ETA-9133 Eligible Veterans and Transitioning Service Members Repo

Workforce Investment Streamlined Performance Reporting (WISPR) System

Appendix C - ETA-9133.xls

WISPR

OMB: 1205-0469

Document [xlsx]
Download: xlsx | pdf

































































ELIGIBLE VETERANS AND
TRANSITIONING SERVICE MEMBERS SERVICES REPORT (ETA FORM 9133)






























OMB No.: 1205-NEW





























Expires: xx/xx/xxxx


























Estimated Average Response Time: 50 Hours

















A. GRANTEE IDENTIFYING INFORMATION





















1. Grantee Name:





3. Workforce Programs































Wagner-Peyser Employment Service
Jobs for Veterans State Grants-DVOP/LVER Programs


















2. Grantee Mailing Address:





4. Cumulative 4-Quarter End Date:























_____________________________________________________________________________









mm/dd/yyyy



















City ________________________________

State ______ Zip Code ___________


5. Report Due Date:


































mm/dd/yyyy



















































B. CUSTOMER SUMMARY INFORMATION





















Performance
Items

A
Totals
(including
non-veterans)

B
Totals
Veterans and Other Eligible Persons

C
TSMs

D
Campaign
Veterans

E
Disabled
Veterans

F
Special
Disabled
Veterans

G
Recently
Separated
Veterans
(3 Yrs)

H
Female
Veterans

I
Homeless
Veterans


















1 2 3 4

















Totals 18-44 45-54 55 and Over

















1. Total Entrants





























2. Total Participants





























2a. Male





























2b. Female





























2c. 18-44





























2d. 45-54





























2e. 55 and Over





























3. Received Staff-Assisted Services





























3a. Attended TAP Employment Workshop





























3b. Received Career Guidance





























3c. Received Job Search Activities





























3d. Referred to Employment





























3e. Received Intensive Services





























3f. Referred to Federal Training





























3g. Placed in Federal Training





























3h. Referred to Federal Job





























3i. Referred to Federal Contractor Job





























































C. REPORT CERTIFICATION/ADDITIONAL COMMENTS





















1. Report Comments/Narrative:






























































































































2. Name of Grantee Certifying Official/Title:


3. Telephone Number:

4. Email Address:























































































































OMB Burden Statement: These reporting instructions have been approved under the Paperwork Reduction Act of 1995. 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]). 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 Performance and Technology, Room S-5206, 200 Constitution Avenue, NW, Washington, DC 20210.
















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