MSHA Form xxxx MSHA State Grant Demographic Information Progress Report

										OMB Control Number 1219-XXXX Expiration Date: XXXX MSHA Form XXXX
	MSHA STATE GRANTS
	DEMOGRAPHIC INFORMATION PROGRESS REPORT
	METRIC		DESCRIPTION		1st QTR (OCT-DEC)		2nd QTR (JAN-MAR)		3rd QTR (APR-JUN)		4th QTR (JUL-SEP)		ANNUAL TOTALS (OCT-SEP)
	1		Number of individuals trained										0
			Age
	2		Number of individuals trained - 24 years and younger										0
	3		Number of individuals trained - 25-34 years old										0
	4		Number of individuals trained - 35-44 years old										0
	5		Number of individuals trained - 45-54 years old										0
	6		Number of individuals trained - 55-64 years old										0
	7		Number of individuals trained - 65 years and older										0
	8		Decline to answer age										0
			Gender
	9		Number of individuals trained -male										0
	10		Number of individuals trained - female										0
	11		Number of individuals trained - transgender, non-binary, or another gender										0
	12		Decline to answer gender										0
			Race and/or Ethnicity
	13		Number of individuals trained - American Indian or Alaska Native [see footnote 1 below]										0
	14		Number of individuals trained - Asian [see footnote 2 below]										0
	15		Number of individuals trained - Black or African American [see footnote 3 below]										0
	16		Number of individuals trained - Hispanic or Latino [see footnote 4 below]
	17		Number of individuals trained - Middle Eastern or North African [see footnote 5 below]										0
	18		Number of individuals trained - Native Hawaiian or other Pacific Islander [see footnote 6 below]
	19		Number of individuals trained - White [see footnote 7 below]										0
	20		Decline to answer race										0
			Primary Language
	21		Number of individuals trained - speak English very well										0
	22		Number of individuals trained - speak English well										0
	23		Number of individuals trained - speak English not well										0
	24		Number of individuals trained - speak no English at all										0
	25		Number of individuals trained - speak a language other than English at home										0
	26		Number of individuals trained - do not speak a language other than English at home										0
	27		Number of individuals trained - speak Spanish										0
	28		Number of individuals trained - speak another language										0
	29		Decline to answer language										0
			Version #2 May 2024
	Footnote 1:		For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.
	Footnote 2:		For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.
	Footnote 3:		For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.
	Footnote 4:		For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.
	Footnote 5:		For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.
	Footnote 6:		For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
	Footnote 7:		For example, English, German, Irish, Italian, Polish, Scottish, etc.