ETA-9147 WIA Adult and Dislocated Worker Recovery Act Funds, Mont

WIA ADULT AND DISLOCATED WORKER PROGRAMS, and NATIONAL EMERGENCY GRANTS

MONTHLY REPORT

ETA Form: ETA-9148

Report Due Date: mm/dd/yyyy

OMB No.

1205-0474

Report Month End Date: mm/dd/yyyy

Expires:

11/30/2009

State: ________________________________________

Performance Items

Current Month (A)

Previous Month (B)

Program-to-Date (C)

A. PARTICIPANT SUMMARY INFORMATION

WIA Adults

1. Total number of new participants served

2. Total number of participants served

3. Number of UI claimants

4. Number of low-Income individuals

5. Number of Temporary Assistance to Needy Families (TANF) recipients

6. Number of public assistance individuals

7. Number of Veterans

8. Number of individuals with disabilities

9. Number of individual training accounts (ITA)

10. Number of participants in training

11. Number in on-the-job training (OJT)

12. Number in skill upgrading and retraining

13. Number in customized training

14. Number receiving supportive services (except needs-related payments)

15. Number receiving needs-related payments

WIA Dislocated Workers

1. Total number of new participants served

2. Total number of participants served

3. Number of UI claimants

4. Number of Veterans

5. Number of individuals with disabilities

6. Number of individual training accounts (ITA)

7. Number of participants in training

8. Number in on-the-job training (OJT)

9. Number in skill upgrading and retraining

10. Number in customized training

11. Number receiving supportive services (except needs-related payments)

12. Number receiving needs-related payments

National Emergency Grants

1. Total number of new participants served

2. Total number of participants served

3. Number of UI claimants

4. Number of Veterans

5. Number of individuals with disabilities

6. Number of individual training accounts (ITA)

7. Number of participants in training

8. Number in on-the-job training (OJT)

9. Number in skill upgrading and retraining

10. Number in customized training

11. Number receiving supportive services (except needs-related payments)

12. Number receiving needs-related payments

B. REPORT CERTIFICATION/ADDITIONAL COMMENTS

Grantee Remarks:

Name of Grantee Certifying Official:

Telephone Number:

Email:

This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0474, expiring 11/30/2009. Persons are not required to respond to this collection of information unless it displays a currently valid OMB number and expiration date. Public reporting burden for this collection of information is estimated to average 26 hours per response, including time for reviewing instructions, searching existing data sources, gathering and reviewing the collection of information. The reason for the collection of information is general program oversight, evaluation and performance assessment. Send comments regarding this burden, to the U.S. Department of Labor, Employment and Training Administration, Office of Performance and Technology, 200 Constitution Avenue, NW, Room S-5206, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0474).