6 14/2014/TT-BLDTBXH ngdy 12 thdng nam 2014 cua Bo trudng Bd Lao ddng - Thuong binh vd Xd hdi); Chung minh thu cua than nhan hgc vidn den tham gap - Ddi tugng thuc hien TTHC: Than nhan hgc vien - Co quan thuc hien TTHC: Co sd dieu tri nghien ma - Thdi han giai quydt: Ngay sau nhan dugc ho so - Ket qua thuc hien TTHC: Giai qpydt cho than nhan tham gap hgc vien - Le phi: khong - Mau do'n, mau td khai: Sd tham gap hoc vien theo mdu theo mau sd 13 (ban hanh kem theo Thdng tu sd 14/2014/TT-BLDTBXH ngdy 12 thdng nam 2014 cua Bd truang Bd Lao ddng - Thuong binh vd Xd hdi) - Yeu cau, didu kien thuc hien TTI^C: Theo nhu ciu cua than nhan hgc vien - Can cu phap ly: Nghi dinh 221/2013/ND-CP ngdy 30/12/2013 cua Chinh phu vi quy dinh che dd dp dung bien phdp xu iy hanh chinh dua vao ca sa bdt budc; Thdng tu 14/2014/TT-BLDTBXH ngdy 12/6/2014 cua Bd Laa ddng Thuang binh vdXd hdi Chi chii: Phan in nghieng Id noi dung da dugc sua ddi, bd sung, thay the M a u s p 13 ( B a n h a n h k e m t h e o T h o n g t a s o / / T T - B L D T B X H n g a y 12 t h a n g n a m c u a B o t r a d n g B o L a o d p n g - T h a o n g binh v a X a h o i sa LAO D O N G - T H O O N G BiNH V A XA HOi S T H E O D O I T H A M GAP C U A C O SU CAI N G H I E N B A T B U O C NAM TT Ngay thang tham gap Can bp q u a n ly tham gap Ho v a ten h o c vien Hp va ten To do! N g a d i tham g a p Quan Hp v a | e n he v a i h o c vien So CMND S o iap-ng tien thu6c vac a c d vat m a n g c h o h o c vien Ghi chu Thu tuc nghi chju tang cua hgc vieri tai Co so Dieu tri nghien ma tiiy - Trinh tu thuc hien Budc 1: Gia dinh hoc vien phai lam E'on de nghj co xac nhan cua Uy ban nhan dan cap xa noi hgc vien cu tru gui Giam doc Trung tam Ngi dung don phai neu ro hg, ten, sd Chung minh nhan dan, noi cu tru, mdi quan he vdi hgc vien, thdi gian de nghi cho hgc vien dugc nghi chiu tang va cam ket quan ly, giam sat Ididng de hgc vien su dung ma trai phep hoac c6 hanh vi vi pham phap luat khac thdi gian ve chiu tang, chiu chi phi ddn hgc vidn ve nlia va dua trd lai trung tam Budc 2: Ngay sau Idii nhan dugc don de nghi cua gia dinh hgc vien, Giam ddc trung tam (hoac ngudi dugc Giam ddc trung tam uy quyen) phai xem xet, quyet dinh viec cho hgc vien nghi chiu tang Quyet dinh phai bang van ban, neu ro thdi gian dugc nghi, trach nhiem cua gia dinh viec dua don, quan Iy hgc vien thdi gian ve chiu tang Quyet dinJi dugc gui cho gia dinh hgc vien, Uy ban nhan dan cap xa noi ngudi cu tru va juu hd so hgc vien - Cach thuc thuc hien: True tiep tai Zo sd Dieu tri nghien ma - Thanh phan, sd lugng hd so: Don de nghi va cam ket cua gia dinh hgc vien cd xac nhan cua IJy ban nhan dan cap xa noi hgc vien cu tru - Thdi han giai quyet: Ngay sau l