Form 1810-0693 ESEA MOE Request Form

Form for Maintenance-of Effort Waiver Requests Under the Elementary and Secondary Education Act of 1965, as amended

ESEA MOE waiver request form.xls

Form for Maintenance-of Effort Waiver Requests Under the Elementary and Secondary Education Act of 1965, as amended

OMB: 1810-0693

Document [xlsx]
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Overview

Form 1
Form 2
Form 3

Sheet 1: Form 1
OMB Number: 1810-0693 Paperwork Burden Statement
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 is 1810-0693. The time required to complete this information collection is estimated to average 8 hours per response, including the time to review 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. 20202-4536. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Todd Stephenson, Office of Elementary and Secondary Education, U.S. Department of Education, 400 Maryland Avenue, S.W., 3C118, Washington, D.C. 20202.
Form 1: Local Educational Agency (LEA) Expenditure Data
*The comparison year expenditures (SY 2010-2011) are equal to actual SY 2010-2011 expenditures unless the LEA failed to maintain effort in SY 2010-2011. For an LEA that did not maintain effort in SY 2010-2011, report 90 percent of the SY 2009-2010 figure in the SY 2010-2011 column in accordance with section 9521(b)(2) of ESEA.

**If an LEA calculates MOE using more than one per-pupil measure (i.e., enrollment, membership, or attendance), provide the data for the per-pupil measure on which the LEA came closest to maintaining effort.)
LEA Name National Center for Education Statistics (NCES) District Identification Number SY 2009-2010 Aggregate Expenditures SY 2010-2011 Aggregate Expenditures* SY 2011-2012 Aggregate Expenditures Difference 2011-2012 vs. SY 2010-2011 Percentage 2011-2012 vs. SY 2010-2011 SY 2009-2010 Per-pupil Expenditures** SY 2010-2011 Per-pupil Expenditures** SY 2011-2012 Per-pupil Expenditures** Difference 2011-2012 vs. SY 2010-2011 Percentage 2011-2012 vs. SY 2010-2011 Percentage Reduction of Covered Program if MOE Waiver Request Denied
Sample LEA 9999999 $1,000,000 $1,100,000 $950,000 -$150,000 -13.64% $8,000 $8,050 $6,800 -$1,250.00 -15.53% -4.04%





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Sheet 2: Form 2
OMB Number: 1810-0693












Form 2: Local Educational Agency (LEA) Revenue Data
LEA Name National Center for Education Statistics (NCES) District Identification Number Local SY 2009-2010 Revenue State SY 2009-2010 Revenue SY 2009-2010 Non-revenue Receipts SY 2009-2010 Total Local SY 2010-2011 Revenue State SY 2010-2011 Revenue SY 2010-2011 Non-revenue Receipts SY 2010-2011 Total Local SY 2011-2012 Revenue State SY 2011-2012 Revenue SY 2011-2012 Non-revenue Receipts SY 2011-2012 Total $ Difference SY 2011-2012 vs. SY 2010-2011 % Difference SY 2011-2012 vs. SY 2010-2011
Sample LEA 9999999 $500,000 $500,100 $5,000 $1,005,100 $550,000 $600,000 $5,600 $1,155,600 $420,000 $530,000 $0 $950,000.00 -$205,600.00 -17.79%
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Sheet 3: Form 3

OMB Number: 1810-0693
Form 3: Explanation
*Section 9521(c) of the ESEA gives the Secretary the authority to waive the ESEA's MOE requirement for an LEA if it would be equitable to grant the waiver due to an exceptional or uncontrollable circumstance such as a natural disaster or a precipitous decline in the LEA's financial resources.
LEA Name National Center for Education Statistics (NCES) District Identification Number Explanation of why LEA did not maintain effort*
Sample LEA 9999998
File Typeapplication/vnd.ms-excel
File TitleAppendix I: Non-Regulatory Guidance on Title I, Part A Waivers -- October 2011 (Excel)
Last Modified ByLuisa Atkinson
File Modified2012-10-18
File Created1996-10-14
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