| Annual Service Plan | ORR-6 OMB Control No. 0970-0036 Expires XX/XX/XXXX |
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| 1. State/Grantee: |
2. Fiscal Year: |
3. Date: |
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| 4. Previous FFY Report (Program Participants) 45 CFR §§ 400.154 and 45 CFR 400.155 |
Total FY Unduplicated |
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| a) Employment | |||||||||||||||
| b) Employability Assessment | |||||||||||||||
| c) On-the-job Training | |||||||||||||||
| d) English Language Instruction | |||||||||||||||
| e) Vocational Training | |||||||||||||||
| f) Skills Recertfication | |||||||||||||||
| g) Day Care for Children | |||||||||||||||
| h) Transportation | |||||||||||||||
| i) Translation and Interpreter Services | |||||||||||||||
| j) Case Management | |||||||||||||||
| k) EAD Assistance | |||||||||||||||
| l) Information and Referral | |||||||||||||||
| m) Outreach Services | |||||||||||||||
| n) Social Adjustment | |||||||||||||||
| o) Citizenship and Naturalization | |||||||||||||||
| ASA RSS services only | |||||||||||||||
| p) ASA housing | |||||||||||||||
| q) ASA immigration-related legal assistance | |||||||||||||||
| 5. Total Unduplicated | |||||||||||||||
| 6. Previous FFY Report Services Participation (45 CFR 400.154 and 45 CFR 400.155) | Total Number | ||||||||||||||
| a) Report number of service participants at the end of FFY who are 0-12 months since arrival in the US | |||||||||||||||
| b) Report number of service participants at the end of FFY who are 13-60 months since arrival in the US | |||||||||||||||
| 7. Previous FFY Set-Aside Programs Services Participation | RSI | SOR | YM | RHP | ARSI S2S | Other | |||||||||
| a) Report number of service participants at the end of FFY who are 0-12 months since arrival in the US | |||||||||||||||
| b) Report number of service participants at the end of FFY who are 13-60 months since arrival in the US | |||||||||||||||
| Plan for upcoming FY | 9. Grant |
10. Contracted Amount by Funding Source |
11. Program Participants |
12. Type of Agency and Percent of Funds |
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| 8. Description of State-provided or Contracted Services |
0-12 Month |
13-60 Month |
Total Number |
A. State or County |
B. Mutual Assistance Association |
C. Refugee Agency |
D. Community College |
E. Adult Basic Education |
F. Non Profit Organization |
G. School District |
H. Area Agency on Aging |
I. Other |
J. Total |
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| a. Employment Services |
RSS | 0 | 0% | ||||||||||||
| b. English Language Instruction |
RSS | 0 | 0% | ||||||||||||
| c. On-the-Job Training |
RSS | 0 | 0% | ||||||||||||
| d. Vocational Training |
RSS | 0 | 0% | ||||||||||||
| e. ASA Housing |
RSS | 0 | 0% | ||||||||||||
| f. ASA Immigration-Related Legal Assistance |
RSS | 0 | 0% | ||||||||||||
| g. Other Services |
RSS | 0 | 0% | ||||||||||||
| RSS-RSI | 0 | 0% | |||||||||||||
| RSS-SOR | 0 | 0% | |||||||||||||
| RSS-YM | 0 | 0% | |||||||||||||
| RSS-RHP | 0 | 0% | |||||||||||||
| RSS-ARSI S2S | 0 | 0% | |||||||||||||
| Other | 0 | 0% | |||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |