| OMB No. 1205-0420 | |||||||||||||
| Expires: 5/31/2016 | |||||||||||||
| State Name: | Date Submitted: | ||||||||||||
| WIA Title IB Annual Report Form (ETA 9091) | |||||||||||||
| Table A - Workforce Investment Act Customer Satisfaction Results | |||||||||||||
| Customer Satisfaction | Negotiated Performance Level | Actual Performance Level - American Customer Satisfaction Index | Number of Surveys Completed | Number of Customers Eligible for the Survey | Number of Customers Included in the Sample | Response Rate | |||||||
| Participants | |||||||||||||
| Employers | |||||||||||||
| Table B - Adult Program Results | |||||||||||||
| Negotiated Performance Level | Actual Performance Level | ||||||||||||
| Entered Employment Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Employment Retention Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Six-Months Average Earnings | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Employment and Credential Rate* | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Table C - Outcomes for Adult Special Populations | |||||||||||||
| Reported Information | Public Assistance Recipients Receiving Intensive or Training Services | Veterans | Individuals With Disabilities | Older Individuals | |||||||||
| Entered Employment Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Employment Retention Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Six-Months Average Earnings | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Employment and Credential Rate* | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Table D - Outcome Information by Service Level for the Adult Program | |||||||||||||
| Reported Information | Individuals Who Only Received Core Services | Individuals Who Only Received Core and Intensive Services | Individuals Who Received Training Services | ||||||||||
| Entered Employment Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Employment Retention Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Six-Months Average Earnings | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Table E - Dislocated Worker Program Results | |||||||||||||
| Negotiated Performance Level | Actual Performance Level | ||||||||||||
| Entered Employment Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Employment Retention Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Six-Months Average Earnings | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Employment and Credential Rate* | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Table F - Outcomes for Dislocated Worker Special Populations | |||||||||||||
| Reported Information | Veterans | Individuals With Disabilities | Older Individuals | Displaced Homemakers | |||||||||
| Entered Employment Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Employment Retention Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Six-Months Average Earnings | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Employment and Credential Rate* | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Table G - Outcome Information by Service Level for the Dislocated Worker Program | |||||||||||||
| Reported Information | Individuals Who Received Only Core Services | Individuals Who Only Received Core and Intensive Services | Individuals Who Received Training Services | ||||||||||
| Entered Employment Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Employment Retention Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Six-Months Average Earnings | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Table H.1 - Youth (14-21) Program Results | |||||||||||||
| Negotiated Performance Level | Actual Performance Level | ||||||||||||
| Placement in Employment or Education Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Attainment of Degree or Certificate Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Literacy and Numeracy Gains | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Table H.1.A - Outcomes for Youth Special Populations* | |||||||||||||
| Reported Information | Public Assistance Recipients | Veterans | Individuals With Disabilities | Out-of-School Youth | |||||||||
| Placement in Employment or Education Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Attainment of Degree or Certificate Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Literacy and Numeracy Gains | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Table H.2 - Older Youth Results (19-21)* | |||||||||||||
| Negotiated Performance Level | Actual Performance Level | ||||||||||||
| Entered Employment Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Employment Retention Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Earnings Change | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Employment and Credential Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Table I - Outcomes for Older Youth Special Populations* | |||||||||||||
| Reported Information | Public Assistance Recipients | Veterans | Individuals With Disabilities | Out-of-School Youth | |||||||||
| Entered Employment Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Employment Retention Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Earnings Change | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Employment and Credential Rate | Numerator | Numerator | Numerator | Numerator | |||||||||
| Denominator | Denominator | Denominator | Denominator | ||||||||||
| Table J - Younger Youth Results (14-18)* | |||||||||||||
| Negotiated Performance Level | Actual Performance Level | ||||||||||||
| Skill Attainment Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Diploma or Equivalent Attainment Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Retention Rate | Numerator | ||||||||||||
| Denominator | |||||||||||||
| Table K - Outcomes for Younger Youth Special Populations | |||||||||||||
| Reported Information | Public Assistance Recipients | Individuals With Disabilities | Out-of-School Youth | ||||||||||
| Skill Attainment Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Diploma or Equivalent Attainment Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Retention Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Table L - Other Reported Information | |||||||||||||
| 12 Month Employment Retention Rate | 12 Mo. Earnings Change (Adults and Older Youth) or 12 Mo. Earnings Replacement (Dislocated Workers) |
Placements for Participants in Nontraditional Employment | Wages At Entry Into Employment For Those Individuals Who Entered Unsubsidized Employment | Entry Into Unsubsidized Employment Related to the Training Received of Those Who Completed Training Services | |||||||||
| Adults | Num | Num | Num | Num | Num | ||||||||
| Den | Den | Den | Den | Den | |||||||||
| Dislocated Workers | Num | Num | Num | Num | Num | ||||||||
| Den | Den | Den | Den | Den | |||||||||
| Older Youth* | Num | Num | Num | Num | |||||||||
| Den | Den | Den | Den | ||||||||||
| Table M - Participation Levels | |||||||||||||
| Total Participants Served | Total Exiters | ||||||||||||
| Adults | |||||||||||||
| Dislocated Workers | |||||||||||||
| Total Youth 2 | |||||||||||||
| Older Youth | |||||||||||||
| Younger Youth | |||||||||||||
| Total | |||||||||||||
| Table N - Cost of Program Activities | |||||||||||||
| Program Activity | Total Federal Spending | ||||||||||||
| Local Adults | |||||||||||||
| Local Dislocated Workers | |||||||||||||
| Local Youth | |||||||||||||
| Rapid Response (up to 25%) WIA Section 134(a)(2)(B) | |||||||||||||
| Statewide Required Activities (Up to 15%) WIA Section 134 (a)(2)(B) | |||||||||||||
| Statewide Allowable Activities WIA Section 134 (a)(2)(B) | Program Activity Description | ||||||||||||
| Total of All Federal Spending Listed Above | |||||||||||||
| Table O - Local Performance (Include this chart for each local area in the state) | |||||||||||||
| Local Area Name ________________________ |
Total Participants Served | Adults | |||||||||||
| Dislocated Workers | |||||||||||||
| Older Youth (19 - 21) | |||||||||||||
| Younger Youth (14 - 18) | |||||||||||||
| ETA Assigned # ________________________ |
Total Exiters | Adults | |||||||||||
| Dislocated Workers | |||||||||||||
| Older Youth (19 - 21) | |||||||||||||
| Younger Youth (14 - 18) | |||||||||||||
| Reported Information | Negotiated Performance Level | Actual Performance Level | |||||||||||
| Customer Satisfaction | Program Participants | ||||||||||||
| Employers | |||||||||||||
| Entered Employment Rates | Adults | ||||||||||||
| Dislocated Workers | |||||||||||||
| Older Youth | |||||||||||||
| Retention Rates | Adults | ||||||||||||
| Dislocated Workers | |||||||||||||
| Older Youth | |||||||||||||
| Younger Youth | |||||||||||||
| Six-Months Average Earnings | Adults | ||||||||||||
| Dislocated Workers | |||||||||||||
| Six-Months Earnings Increase (Older Youth) | Older Youth | ||||||||||||
| Credential/Diploma Rates | Adults | ||||||||||||
| Dislocated Workers | |||||||||||||
| Older Youth | |||||||||||||
| Younger Youth | |||||||||||||
| Skill Attainment Rate | Younger Youth | ||||||||||||
| Placement in Employment or Education | Youth (14 - 21) | ||||||||||||
| Attainment of Degree or Certificate | Youth (14 - 21) | ||||||||||||
| Literacy or Numeracy Gains | Youth (14 - 21) | ||||||||||||
| Description of Other State Indicators of Performance (WIA Section 136(d) (1) - insert additional rows if there are more than two other state indicators of performance). | |||||||||||||
| Overall Status of Local Performance | Not Met | Met | Exceeded | ||||||||||
| Table P - Veteran Priority of Service | |||||||||||||
| Total | Percent Served | ||||||||||||
| Covered Entrants Who Reached the End of the Entry Period | |||||||||||||
| Covered Entrants Who Received a Service During the Entry Period | |||||||||||||
| Covered Entrants Who Received a Staff-Assisted Service During the Entry Period |
|||||||||||||
| Table Q - Veterans' Outcomes by Special Populations | |||||||||||||
| Reported Information | Post 9/11 Era Veterans | Post 9/11 Era Veterans who Received at least Intensive Services | TAP Workshop Veterans | ||||||||||
| Entered Employment Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Employment Retention Rate | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| Six-Months Average Earnings | Numerator | Numerator | Numerator | ||||||||||
| Denominator | Denominator | Denominator | |||||||||||
| OMB Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB number. Obligation to respond is required to obtain or retain benefits (Workforce Investment Act [Section 185(a)(2)] and Wagner-Peyser Act [29 USC 49i]). The 80 hour public reporting burden for this collection of information, which is to assist with planning and program management and to meet Congressional and statutory requirements, includes time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. Send comments regarding this burden estimate, or any other aspect of this collection, including suggestions for reducing burden, to the U.S. Department of Labor, Employment and Training Administration, Office of Policy Development and Research, Room N-5641, 200 Constitution Avenue, NW, Washington, DC 20210. | |||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |