ETA-9084 Comprehensive Services Quarterly Performance Report

ETA Form 9084 - Comprehensive Services Quarterly Performance Report
OMB No: 1205-0422
Expires: 01/31/2021

A. GRANTEE IDENTIFYING INFORMATION
1. Grantee Name:

2. Grant Number:

3. Program/Project Name:
4. Grantee Address:
City:

5. Report Quarter End Date:
State:

Performance Items
B. CUSTOMER SUMMARY INFORMATION
1. Total Exiters
2. Core Services: Self-Services only
3. Total Participants Served
4. New Participants Served
4a. Male
4b. Female
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
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 Veteran's Spouse
4n. Homeless
4o. Long-term Unemployed
4p. Multiple Barriers
C. CUSTOMER SERVICES AND ACTIVITIES
1. Core Services
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

ZIP Code:

Previous
Quarter
(A)

6. Report Due Date:

Current
Quarter
(B)

Cumulative
4-Qtr Period
(C)

D. PERFORMANCE RESULTS
Outcome
(Cumulative 4-Quarter Results Tabulated for Exit Cohort Shown)

Value

numerator
denominator

Value

numerator
denominator

Value

numerator
denominator

1. Entered Employment Rate
(xx/xx/xx to xx/xx/xx)
2. Retention Rate
(xx/xx/xx to xx/xx/xx)
3. Average Earnings
(xx/xx/xx to xx/xx/xx)
4. Education (Credential) Measure
(xx/xx/xx to xx/xx/x)

E. REPORT CERTIFICATION/ADDITIONAL COMMENTS
1. Report Comments/Narrative:

This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0422. 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, which is required for obtaining or retaining benefits (PL 105-220, Sec. 166), is estimated to average 2 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, Indian and Native Americans Program, 200 Constitution
Avenue, NW, Room N4209, Washington, D.C. 20210.

2. Name of Grantee Certifying Official/Title

3. Telephone Number:

4. Email Address:

ETA Form 9084 (September 2019)

ETA Form 9084 Definitions

ETA Form 9084 Definitions
Line No.

Item

Definition

B.1

Total Exiter

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

B.2

Core Services: SelfServices only

According to WIA regulations §666.140, self-services are those core services that are made
available and accessible to the general public, that are designed to inform and educate
individuals about the labor market and their employment strengths and weaknesses, and that
do not require significant staff involvement with the individual in terms of resources or time.
ETA views self-services as occurring when individuals serve themselves. Such individuals are
not considered to be Section 166 participants (see the definition of Participant, below).

B.3

Total Participants
Served

A participant is any individual who is determined eligible to participate in the Section 166
program and receives a service funded by the program. Participant counts do not include
individuals who only receive a determination of eligibility or who are self-service customers.
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.4

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.4.a

Male

Enter the total number of new participants whose gender is male.

B.4.b

Female

Enter the total number of new participants whose gender is female.

B.4.c

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.4.d

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.4.e

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.4.f

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.4.g

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.4.h

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.4.i

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

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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.4.j

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.4.k

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.4.l

Eligible Veterans

Enter the total number of new participants who met one of the following conditions as a
veteran:
1. 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
2. Is a person who is (a) the spouse 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.4.m

Eligible Spouses

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. 1) missing in action;
2. 2) captured in the line of duty by a hostile force; or is
3. 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.]

B.4.m

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.

B.4.n

Long-Term
Unemployed

The number of participants who are (1) unemployed at the time of participation in the
program; (2) have been unemployed for any 15 or more of the 26 weeks immediately prior to
participation in the program; and (3) have made specific efforts to find a job throughout the
period of unemployment.

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B.4.o

Multiple Barriers

The number of participants who have any two or more of the following barriers to
employment: public assistance recipient, basic skills deficient, offender, limited-English
proficient, lacks significant work history, homeless, low income, single head of household with
dependent children, disability, substance abuse, or displaced homemaker.

C.1

Core Services
Requiring Registration

Those who meet the definition of a Section 166 participant and who received one or more
core services during the reporting period. Allowable core services are defined in WIA
regulations §668.340(b) and include 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

Those who meet the definition of a Section 166 participant and who received one or more
intensive services during the reporting period. Allowable intensive services are defined in WIA
regulations §668.340(c) and include comprehensive and specialized testing and assessment,
development of an individual employment plan, group or individual counseling, short-term prevocational services, work experience, tryout employment, dropout prevention activities, and
other services identified in the approved Two-Year Plan.

C.2.a

Work Experience

Participants assigned to a short-term or part-time work assignment providing them the
opportunity to gain the skills and knowledge necessary to perform a job, including work habits
and behaviors.

C.3

Training Services

Those who meet the definition of a Section 166 participant and who received one or more
training services during the reporting period. Allowable training services are defined in WIA
regulations §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.3.a

CRT: Basic Skills or
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.3.b

CRT: 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.3.c

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-theJob 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 of the participant as appropriate.

C.3.d

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.3.e

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.

D.1

Entered Employment

Of those who are not employed at the date of participation: the number of adult participants

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Rate

who are employed in the first quarter after the exit quarter divided by the number of adult
participants who exit during the quarter.

D.2

Retention Rate

Of those who are employed in the first quarter after the exit quarter: the number of adult
participants who are employed in both the second and third quarters after the exit quarter
divided by the number of adult participants who exit during the quarter.

D.3

Average Earnings

Of those adult participants who are employed in the first, second, and third quarters after the
exit quarter: total earnings in the second plus the total earnings in the third quarters after the
exit quarter divided by the number of adult participants who exit during the quarter.

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 in Section D. Performance Results),
or how adult customers have been impacted in a positive way by the CS program.