1 Annual Service Plan

Annual Service Plan Original ( ) Revision ( )
Date: ___ ______ Time Period Covered by Plan From: To: __________________
State or County: ___________________________
Description of Contracted or State-provided Services		Contracted Amount by Funding Source	Total Number	Program 0 - 12 Months		Participants 13 - 60 Months	Type of Agency and Percent of Funds
	SS
	TAP
	Other
ELT	SS
	TAP
	Other
OJT	SS
	TAP
	Other
Skills Training	SS
	TAP
	Other
Case Management	SS
	TAP
	Other
Other	SS
	TAP
	Other
Type of Agency		A. State/ County			E. Adult Basic Education
		B. Mutual Assistance Association			F. Other Non-Profit Organization
		C. Voluntary Agency			G. _________________________
		D. Community College

ORR-6 OMB Control No. 0970-0036