Form FNS-583 Food Stamp Employment and Training (E&T) Program Activit

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FORM APPROVED OMB NO. 0584-0339

U.S. DEPARTMENT OF AGRICULTURE
FOOD AND NUTRITION SERVICE
FOOD STAMP EMPLOYMENT AND TRAINING
(E&T) PROGRAM ACTIVITY REPORT

STATE NAME

QUARTER COVERED
1 - First
3 - Third
2 - Second
4 - Fourth
FEDERAL FISCAL YEAR

STATE CODE

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0584-0339. The time required to complete this information
collection is estimated to average 154 hours per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information.

COMPLETE ON FIRST QUARTER REPORT
1. Number of work registrants receiving food stamps on October 1 of the new fiscal year:

COMPLETE EACH QUARTER
MONTH 1

MONTH 2

MONTH 3

QUARTERLY
TOTAL

FISCAL YEAR
TO DATE

2. Number of new work registrants
3. Number of ABAWD applicants and recipients
participating in qualifying components
4. Number of all other applicants and recipients
(including ABAWDs involved in non-qualifying
activities) participating in qualifying components
5. Number of ABAWD case months used under
the State agency's 15% exemption allowance

COMPLETE ON FOURTH QUARTER REPORT FOR ENTIRE FISCAL YEAR
6. Number of individuals who participated in each component (list components and attach separate sheet if necessary)
NUMBER WHO PARTICIPATED IN EACH COMPONENT

COMPONENTS

ABAWD

NON-ABAWD

TOTAL

TOTAL COMPONENT PARTICIPATION
EMPLOYMENT AND TRAINING PROGRAM PARTICIPATION

NUMBER WHO PARTICIPATED IN THE E&T PROGRAM

7. Number of individuals who participated in the E&T Program during the fiscal year

I CERTIFY THAT THIS REPORT IS CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE
SIGNATURE

TITLE

Form FNS-583 (30-05) Previous editions are obsolete

DATE

SBU

TELEPHONE

Electronic Form Version Designed in Adobe 7.1 Version

No further monies or other benefits may be paid out under this program unless this report is completed and filed as required by 7 CFR 273.7

FOOD STAMP EMPLOYMENT AND TRAINING (E&T) PROGRAM ACTIVITY REPORT (FNS-583)
GENERAL INSTRUCTIONS

This report covers State agency E&T program activities during the report period. Each State agency must
submit a consolidated State level report to the Food and Nutrition Service (FNS). Submit the original and
one copy of this report to the FNS Regional Office no later than the 45th day following the end of the report
period. For the 2nd, 3rd and 4th quarters, add the quarterly total to the total from the previous quarter(s)
and list cumulative total under "FISCAL YEAR TO DATE". State agencies must retain a copy of the report
for audit purposes.
NOTE: Items 3 and 4 below require a monthly count of component participation. An individual who
participates each month must be counted 12 times during the fiscal year. In Item 6, that same individual
should be counted once for each component in which he/she participated. For example, an ABAWD
participated the entire fiscal year - 6 months in a workfare component and 6 months a training component.
That ABAWD must be counted each month in Item 3. At the end of the fiscal year the same ABAWD must
be counted twice in Item 6 - once in the workfare component and once in the training component. However,
in Item 7 count the individual only once for the fiscal year.
ITEM 1 - Record the total number of work registrants in the State on October 1 of the new fiscal year. Do not
count these registrants again during the fiscal year.
ITEM 2 - Record the number of individuals registered for work each month, beginning with October. Count
individuals as work registrants only once during the fiscal year.
ITEM 3 - Record the number of able-bodied adults without dependents (ABAWDs), both applicants and
recipients, subjects to the 3-month food stamp time limit that participated in qualifying ABAWD E&T activities
each month of the report period. NOTE: Qualifying ABAWD E&T activities maintain food stamp eligibility for
those subject to the time limit. To remain eligible, ABAWDs must:
Participate for 20 hours or more each week in qualifying activities in:
1. A program under title I of the Workfare Investment Act of 1998.
2. A program under section 236 of the Trade Act of 1974.
3. An E&T program. However, job search and job search training are not qualifying activities
unless they make up less than half of the required 20 hours.
Participate in workfare. Job search counts as a qualifying activity during the first 30 days after
initial certification, before assignment to a workfare position.
ITEM 4 - Record the number of all other applicants and recipients who participated in an E&T activity each
month of the report period. Include ABAWDs who participated in non-qualifying activities.
ITEM 5 - Record the number of ABAWD case months used each month of the report period under the State
agency's 15 percent exemption allowance, in accordance with section 6(o)(6) of the Food Stamp Act.
ITEM 6 - On the 4th quarter report, list the E&T components offered during the fiscal year and record the
number of ABAWDs and non-ABAWDs who participated in each.
ITEM 7 - On the 4th quarter report, record the number of ABAWDs and non-ABAWDs who participated in the
E&T Program during the fiscal year. Count each individual only once.