Instructions for Completing
the Projects With Industry Annual Reporting Form
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection in 1820-0631. The time required to complete this information collection is estimated to average 90 hours per response, including the time for reviewing instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Thomas E. Finch, Ph.D., Service Programs Unit, Training and Service Programs Division, Rehabilitation Services Administration, U.S. Department of Education, 400 Maryland Avenue, S.W., PCP, 5059, Washington, D.C. 20202-4651.
Please provide information for the appropriate fiscal year for each of the items in the attached form.
Note: Grantee need not respond if an OMB number is not present.
Definitions:
“Individual served” or “person served,” means an individual for whom services by a PWI project have been initiated with the objective that those services will result in placement in competitive employment (34 CFR 379.5(b)(6)).
“Individual Placed” means an individual who has attained competitive employment as a result of receiving services from the PWI project and has maintained employment for a period of at least 90 days (also referred to as a “placement”).
“Competitive employment”, as used in the definition of a placement outcome under this program, means work in the competitive labor market that is performed on a full-time or part-time basis in an integrated setting; and for which an individual is compensated at or above the minimum wage, but not less than the customary or usual wage and terms and benefits provided by the employer for the same or similar work performed by individuals who are not disabled (34 CFR 379.5(b)(2)).
“Exited the program” - An individual is considered to have exited the program when either the participant has been placed into competitive employment or the participant has not received a project service for 90 consecutive calendar days, excluding follow-up services or regular contact with the participant or employer to obtain information regarding the individual’s employment status or need for additional services after the individual has been placed. Participants who have a planned gap in service of greater than 90 days are not considered to have exited the program if the gap in service is due to a temporary time-limited delay or disruption in the receipt of service.
“Individualized Education Program (IEP)” – A written statement developed for each child with a disability in accordance with section 614 (d) of the Individuals with Disabilities Education Act.
“504 Plan” – A plan developed by a preschool, elementary, or secondary educational program that is subject to section 504 of the Rehabilitation Act describing the appropriate educational services, modifications, and accommodations to be provided to meet the individual needs of a qualified student who has a physical or mental impairment that substantially limits one or more major life activities, to the same extent as the needs of students without disabilities are met.
PART I - DEMOGRAPHIC AND DESCRIPTIVE DATA
Section I - Age
Enter the number of individuals served by the project during the reporting period, in each category below:
a. 21 and under
b. 22 – 40
c. 41 – 64
d. 65 and over
Enter the number of individuals placed in competitive employment during the reporting period, in each category below:
a. 21 and under
b. 22 – 40
c. 41 – 64
65 and over
Students with Disabilities
1. If the project is serving students with disabilities enter the number of students served during the reporting who were 21 and under and had an Individualized Education Program (IEP) or a “504 plan”.
IEP
“504 Plan”
Section II – Gender
Enter the number of individuals served by the project during the reporting period, who were:
female
male
Enter the number of individuals placed in competitive employment during the reporting period, who were:
female
male
Section III – Race/Ethnicity
1. Enter the number of individuals served during the reporting period, in each category below:
a. Hispanic/Latino of any race; and,
for individuals who are non-Hispanic/
Latino only,
b. American Indian or Alaska Native,
Asian,
Black or African American,
e. Native Hawaiian or Other Pacific
Islander,
f. White,
Two or more races, and
h. Race/ethnicity unknown
2. Enter the number of individuals placed in competitive employment during the reporting period, in each category below:
a. Hispanic/Latino of any race; and,
for individuals who are non-Hispanic/
Latino only,
b. American Indian or Alaska Native,
c. Asian,
d. Black or African American,
e. Native Hawaiian or Other Pacific
Islander,
f. White,
g. Two or more races, and
h. Race/ethnicity unknown
Section IV – Education
Level of Education
1. For each item below, enter the number of individuals served during the reporting period whose highest level of educational achievement is reflected by the category.
Some secondary education (no high school diploma)
Certificate of Completion/Attendance
d. High School diploma or GED
e. Some college or other training
Associate degree or Vocational/Technical Certificate
Bachelor’s degree
Master’s degree or higher
2. Enter the number of individuals placed in competitive employment during the reporting period whose highest level of educational achievement is reflected by the category.
No formal education or primary education only
Some secondary education (no high school diploma)
Certificate of Completion/Attendance
High School diploma or GED
Some college or other training
Associate degree or Vocational/Technical Certificate
Bachelor’s degree
Master’s degree or higher
Section V - Disability
1. Enter the number of individuals served during the reporting period whose primary disability is characterized by the category below:
a. Cognitive (impairments involving learning, thinking processing information and concentration, e.g., mental retardation or learning disabilities)
b. Mental/Emotional (impairments in mental health such as personality disorders, bipolar disorder, depression, and anxiety disorder)
c. Physical
d. Hearing
e. Vision
f. Multiple Disabilities
g. Other
3. Enter the number of individuals placed in competitive employment during the reporting period whose primary disability is characterized by the category below:
a. Cognitive (impairments involving learning, thinking processing information and concentration, e.g., mental retardation or learning disabilities)
b. Mental/Emotional (impairments in mental health such as personality disorders, bipolar disorder, depression, and anxiety disorder)
c. Physical
d. Hearing
e. Vision
f. Multiple Disabilities
Other
Section VI – Other Services and Benefits
1. Enter the total number of individuals who have received vocational rehabilitation (VR) services from a State VR Agency prior to project entry.
2. Enter the total number of individuals who received VR services from a State VR Agency during the reporting period.
3. Enter the total number of individuals who have received Social Security Insurance (SSI) or Social Security Disability Insurance (SSDI) benefits prior to project entry.
4. Enter the total number of individuals who received SSI or SSDI benefits during the reporting period.
Applicants
Enter the total number of applicants for project services during the reporting period, including:
1.a. The number of individuals determined to be eligible
for project services in accordance with 34 CFR 379.3.
1.b. The number determined to be ineligible for project services.
Individuals Served by the Project
2.a. Enter the total number of individuals served by the project during the reporting period. [The total number served should equal the numbers served reported in 2.b. and 2.c.]
2.a.1. Enter the total number of individuals with significant disabilities served by the PWI project during the reporting period. This number includes all individuals with significant disabilities who received project services during the reporting period, including both those individuals who entered the program in the previous reporting period and continued to receive services during this reporting period and those individuals who entered the program and received projects services during the reporting period.
2.a.2. Enter the total number of individuals served by the project during the reporting period who had been unemployed six months or more at the time of project entry. This number includes all individuals who had been unemployed six months or more at the time of project entry who received project services during the reporting period, including both those individuals who entered the program in the previous reporting period and continued to receive services during this reporting period and those individuals who entered the program and received projects services during the reporting period.
2.a.3. Enter the total number of individuals served by the project during the reporting period who were not employed at project entry. This number includes all individuals who were not employed at the time of project entry who received project services during the reporting period, including both those individuals who entered the program in the previous reporting period and continued to receive services during this reporting period and those individuals who entered the program and received projects services during the reporting period.
2.b. Enter the number of new individuals served by the PWI project during the reporting period. This number includes only those individuals who completed the project’s intake process and who were determined eligible to receive project services during the current reporting period. Do not include individuals who were referred to other service providers and were not yet determined eligible for PWI project services.
2.c. Enter the number of individuals continuing to receive services from the PWI project during the reporting period. This number includes individuals who were determined eligible and received PWI services prior to the current reporting period and continued to receive project services during the reporting period.
Individuals Placed in Competitive Employment
3. Enter the total number of individuals placed in competitive employment during the reporting period. An individual will be counted as "placed" or a "placement" if he or she holds a job for a continuous period of at least 90 days prior to the end of the project year (September 30).
3.a. Enter the number of individuals with significant disabilities placed in competitive employment during the reporting period.
3.b. Enter the number of individuals placed in competitive employment during the reporting period who had been unemployed for a period of at least six months before entering the PWI project.
3.c. Enter the number of individuals placed in competitive employment during the reporting period who were not employed at project entry.
Wages and Earnings
4. Average weekly earnings for individuals placed in competitive employment during the reporting period:
4.a. Enter the average weekly earnings during the week prior to entry into the PWI project. Include participants with no earnings in this calculation. Earnings should include all income earned from full-time or part-time work and should not include benefit payments.
4.b. Enter the average weekly earnings at placement. [Note: the definition of “placement” is provided at the beginning of the instructions.]
5. Average hourly wage and hours worked for individuals placed in competitive employment during the reporting period who were employed at project entry:
5.a. For individuals employed at the time of project entry, (the time when they were accepted for services) enter the average hourly wage at the time of project entry.
5.b. For individuals employed at the time of project entry, enter the average hours worked per week at time of project entry.
5.c. For individuals employed at the time of project entry, enter the average hourly wage at placement.
5.d. For individuals employed at the time of project entry, enter the average hours worked per week at placement.
6. Average hourly wage and hours worked for individuals placed in competitive employment during the reporting period who were unemployed at project entry:
6.a. For individuals unemployed at project entry, enter the average hourly wage at placement.
6.b. For individuals unemployed at project entry, enter the average hours worked per week at placement.
Individuals Exiting the Program
7. Enter the total number of individuals who exited the program during the reporting period. This total number reported should equal the numbers reported in 7.a. and 7.b. [Note: The date of exit is the date on which the last service was provided by the PWI program which should be recorded in the individual’s case file.]
7.a. Enter the number of individuals who have exited the program by way of placement into competitive employment for 90 consecutive days. This number should be the same as the total number of individuals placed into competitive employment reported in item 3.
7.b. Enter the number of individuals who have exited the program, excluding the number of individuals who exited with a placement as reported in item 7.a., because they did not receive any program services for 90 consecutive days and did not have a planned gap in service due to a temporary time-limited delay or disruption in the receipt of service.
7.b.1. Enter the number of individuals who have exited the program who are individuals with significant disabilities.
7.b.2. Enter the number of individuals who have exited the program who had been unemployed six months or more at the time of project entry.
Employment Retention
8. Enter the number of eligible individuals with significant disabilities placed in competitive employment by the project during this or a previous reporting period who continued to be employed during this reporting period as described below:
8.a. Employed 3 months after placement, or, in the case of individuals whose employment goal was to advance in employment, the number who were employed 3 months after achieving their employment goal.
8.b. Employed 6 months after placement, or, in the case of individuals whose employment goal was to advance in employment, the number who are employed 6 months after achieving their employment goal.
8.c. Employed 9 months after placement, or, in the case of individuals whose employment goal was to advance in employment, the number who are employed 9 months after achieving their employment goal.
9. Enter the number of eligible individuals who are NOT individuals with significant disabilities placed in competitive employment by the project during this or a previous reporting period who continued to be employed during this reporting period as described below:
9.a. Employed 3 months after placement, or, in the case of individuals whose employment goal was to advance in employment, the number who are employed 3 months after achieving their employment goal; and
9.b. Employed 6 months after placement, or, in the case of individuals whose employment goal was to advance in employment, the number who are employed 6 months after achieving their employment goal.
9.c. Employed 9 months after placement, or, in the case of individuals whose employment goal was to advance in employment, the number who are employed 9 months after achieving their employment goal.
[Note: In items 8 and 9 include individuals placed in competitive employment in this or the previous reporting period who during this reporting period were still employed 3, 6, and 9 months after placement. For example, an individual who met the placement criteria on Aug.31 of the previous reporting period would be counted in item 9.a. if the person was still employed on December 1 of the current reporting period. The same individual would be counted again in 9.b. if the person was still employed on February 28 of the current reporting period. The same individual would be counted in 9.c. if the person was still employed on June 1 of the current reporting period. If the same individual became unemployed after the 3 month follow-up and remained unemployed at the 9 month follow-up the person would be counted in item 9.a., but not in item 9.c.]
10. Enter the average weekly earnings of individuals with significant disabilities placed in competitive employment by the project:
10.a. 3 months after placement in competitive employment.
10.b. 6 months after placement in competitive employment.
10.c. 9 months after placement in competitive employment.
11. Enter the average weekly earnings of individuals who are NOT
individuals with significant disabilities placed in
competitive employment by the project:
11.a. 3 months after placement in competitive employment.
11.b. 6 months after placement in competitive employment.
11.c. 9 months after placement in competitive employment.
12. Project Funding
12.a. Enter the amount of the Federal PWI award the project received for use during the reporting period.
12.b. Enter the amount of the project's total Non-Federal contribution. The Non-Federal contribution, including project match, may be "in-kind." Estimate the dollar equivalency of any in-kind Non-Federal contributions. [Note: The total Non-Federal contribution should include the required 20 percent match and any other additional Non-Federal contribution above the required amount.]
Cost per placement
13. Enter the projected cost per placement as stated in the grant application.
Note: The Department of Education will calculate the project’s “average cost per placement” to determine compliance with the Cost per Placement indicator in 34 CFR 379.53(b)(3). The Department will calculate the actual average cost per placement by dividing the sum of the project costs in item number 12 (i.e., Federal dollar amount of the grant plus the total non-Federal contribution) by the number of individuals successfully placed as reported in item number 2. The Department will then compare this figure to the projected average cost per placement. The Department will calculate the projected average cost per placement by dividing the sum of the project costs in item number 12 (i.e., Federal dollar amount of the grant plus the total non-Federal contribution) by the number of individuals the applicant projected in its application would be placed by the project.
PART III - PERFORMANCE DATA
The annual performance data demonstrates whether substantial progress has been made toward meeting the grantee’s individual project objectives as stated in the approved grant application. For the PWI program, the information described in these instructions will provide the U.S. Department of Education (ED) with the information needed to determine whether recipients have demonstrated substantial progress. Performance reporting requirements are found in 34 CFR 74.51, 75.118, 75.253, 75.590 and 80.40 of the Education Department General Administrative Regulations (EDGAR).
In the Performance Data section, you will report on the results to date of your project evaluation as required under EDGAR, 34 CFR 75.590. According to the instructions, for each project objective included in your approved grant application, provide quantitative and/or qualitative data and a description of preliminary findings or outcomes that demonstrate that you have met or are making progress towards meeting the project objective.
OMB Control Number: ___________
PR/AWARD NUMBER: ______________________________________________
PROJECT DIRECTOR: _____________________________________________
U. S. Department of Education
Rehabilitation Services Administration
Projects With Industry Annual Reporting Form
Project Year: October 1, 200_ to September 30, 200_
PART I - DEMOGRAPHIC AND DESCRIPTIVE DATA
Section I - Age
1. Enter the number of individuals served during the reporting period, in each category below:
a. 21 and under _______
b. 22 – 40 _______
c. 41 – 64 _______
d. 65 and over _______
2. Enter the number of individuals placed during the reporting
period, in each category below:
a. 21 and under _______
b. 22 – 40 _______
c. 41 – 64 _______
d. 65 and over _______
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
Demographic and Descriptive Data – continued
Students with Disabilities
1. If the project is serving students with disabilities enter the number of students served during the reporting who were 21 and under and had an Individualized Education Program (IEP) or a “504 plan”.
a. IEP ______
b. “504 Plan” ______
Section II – Gender
Enter the number of individuals served during the reporting
period, who were:
a. female _______
b. male _______
Enter the number of individuals placed during the reporting
period, who were:
a. female _______
b. male _______
Section III – Race/Ethnicity
1. Enter the number of individuals served during the reporting period, in each category below:
a. Hispanic/Latino of any race; and,
for individuals who are non-Hispanic/
Latino only, _______
b. American Indian or Alaska Native, _______
c. Asian, _______
d. Black or African American, _______
e. Native Hawaiian or Other Pacific
Islander, _______
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
f. White, _______
g. Two or more races, and _______
h. Race/ethnicity unknown _______
2. Enter the number of individuals placed during the reporting period, in each category below:
a. Hispanic/Latino of any race; and,
for individuals who are non-Hispanic/
Latino only, _______
b. American Indian or Alaska Native, _______
c. Asian, _______
d. Black or African American, _______
e. Native Hawaiian or Other Pacific
Islander, _______
f. White, _______
g. Two or more races, and _______
h. Race/ethnicity unknown _______
Section IV – Education
1. Enter the number of individuals served during the reporting period, in each category below:
No formal education or primary education only _______
Some secondary education (no high school diploma) _______
Certificate of Completion/Attendance _______
High School diploma or GED _______
Some college or other training _______
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
Associate degree or Vocational/Technical
Certificate _______
Bachelor’s degree _______
Master’s degree or higher _______
2. Enter the number of individuals placed during the reporting period, in each category below:
a. No formal education or primary education only _______
b. Some secondary education (no high school diploma) _______
c. Certificate of Completion/Attendance _______
d. High School diploma or GED _______
e. Some college or other training _______
f. Associate degree or Vocational/Technical
Certificate _______
g. Bachelor’s degree _______
h. Master’s degree or higher _______
Section V - Disability
1. Enter the number of individuals served during the reporting period, in each category below:
a. Cognitive _______
b. Mental/Emotional _______
c. Physical _______
d. Hearing _______
e. Vision _______
f. Multiple Disabilities _______
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
Demographic and Descriptive Data – continued
g. Other _______
2. Enter the number of individuals placed during the reporting period, in each category below:
a. Cognitive _______
b. Mental/Emotional _______
c. Physical _______
d. Hearing _______
e. Vision _______
f. Multiple Disabilities _______
g. Other _______
Section VI – Other Services
Enter the total number of individuals who have received Vocational Rehabilitation (VR) services prior to
project entry. _______
Enter the total number of individuals who received
VR services during the reporting period. _______
Enter the total number of individuals received
SSI/SSDI benefits prior to project entry. _______
Enter the total number of individuals who received
SSI/SSDI benefits during the reporting period. _______
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
1. Total number of applicants for project services _________
1.a. Number of applicants determined to be
eligible for project services. _________
1.b. Number of applicants determined to be
ineligible for project services. _________
2.a. Total number of individuals served. _________
2.a.1. Number of individuals served with significant disabilities. _________
2.a.2. Number of individuals served who had
been unemployed six months or more at time of
project entry. _________
2.a.3. Number of individuals served who were not
employed at project entry _________
2.b. Number of new individuals served. _____ __
2.c. Number of individuals who continued to receive
services during this reporting period. _________
3. Total number of individuals placed. _________
3.a. Number of individuals placed who are
individuals with significant disabilities. ________
3.b. Number of individuals placed who had been
unemployed six months or more at time of
project entry. ________
3.c. Number of individuals placed who were not
employed at project entry. ________
4. Average weekly earnings for individuals placed:
4.a. Prior to project entry ________
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
4.b. At placement ________
5. Average hourly wage and hours worked for
individuals employed at project entry:
5.a. Average hourly wage for employed individuals
at the time of project entry. ________
5.b. Average hours worked per week for employed
individuals at time of project entry. ________
5.c. Average hourly wage at placement for
individuals employed at project entry. ________
5.d. Average hours worked per week at placement
for individuals employed at project entry. ________
6. Average hourly wage and hours worked for
individuals unemployed at project entry:
6.a. Average hourly wage at placement for individual unemployed at project entry. ___
6.b. Average hours worked per week at placement
for individuals unemployed at project entry. ___
7. Number of individuals who exited the program:
7.a. Exit as a placement into competitive
employment. ________
7.b. Exit without a placement and no program
services for 90 consecutive days. ________
7.b.1. Number of individuals with significant
disabilities who exited without placement. ________
7.b.2. Number of individuals who had been
unemployed six months or more at the time of
project entry who exited the program without
placement. ________
8. Retention of individuals with significant disabilities
placed in competitive employment who were:
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
Compliance Indicator Data – continued
8.a. Employed 3 months after placement, or, in the
case of individuals whose employment goal was to
advance in employment, the number who are employed
3 months after achieving their employment goal. ________
8.b. Employed 6 months after placement, or,
in the case of individuals whose employment goal
was to advance in employment, the number who are
employed 3 months after achieving their
employment goal. ________
8.c. Employed 9 months after placement, or, in the
case of individuals whose employment goal was to
advance in employment, the number who are employed
9 months after achieving their employment goal. ________
9. Retention of individuals without significant disabilities placed in competitive employment who were:
9.a. Employed 3 months after placement, or, in the
case of individuals whose employment goal was to
advance in employment, the number who are employed
3 months after achieving their employment goal. ________
9.b. Employed 6 months after placement, or, in the
case of individuals whose employment goal was to
advance in employment, the number who are employed
9 months after achieving their employment goal. ________
9.c. Employed 9 months after placement, or, in the
case of individuals whose employment goal was to
advance in employment, the number who are employed
9 months after achieving their employment goal. ________
10. The average weekly earnings of individuals with significant disabilities:
10.a. 3 months after placement ____ ____
10.b. 6 months after placement ___ _____
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
Compliance Indicator Data – continued
10.c. 9 months after placement ___ _____
11. The average weekly earnings of individuals who are NOT individuals with significant disabilities:
11.a. 3 months after placement _____ __
11.b. 6 months after placement ________
11.c. 9 months after placement ________
12. Project funding:
12.a. Amount of Federal PWI award ________
12.b. Total Non-Federal contribution ________
13. Projected cost per placement ________
GRANTEE NAME:________________________________________________
PR/AWARD NUMBER:_____________________________________________
PROJECT OBJECTIVE:___________________________________________
_____________________________________________________________
_____________________________________________________________
Explanation of Progress:
PROJECT OBJECTIVE:___________________________________________
_____________________________________________________________
_____________________________________________________________
Explanation of Progress:
PROJECT OBJECTIVE:___________________________________________
_____________________________________________________________
_____________________________________________________________
Explanation of Progress:
GRANTEE NAME: ____________________________________________
PR/AWARD NUMBER:_________________________________________
PROJECT OBJECTIVE:___________________________________________
_____________________________________________________________
_____________________________________________________________
Explanation of Progress:
PROJECT OBJECTIVE:___________________________________________
_____________________________________________________________
_____________________________________________________________
Explanation of Progress:
PROJECT OBJECTIVE:___________________________________________
_____________________________________________________________
_____________________________________________________________
Explanation of Progress:
| File Type | application/msword |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |