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OMB No. |
0970-0378 |
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Expiration Date: |
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| Form OFA 200 - TANF Emergency Fund Subsidized Employment Report |
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| Jurisdiction: |
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Date Completed: |
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Program Start Date: |
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FY 2010 |
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Quarter 3 |
Quarter 4 |
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April |
May |
June |
July |
August |
September |
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| 1. Number of subsidized job placements in the month |
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| 2. Number of cumulative placements |
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FY 2011 |
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Quarter 1 |
Quarter 2 |
Quarter 3 |
Quarter 4 |
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October |
November |
December |
January |
February |
March |
April |
May |
June |
July |
August |
September |
| 1. Number of subsidized job placements in the month |
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| 2. Number of cumulative placements |
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| Instructions: |
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| Line 1: For each month, enter the number of individuals in subsidized employment that equate to the dollars you reported on the OFA-100 in subsidized employment for that month (TANF, MOE, and/or TANF Emergency Fund dollars). For example, if for the first quarter of FY 2010 you reported subsidized employment expenditures of $90,000 because in each month of that quarter you spent $30,000, you should report the number of subsidized jobs the $30,000 funded in October, November, and December of 2009. |
| Line 2: Enter the total number of individuals placed in subsidized jobs since the start of the program. |
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| The definition of subsidized employment used for this collection is the same as the definition for the TANF program in general, given in 45 CFR 261.2(c) and (d). |
| (c) Subsidized private sector employment means employment in the private sector for which the employer receives a subsidy from TANF or other public funds to offset some or all of the wages and costs of employing an individual. |
| (d) Subsidized public sector employment means employment in the public sector for which the employer receives a subsidy from TANF or other public funds to offset some or all of the wages and costs of employing an individual. |
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| FY 2011 data collection is included in anticipation of an extension of the TANF Emergency Fund. |
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| Responses to this request for information are voluntary. |
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| Submittal Procedure: |
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| Submit completed data reports electronically to: |
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TANFEmergencyFund@acf.hhs.gov |
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| Submission Dates: |
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| Data is to be reported 45 days after the end of each quarter. Data reported in prior quarterly submissions can be amended in subsequent quarterly submissions. Quarterly reports should be submitted as follows: |
| FY 2010 Quarter 3 (Apr. – Jun.): Report by November 14 |
| FY 2010 Quarter 4 (Jul. – Sep.): Report by November 14 |
| FY 2011 Quarter 1 (Oct. – Dec.): Report by February 14 |
| FY 2011 Quarter 2 (Jan. – Mar.): Report by May 15 |
| FY 2011 Quarter 3 (Apr. – Jun.): Report by August 14 |
| FY 2011 Quarter 4 (Jul. – Sep.): Report by November 14 |
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| The Paperwork Reduction Act of 1995 |
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| Public reporting burden for this collection of information is estimated to average 24 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. |