ETA 9084 Servies Program Report, added fields highlighted

EMPLOYMENT AND TRAINING ADMINISTRATION

OMB Control Number 1205-0422

Expiration Date: 0905/3031/201313

Workforce Investment Act, Section 166

Indian and Native American Programs

General Reporting Instructions for the Comprehensive Services Program Report (ETA Form 9084) and Standardized Participant Information Record Data

Revised 2013

This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0422, expiring 0905/3031/20133. Persons are not required to respond to this collection of information unless it displays a currently valid OMB number. Public reporting burden for this collection of information is estimated to average 24 hours per quarterly report per grantee, including time for reviewing instructions, searching existing data sources, gathering and reviewing the collection of information. Respondent’s obligation to reply is required to obtain or maintain benefits (PL 105-220 Sec 166). The collection of this information is used for general program oversight, evaluation and performance assessment. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to the U. S. Department of Labor, Employment and Training Administration, Division of Indian and Native American Program , 200 Constitution Avenue, Room C-4311, NW, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0422).

1. GENERAL INSTRUCTIONS

Workforce Investment Act (WIA) Section 166 grantees are required to submit performance reports to the United States Department of Labor, Employment and Training Administration (USDOL/ETA) to comply with the record keeping and reporting requirements of the Comprehensive Services (CS) Program grant. Each grantee is required to submit a CS Program Quarterly Performance Report (ETA Form 9084) containing aggregate performance data on current program participants, and an electronic data file of records on all participants who exit from the CS program. Forms and general instructions for submitting these reports can be found under section II below. The information contained on this report will be used to determine the levels of participation, services received, and accomplishments for each CS program grant.

2. REPORTING FORMS AND INSTRUCTIONS

1. CS Program Quarterly Performance Report – The format and instructions for completing the ETA 9084 report can be found under Appendix A. This report provides information on current program participants, including important socio-economic characteristics, participants who have exited the program, and performance outcomes for the most recent quarter and cumulated for the most recent four-quarter reporting period.

2. Standardized Participant Information Record Data (CS Program exiters only) – This report is an electronic data file containing important characteristics, services/activities, and certain outcomes achieved for each individual who received services financially assisted by the CS Program and who exited the program. The format and data specifications for grantees to prepare the Standardized Participant Information Record Data can be found under

Section B. of these instructions.

At a minimum, grantees are required to submit a single electronic file of these individual records on all CS program participants who exit the program each quarter. Grantees have the option, but are not required, to submit updated individual records in subsequent post-program quarters to reflect outcome information that may be captured through supplemental/case management follow-up. It is important to note that these records contain personally identifiable client information (i.e., Social Security Numbers), which will be matched by the USDOL/ETA, on behalf of the grantees, with employment data available from state Unemployment Insurance (UI) and other administrative wage records (e.g., Federal and Military employment). This matching procedure is necessary in order for USDOL/ETA to collect consistent and reliable outcome information for each grantee by calculating a set of common performance measures that includes entry into employment, employment retention, and six-month average earnings.

3. DUE DATES

All quarterly reports under section II are due no later than 45 days after the end of each reporting quarter. The table below shows the expected due dates for each reporting quarter.

Report Quarter	Due Dates
July – September	November 14th
October – December	February 14th
January – March	May 15th
April – June	August 14th

Should the due date of the report fall on a Saturday, Sunday, or holiday, the report is due the business day before.

4. SUBMISSION PROCEDURES

Information contained on the CS Quarterly Performance Report must be submitted directly to ETA’s Enterprise Business Support System (EBSS) via technical instructions issued through the USDOL/ETA, Division of Indian and Native American Programs (DINAP), or the ETA performance website (www.doleta.gov/performance). Grantees will only be permitted to update reported results for the 1^st quarter prior to the current report quarter’s submission.

Appendix A

ETA Form 9084 - Comprehensive Services Quarterly Performance Report

OMB No. 1205-0422

Expires: 095/301/2013

A. GRANTEE IDENTIFYING INFORMATION

1. Grantee Name:

2. Grant Number:

3. Program/Project Name:

4. Grantee Address: City State Zip Code

5. Report Quarter End Date:

6. Report Due Date:

Performance Items

Previous Quarter (A)

Current Quarter (B)

Cumulative 4-Qtr Period (C)

B. CUSTOMER SUMMARY INFORMATION

1. Total Exiters

2. Core Services: Self-Services only

3. Total Participants Served

4. New Participants Served

Gender

4a. Male

4b. Female

School Status

4c. In-School, H.S. or less

4d. In-School, Post H.S.

4e. Not Attending School; H.S. Graduate

4f. Not Attending School; H.S. Dropout

Other Demographics

4g. Offender/Criminal Justice Barrier

4h. Individuals with a Disability

4i. Public Assistance Recipient

4j. Basic Skills Deficiency

4k. Limited English Proficient

4l. Eligible Veterans

4m. Eligible Veterans Spouses

4n. Homeless

4o. Long-term Unemployed

4p. Multiple Barriers

C. CUSTOMER SERVICES AND ACTIVITIES

1. Core Services Requiring Registration

2. Intensive Services

2a. Work Experience

3. Training Services

3a. CRT: Basic Skills or Literacy Activities

3b. CRT: Occupational Skills Training

3c. On-the-Job Training

3d. Entrepreneurial and Small Business Training

3e. Other Training Services

D. PERFORMANCE RESULTS

Outcome (Cumulative 4-Quarter Results Tabulated for Exit Cohort Shown)

Value

numerator

Value

numerator

Value

numerator

denominator

denominator

denominator

1. Entered Employment Rate mmddyyyy - mmddyyyy

2. Retention Rate mmddyyyy - mmddyyyy

3. Average Earnings mmddyyyy - mmddyyyy

4. Education (Credential) Measure mmddyyyy -mmddyyyy

E. REPORT CERTIFICATION/ADDITIONAL COMMENTS

1. Report Comments/Narrative:

2. Name of Grantee Certifying Official/Title:

3. Telephone Number:

4. Email Address:

Instructions for Completing the

CS Program Quarterly Performance Report

Section A. Grantee Identifying Information

A.1 Grantee Name – Enter the grantee name as it appears on the appropriate Notice of Obligation (NOO) or equivalent official document from the U.S. Department of Labor.

A.2 Grant Number – Enter the grant number as it appears on the appropriate NOO or equivalent official document from the U.S. Department of Labor.

A.3 Program/Project Name – Enter the name of the CS program or project.

A.4 Grantee Address – Enter the mailing address as it appears on the appropriate NOO or equivalent official document from the U.S. Department of Labor.

A.5 Report Quarter End Date – Enter the last month, day, and year (mm/dd/yyyy) of the quarter on which the report is being prepared. For example, if the report is being prepared for the quarter ending September 30^th, 201306, the Report Quarter End Date format should be represented as 09/30/201306.

A.6 Report Due Date – Enter the month, day, and year (mm/dd/yyyy) on which the report is due to the Department. For example, if the report is being prepared for the quarter ending 09/30/2013, the Report Due Date format should be represented as 11/14/2013.

Section B. Participant Summary Information

This section collects information on the number of current participants (including new and carried-over participants) and information on those participants who exit the CS program during the reporting period. Socio-economic characteristics of new participants contained in this section should be based on information collected from the individual at the time of participation in the CS program. Grantees are required to certify and submit results for both the current quarter (Column B) and cumulative totals for the most recent four-quarter reporting period (Column C). For all data collection items contained within this section, the data format is Integer with a maximum field length of 6-digits.

B.1 Total Exiters – Enter the total number of participants who exit from the program during the reporting period. Exit from the program occurs when a participant has not received any services funded by the program or a partner program for 90 consecutive calendar days and has no gap in service and is not scheduled for future services. The date of exit is applied retroactively to the last day on which the individual received a service funded by the program or a partner program.

B2 Core Services: Self-Services Only- Enter the total number of individuals who received a core service at no cost to the program, such as job search on the computer or the use of telephone or fax machine.

B.32 Total Participants Served – Enter the total number of individuals (including new and carried-over) who received a service or, if it is an ongoing activity, are continuing to receive services under the program during the reporting period. A participant is any individual who is determined eligible to participate in the program and receives a service funded by the program. Participant counts do not include individuals who only receive a determination of eligibility to participate in the program.

B.43 New Participants Served – Enter the total number of individuals who, following a determination of eligibility, began receiving a first service funded by the program during the reporting period.

B.43a Male – Enter the total number of new participants whose gender is male.

B.43b Female – Enter the total number of new participants whose gender is female.

B.43c In-School, H.S. or less – Enter the total number of new participants who have not received a secondary school diploma or its recognized equivalent and are attending any secondary school (including elementary, intermediate, junior high school, whether full or part-time, and alternative school), or are between school terms and intend to return to school.

B.43d In-School, Post H.S. – Enter the total number of new participants who have received a secondary school diploma or its recognized equivalent and are attending a post-secondary school or program (whether full or part-time), or are between school terms and intend to return to school.

B.43e Not Attending School; H.S. Graduate – Enter the total number of new participants who are not attending any school and have either graduated from high school or hold a GED.

B.43f Not Attending School; H.S. Dropout – Enter the total number of new participants who are no longer attending any school and have not received a secondary school diploma or its recognized equivalent.

B.43g Offender/Criminal Justice Barrier - Enter the total number of new participants who either (a) are or have been subject to any stage of the criminal justice process for committing a status offense or delinquent act, or (b) require assistance in overcoming barriers to employment resulting from a record of arrest or conviction for committing delinquent acts, such as crimes against persons, crimes against property, status offenses, or other crimes.

B.43h Individuals with a Disability – Enter the total number of new participants who indicate they have any “disability,” as defined in Section 3(2)(a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102). Under that definition, a “disability” is a physical or mental impairment that substantially limits one or more of the person’s major life activities. (For definitions and examples of “physical or mental impairment” and “major life activities,” see paragraphs (1) and (2) of the definition of the term “disability” in 29 CFR 37.4, the definition section of the WIA non-discrimination regulations.)

B.43i Public Assistance Recipient - Enter the total number of new participants who were receiving cash assistance or other support services from one of the following sources: Temporary Assistance for Needy Families, Food Stamp Assistance, General Assistance (GA) (State/local government), Refugee Cash Assistance (RCA), and Supplemental Security Income (SSI-SSA Title XVI), Supplemental Security Disability Insurance, Veterans Benefits, Foster Child Payments, USDA's Commodity Supplemental Food Program (CSFP), Department of Interior's, Bureau of Indian Affairs, General Assistance or Tribal Work Experience Program (TWEP).

B.43j Basic Skills Deficiency - Enter the total number of new participants who either (a) compute or solve problems, reads, writes or speaks English (Spanish in Puerto Rico) at or below grade level 8.9; or (b) are unable to compute or solve problems, read, write, or speak English at a level necessary to function on the job, in the individual’s family or in society. A determination of basic skills deficiency must be based on a generally accepted standardized testing instrument or a comparable score on a criterion-referenced test.

B.43k Limited English Proficient - Enter the total number of new participants who have limited ability in speaking, reading, writing or understanding the English language and (a) whose native language is a language other than English, or (b) who live in a family or community environment where a language other than English is the dominant language.

B.43l Eligible Veterans – Enter the total number of new participants who met one of the following conditions as a veteran: Enter the total number of participants who, at enrollment, have served at least one day in the active military, naval, or air service, and who were discharged or released from such service under conditions other than dishonorable. This also includes veterans who served full-time in reserve and national guard units activated for Federal service. This does not include full-time duty performed strictly for training purposes, such as weekend or annual training. Activated for Federal service also does not include full-time duty performed by national guard personnel who are mobilized by State authorities. State mobilizations usually occur in response to an event such as natural disasters or public emergencies. [Note: Eligible Veterans must be given priority of service.]

Is a person who served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve component under an order to active duty pursuant to section 167 (a), (d), or, (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge; or

B.43m Eligible Spouse - Enter the total number of participants, who at enrollment, is a spouse of a veteran. This includes any veteran who died of a service-connected disability; any member of the Armed Forces serving on active duty, who at the time of application, is listed in one or more of the following categories and has been so listed for a total of more than 90 days: 1) missing in action; 2) captured in the line of duty by a hostile force; or is 3) forcibly detained or interned in the line of duty by a foreign government or power; any veteran who has a total disability resulting from a service-connected disability, as evaluated by the Department of Veterans Affairs; or Any veteran who died while a disability was in existence. [Note: Eligible Spouses, who meet program eligibility requirements, must be given priority of service.]

Is a person who is the spouse, eligible for WIA Section 166, of any person who died on active duty or of a service-connected disability, (b) the spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C. 101 and the regulations issued thereunder, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days: (i) missing in action; (ii) captured in the line of duty by a hostile force; or (iii) forcibly detained or interned in the line of duty by a foreign government or power; or (c) the spouse of any person who has a total disability permanent in nature resulting from a service-connected disability or the spouse of a veteran who died while a disability so evaluated was in existence.

B.43n Homeless – Enter the total number of new participants who lack a fixed, regular, adequate night time residence. This definition includes any individual who has a primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings. This definition does not include an individual imprisoned or detained under an Act of Congress or State law. An individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that alone, be recorded as homeless.

Section C. Program Services and Activities

This section collects information on the number of current participants (including new and carried-over participants) who received or, if it is an ongoing activity, are continuing to receive one or more of the allowable services/activities under the CS program. Grantees are only required to report the total number of participants who received one or more of the reference program activities below. Grantees are required to certify and submit results for both the current quarter (Column B) and cumulative totals for the most recent four-quarter reporting period (Column C). For all data collection items contained within this section, the data format is Integer with a maximum field length of 6-digits.

C.1 Core Services – Enter the total number of participants who received one or more core services during the reporting period. Allowable core services are defined in WIA regulations 20 CFR §668.340(b) and include, for example, outreach, intake, orientation to services, initial assessment of skill levels, aptitudes, abilities and supportive service needs, eligibility certification or assistance in establishing eligibility for financial assistance for training, job search and placement assistance, and career counseling.

C.2 Intensive Services – Enter the total number of participants who received one or more intensive services during the reporting period. Allowable intensive services are defined in WIA regulations 20 CFR §668.340(c) and include, for example, comprehensive and specialized testing and assessment, development of an individual employment plan, group or individual counseling, short-term pre-vocational services, work experience, tryout employment, dropout prevention activities, and other services identified in the approved Two-Year Plan.

C.3 Training Services – Enter the total number of participants who received one or more training services during the reporting period. Allowable training services are defined in WIA regulations 20 CFR §668.340(d) and include, for example, occupational skills training, on-the-job training, skill upgrading and retraining, entrepreneurial and small business development technical assistance and training, job readiness training, adult basic education (including English-as-a-Second Language), customized training, and educational and tuition assistance.

C.3a Basic Skills Training or Other Literacy Activities – Of those participants who received one or more training services during the reporting period (previously entered under C.3), enter the total number of participants who received remedial education, including Adult Basic Education (ABE), basic literacy or GED training classes, or English-as-a-second-language (ESL) training programs. Basic skills training or other literacy activities may be provided alone or in combination with other intensive or training services.

C.3b Occupational Skills Training – Of those participants who received one or more training services during the reporting period (previously entered under C.3), enter the total number of participants who received occupational skills training. Occupational skills training includes training ordinarily conducted in an institutional setting and is designed to provide individuals with technical skills and ability required to perform a specific job or group of jobs (e.g., community college, vocational technical school).

C.3c On-the-Job Training – Of those participants who received one or more training services during the reporting period (previously entered under C.3), enter the total number of participants who received On-the-Job Training (OJT) as referenced in the WIA statute. OJT includes training by an employer that is provided to a paid participant while engaged in productive work in a job that (a) provides knowledge or skills essential to the full and adequate performance of the job, (b) provides reimbursement to the employer of up to 50 percent of the wage rate of the participant, for the extraordinary costs of providing the training and additional supervision related to the training, and (c) is limited in duration appropriate to the occupation for which the participant is being trained, taking into account the content of the training, the prior work experience of the participant, and the service strategy for the participant as appropriate.

C.3d Entrepreneurial and Small Business Training – Of those participants who received one or more training services during the reporting period (previously entered under C.3), enter the total number of participants who were receiving entrepreneurial and small business training.

C.3e Other Training Services – Of those participants who received one or more training services during the reporting period (previously entered under C.3), enter the total number of participants who received any other training service not included in C.3a through C.3d above. This includes programs that combine workplace training with related instruction, which may include cooperative education programs, skill upgrading and retraining, job readiness training, customized training, and education/tuition assistance.

Denominator: Total Exiters – Report the total number of participants who exit from the program during the reporting period. The numbers entered in this row shall be identical to those entered in row B.1.

Section D. Performance Results (Optional)

This section is optional for grantees and collects information (maximum of three grantee-specific measures) on CS Program accomplishments beyond the adult common measures. USDOL/ETA will utilize the Standardized Participant Record Data contained in Appendix B to calculate performance results, on behalf of the grantees, for the following adult common measures: entered employment, employment retention, and six months average earnings.

For each measure that is reported under this section, grantees should record the actual outcome result and, where appropriate, the numerator and denominator values. The EBSS on-line system will not automatically calculate the value based on the numerator and denominator values. Grantees should enter all values for each measure for both the current quarter (Column B) and cumulative totals for the most recent four-quarter period (Column C). Grantees should also utilize Section E.1 of the report to outline the exact methodology of the measure, including any important operational parameters, and briefly describe how the reported results of the measure assist the grantee in understanding how well the CS Program is meeting the needs of its customers.

Section E. Report Certification/Additional Comments

E.1 Report Comments/Narrative – Grantees may include additional information not captured as part of the report format or attach an electronic document that describes innovative service delivery strategies, progress on measures of program accomplishments (as outlined above in Section D. Performance Results), or how adult customers have been impacted in a positive way by the CS program.

E.2 Name of Grantee Certifying Official/Title – Enter the name and title of the grantee official that is certifying submission of the report to the Department.

E.3 Telephone Number – Enter the area code (999) and telephone number (999-9999) of the authorized official.

E.4 Email Address – Enter the email address of the authorized official.

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E TA Rev. 2013