| OMB Control Number: 0970-0490; Expiration date: 01/31/2020 | ||||||||||||||
| Wilson-Fish Alternative Program Recipient Data | ||||||||||||||
| 1. WF Agency/State or County: | 2. Federal Fiscal Year: | |||||||||||||
| A: FY Recipients of WF Assistance and Services by Immigration Status | ||||||||||||||
| Immigration Status: | a. Refugees |
% of Total |
b. C/H Entrants |
% of Total |
c. Asylees |
% of Total |
d. Trafficking Victims |
% of Total |
e. SIVs Iraqi/ Afghan |
% of Total |
f. Secondary Migrants |
% of Total |
g. Total |
% Total |
| 1. Number of FY Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 2. Number of RCA Recipients from FY Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 3. Number of RCA Differential Recipients from FY Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 4. Number of RMA Recipients from FY Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 5. Number of RMA-only Recipients from FY Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 6. Number of RSS-only Recipients from FY Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 7. Total Number of Unduplicated WF Recipients from FY Arrivals | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! |
| 8. Number of RCA Carryover Recipients | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 9. Number of RCA Differential Carryover Recipients | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 10. Number of RMA Carryover Recipients | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 11. Number of RMA-only Carryover Recipients | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 12. Number of RSS-only Carryover Recipients | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | 0 | #DIV/0! | ||||||
| 13. Total Number of Unduplicated Carryover Recipients | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! |
| 14. Total Number of FY Unduplicated WF Recipients | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! |
| 15. Total Number of FY RCA & RCA Differential Recipients | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! |
| 16. Total Number of FY RMA Recipients | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! | 0 | #DIV/0! |
| B: FY Arrivals by Case Composition Type | ||||||||||||||
| Case Composition Type | a. RCA Type | b. TANF Type | c. SSI eligible | d. Total | ||||||||||
| 1. Number of FY Arrivals | 0 | |||||||||||||
| 2. Percentage of Total Arrivals | #DIV/0! | #DIV/0! | #DIV/0! | #DIV/0! | ||||||||||
| C: FY Cash Assistance Recipients by Cash Assistance Type | ||||||||||||||
| Cash Assistance Type | a. RCA | b. RCA Differential | c. SSI eligible | d. Former MG Enrollees | e. Total | |||||||||
| 1. Number of Recipients from FY Arrivals | 0 | 0 | 0 | |||||||||||
| 2. Number of Recipients from Previous FY Arrivals | 0 | 0 | 0 | |||||||||||
| 3. Total Number of FY Cash Assistance Recipients | 0 | 0 | 0 | 0 | 0 | |||||||||
| THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) | ||||||||||||||
| Public reporting burden for this collection of information is estimated to average two (2) 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. | ||||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |