Form ETA-9140-A Beneficiary Choice Quarterly Performance Report

Reintegration of Ex-Offenders, Adult Reporting System

Sample-Standardized-PRI-Performance-Report- 10 05 07.xls

Beneficiary Choice Quarterly Performance Report

OMB: 1205-0455

Document [xlsx]
Download: xlsx | pdf
STANDARDIZED QUARTERLY PERFORMANCE REPORT





















Beneficiary-Choice Contracting Grant





















Report Due Date: mm/dd/yyyy






OMB No. 1205-0455























ETA Form No. ETA-9140-A






Expires: 1/31/2009























A. GRANTEE IDENTIFYING INFORMATION





















Grantee Name: Grant Number:











































Program/Project Name: Project or Sub-Project ID/Number:











































Report Quarter End Date:


















































City ________________________________

State ______ Zip Code __________

Enrollment Goal:






















Performance Items Previous Quarter
(A)
Current Quarter
(B)
Cumulative for Program Year
(C)
Program-to-Date
(D)






















B. PARTICIPANT SUMMARY INFORMATION





















1. Total Exiters





























2. Total Participants Served





























3. New Participants Served





























Gender 4a. Male





























4b Female





























Ethnicity / Race 5a. Hispanic/Latino





























5b. American Indian or Alaska Native





























5c. Asian





























5d Black or African American





























5e. Hawaiian Native or Other Pacific Islander





























5f. White





























Education Level 6a. 8th grade and under





























6b. 9th grade - 12th grade





























6c. High School graduate or equivalent





























6d. 1 - 3 years of college, or full-time technical or vocational school





























6e. 4 years college or more





























Age 7a. 18 - 29





























7b. 25 - 34





























7c. 35 - 44





























7d. 45 - 54





























7e. 55 or older





























Other Demographics 8. Eligible Veterans





























9. Limited English Proficient





























10. Persons with a Disability





























11. Not Employed at Program Participation





























C. Additional Participant Information to be collected at enrollment





















Housing Status 1a. Own/rent apartment, room, or house





























1b. Staying at someone's apartment, room or house (Stable)





























1c.. Halfway house/transitional house





























1d. Residential treatment





























1e. Homeless





























1f. Staying at someone's apartment, room or house (Unstable)






























2. History of Alcohol Abuse/Drug Use






























3. Average Number of Days Since Release






























4. Average Number of Years Incarcerated





























Post-Release Status 5a. Parole





























5b. Probation





























5c. Other Post-Release Supervision





























5d. None





























Type of Crime 6a. Property Crimes





























6b. Drug Crimes





























6c. Public Order Offenses





























6d. Other Offenses





























7. DOJ Pre-Release Participants





























Performance Items

Previous Quarter
(A)

Current Quarter
(B)
Cumulative for Program Year
(C)
Program-to-Date
(D)






















Value Numerator Value Numerator Value Numerator Value Numerator





















Denominator Denominator Denominator Denominator





















D. PROGRAM SERVICES, ACTIVITIES, AND OTHER RELATED ASSISTANCE























1. Received Education or Job Training Activities























































2. Received Workforce Preparation Activities























































3. Community Involvement Activities























































4. Received Mentoring Activities























































5. Received Health Services























































6. Received Supportive Services























































7. Overall Participation Rate (participating in at least one activity from 1 through 5. Does not include supportive services.)























































Performance Items

Previous Quarter
(A)

Current Quarter
(B)
Cumulative for Program Year
(C)
Program-to-Date
(D)






















Value Numerator Value Numerator Value Numerator Value Numerator





















Denominator Denominator Denominator Denominator





















E. SHORT-TERM INDICATORS OF PERFORMANCE























Leading Indicators of Performance





















1. Enrollment Rate























































2. Abstained from Alcohol Abuse or Illegal Drug Use
(6 months after enrollment)
























































3. Stable Living Arrangements
(6 months after enrollment)
























































4a. Number of Initial Job Placements















































4b. Average Hourly Wage Rate at Placement























































4c. Number of Job Re-Placements















































4d. Average Hours Worked 1st Week of Placement























































5. Number Obtained High School Diploma or GED























































6. Number Obtained a Certificate























































7. Entered Post Secondary Education























































8. Entered Vocational/Occupational Skills Training























































9a. Number of Re-arrests for a New Crime -- one year























































9b. Number of Re-arrests for a New Crime -- six months
























































9c. Number of Re-Incarcarations for New Crime 6 Mos.
































9d. Number of Re-Incarcarations for New Crime 1 yr.
































9e. Number of re-Convictions for New Crime 6 mos.
































9f. Number of re-Convictions for New Crime 6 mos.































F. LONG-TERM INDICATORS OF PERFORMANCE























Common Performance Measures
























1. Entered Employment Rate























































2. Employment Retention (includes all participants who entered employment, regardless of follow-up)























































3. Attainment of a Degree Or Certificate



























































4. Average 6 Months Post-Program Earnings (includes only those who have been successfully contacted during follow-up)























































Additional Performance Measures





















5. Recidivism Rate























































G. REPORT CERTIFICATION/ADDITIONAL COMMENTS





















Grantee Remarks:























































































Name of Grantee Certifying Official:


Telephone Number:

Email:






















































File Typeapplication/vnd.ms-excel
Last Modified Byshortenhaus-scott
File Modified2007-10-05
File Created2004-12-26

© 2024 OMB.report | Privacy Policy