Participant Data Collection, Participant Burden

Youthful Offender Grants Management Information System

Copy of Youth Offender Record-Layout8.xlsx

Participant Data Collection, Participant Burden

OMB: 1205-0513

Document [xlsx]
Download: xlsx | pdf

Draft Youth Offender Data Elements

No. DATA ELEMENT NAME DATA ELEMENT DEFINITIONS/INSTRUCTIONS VALID VALUES

SECTION I - INDIVIDUAL INFORMATION


SECTION I.A - IDENTIFYING AND DEMOGRAPHIC INFORMATION


1 First name Record the individual's first name. Text

2 Middle initial Record the individual's middle initial. Text

3 Last name Record the individual's last name. Text

4 Address 1 Record the individual's home address. Text

5 Address 2 Record the individual's home address. Text

6 City Record the individual's home city. Text

7 State Record the State of residence. Dropdown Menu -- All States

8 Zip Code Record the individual's Zip code of residence NNNNN

9 Cell Phone Record the individual's cell phone number. NNN-NNN-NNNN

10 Home Phone Record the individual's home telephone number. NNN-NNN-NNNN

11 Other Phone Record any additional numbers the individual may have. NNN-NNN-NNNN

12 E-mail Record the individual's email address. Text

13 Contact Person 1 Record the name of a contact person for the participant. Text

14 Contact Person 1 Phone Number Record the telephone number of the first contact person for the participant NNN-NNN-NNNN

15 Contact Person 2 Record the name of asecond contact person for the participant Text

16 Contact Person 2 Phone Number Record the telephone number of the second contact person for the participant NNN-NNN-NNNN

17 Participant Number Record the unique identification number assigned to the individual. At a minimum, this identifier for a person must be the same for every period of participation in the program. This should not be the social security number. XXXXXX
(No hyphens)


18 Date of Birth Record the individual's date of birth. MM/DD/YYYY

19 Gender Indicate the participant's gender by select Male or Female

Leave blank if the individual does not wish to disclose his/her gender.
1 = Male
2 = Female
Blank = no self-disclosure


20 Ethnicity Hispanic/ Latino Indicate the participant's ethnicity by selecting Yes or No.

Leave blank if the participant does not disclose his/her ethnicity.
1 = Yes
2 = No
Blank = no self-disclosure


21 American Indian or Alaska Native Indicate whether the participant is American Indian or Alaska Native by selecting Yes.

Leave blank if the participant is not American Indian or Alaska Native or refused to report on this element.
1 = Yes
Blank = not reported


22 Asian Indicate whether the participant is Asian by selecting Yes or Not Reported.

Leave blank if the participant is not Asian or refused to report on this element.
1 = Yes
Blank = not reported


23 Black or African American Indicate whether the participant is Black or African American by selecting Yes or Not Reported.

Leave blank if the participant is not Black or African American or refused to report on this element.
1 = Yes
Blank = not reported


24 Hawaiian Native or other Pacific Islander Indicate whether the participant is Hawaiian Native or other Pacific Islander by selecting Yes or Not Reported.

Leave blank if the participant is not Hawaiian Native or other Pacific Islander or refused to report on this element.
1 = Yes
Blank = not reported


25 White Indicate whether the participant is White by selecting Yes or Not Reported.

Leave blank if the participant is not White or refused to report on this element.
1 = Yes
Blank = not reported


26 Date Program Verified Selective Service Registration Enter the date that the program verified that the applicant registered for the selective service if the applicant is a male 18 years of age or older. MM/DD/YYYY

SECTION I.B - BACKGROUND INFORMATION

27a Parent of a Child Enter Yes if the individual is a parent of a child. Enter No if the individual is not a parent on a child. 1 = Yes 2 = No

27b Number of Children Enter the number of children under 18 years of age that the participant has, including biological, adopted, step, and foster children. 00

28 Children living with participant Enter the number of the participant's own children under 18 years of age living in the household, including biological, adopted, step, and foster children. 00

29 Other dependents living with participant Enter the number of dependents other than children living with the participant. 00

30a High School Enrollment Status at Arrest Use the appropriate code to record to indicate whether the enrollee was a high school student, high school graduate, or high school dropout at the time of their arrest.
1 = High school student
2 = High school graduate
3 = High School dropout



30b High School Enrollment Status at Enrollment into the Program Use the appropriate code to record to indicate whether the enrollee was a high school student, high school graduate, or high school dropout at the time of their enrollment into the program.
1 = High school student
2 = High school graduate
3 = High School dropout



31 Highest School Grade Completed at Enrollment Use the appropriate code to record the highest school grade completed by the individual.

Record 87 if the individual completed the 12th grade and attained a high school diploma.
Record 88 if the individual completed the 12th grade and attained a GED or equivalent.
Record 89 if the individual with a disability received a certificate of attendance/completion.
Record 90 if the individual attained other post-secondary degree or certification.
00 = No school grades completed
01 - 12 = Number of elementary/secondary school grades completed
13-15 = Number of college, or full-time technical or vocational school years completed
16 = Bachelor's degree or equivalent
17 = Education beyond the Bachelor's degree
87 = Attained High School Diploma
88 = Attained GED or Equivalent
89 = Attained Certificate of Attendance/Completion
90 = Attained Other Post-Secondary degree or Certificate


32 Foster Youth Select Yes if the individual is a person who is or is aging out of the foster care system.
Select No if the individual does not meet the conditions described above.
1 = Yes
2 = No


33 Youth Offender Status Currently in, returning from, or had been in a juvenile correctional facility
Curently in, returning from, or had been in a juvenile detention facility Currently on, leaving, or had been on juvenile probation Currently in, leaving , or had been in juvenile alternative sentencing or diversion Currently in, returning from, or had been in an adult prison Currently in, returning from, or had been in an adult jail Currently on, leaving, or had been on adult probation Currently in, leaving, or had been in adult sentence or diversion At-risk individual who is not an offender
1 = Currently in, returning from, or had been in a juvenile correctional facility
2 = Currently in, returning from, or had been in a juvenile detention facility 3 = Currently on, leaving,or had been on juvenile probation 4 = Currently in, leaving, or had been in juvenile alternative sentencing or diversion 5 = Currently in, returning from, or had been in an adult prison 6 = Currently in, returning from, or had been in an adult jail 7 = Currently on, leaving, or had been on adult probation 8 = Currently in, leaving, or had been in adult sentence or diversion 9 =At-risk individual who is not an offender


34 Date Released from Correctional Facility or Detention or Placed on Probation Enter the date the individual was released from a correctional facility or detention or was placed on probation. MM/DD/YYYY

35 Direct Referral from Juvenile Justice System Select Yes if the individual was directly referred by the juvenile justice system. Select No if the individual was not directly referred by the juvenile justice system. 1 = Yes 2 = No

36 Basic Skills Deficient Select Yes if the individual is basic skills deficient. Basic skills deficient is defined as an the individual who computes or solves problems, reads, writes, or speaks English at or below the eighth grade level or is unable to compute or solve problems, read, write, or speak English at a level necessary to function on the job, in the individual’s family, or in society. This can be measured using recognized assessments (i.e., TABE or CASSES)
Select No if the individual does not meet the conditions described above.
1 = Yes
2 = No


37 Limited English Proficient Select Yes if the individual has limited ability in speaking, reading, writing or understanding the English language and (a) whose native language is a language other than English, or (b) who lives in a family or community environment where a language other than English is the dominant language.
Select No if the individual does not meet the conditions described above.
1 = Yes
2 = No


38 Individual with a Disability Select Yes if the individual indicates that he/she has any "disability," as defined in Section 3(2)(a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102). Under that definition, a "disability" is a physical or mental impairment that substantially limits one or more of the person's major life activities. (For definitions and examples of "physical or mental impairment" and "major life activities," see paragraphs (1) and (2) of the definition of the term "disability" in 29 CFR 37.4, the definition section of the WIA non-discrimination regulations.)
Select No if the individual indicates that he/she does not have a disability that meets the definition.
Leave blank if the individual does not wish to self-identify.
1 = Yes
2 = No
Blank = no self-identification


39 Health Issues Select Significant health issues if the participant has any health issue that could impact the individual's ability to work. Examples of such health issues can include, but are not limited to, untreated high blood pressure, HIV/STDs, asthma, depression, and other mental/physical health issues.

Otherwise, select No significant health issues.
1 = Significant health issues
2 = No significant health issues


40 Employment Status at Enrollment Use the appropriate code to record the applicant's employment status at enrollment. 1 = Employed
2 = Employed, but Received Notice of Termination of Employment or Military Separation
3 = Not Employed


41 Hours Worked at Enrollment Enter the average hours per week that the participant works.

Leave blank if the participant is not employed at participation.
00
Blank = not employed


42 Average Hourly Wage at Enrollment Enter the participant's average hourly wage.

Leave blank if the participant is not employed at participation.
00.00
Blank = not employed


43 Start Date for Job at Enrollment Enter the date on which the participant began to work at the above job.

Leave blank if the participant is not employed at participation.
MM/DD/YYYY
Blank = not employed


44 Housing Status at Enrollment Select Own/Rent Apartment, Room, Or House if, at enrollment, the individual is living in an apartment, room, or house that the he/she owns or rents.

Select Staying at someone's apartment, room, or house (Stable) if, at enrollment, the individual is living in an apartment, room, or house that somebody else owns or rents and if the person is not at risk of being displaced from this housing, i.e the housing situation is long-term.

Select Halfway house/transitional house if, at enrollment, the individual is living in a residence designed to assist persons as they re-enter society and learn to adapt to independent living after having been in prison.

Select Residential treatment if, at enrollment, the individual lives in a residential treatment center. A residential treatment center is a group home that provides room and board, and provides specialized treatment or rehabilitation persons with emotional, psychological, or developmental problems as well as chemical dependencies.

Select Homeless if, at enrollment, the individual lacks a fixed, regular, adequate night time residence. This definition includes any individual who has a primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings. This definition does not include an individual imprisoned or detained under an Act of Congress or State law. An individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that alone, be recorded as homeless.

Select Staying at someone's apartment, room, or house
(Unstable) if, at enrollment, the individual is living in an apartment,
room, or house that somebody else owns or rents and if the person is
at risk of being displaced from this housing, i.e the housing situation is
short-term.
1 = Own/rent apartment, room, or house
2 = Staying at someone's apartment, room, or house (Stable)
3 = Halfway house/ transitional house
4 = Residential treatment
5 = Homeless
6 = Staying at someone's apartment, room, or house (Unstable)


SECTION II - PROGRAM ACTIVITIES AND SERVICES INFORMATION

SECTION II.A - PROGRAM PARTICIPATION DATA

45 Date of Enrollment This date will be generated by the system to be the date on which enrollment information is submitted. MM/DD/YYYY



46 Date of the End of the Third Month in which the Enrollee did Not Receive Any Program Services For the purpose of collecting follow-up data, the computer will generate the date of the end of third month in which the participant did not receive any service (other than follow-up services) funded by the program. Note that there is no formal exit from the program, and participants may always return for any at all services at any time, with the exception of participants who grantees determine they can no longer serve due to safety reasons. MM/DD/YYYY

47 Reasons for Leaving the Program Early Record the reason the participant left the program early. 01 = Moved to Different Geographic Area 02 = Health/Medical
03 = Deceased
04 = Family Care
05 = Reservists Called to Active Duty
06 = Left Early for Other Reason or Left without Giving Reason


SECTION II.B - SERVICES AND OTHER RELATED ASSISTANCE DATA

Education Activities

48 Date Entered Reading Remediation Enter the date on which the participant started math/reading remediation.

Reading remediation consists of classroom instruction designed to improve an participant’s math/reading skills for those participants who are determined to be basic literacy skills deficient. Basic education skills include reading comprehension, speaking, listening, problem solving, reasoning, and the capacity to use these skills.
MM/DD/YYYY

49 Date of First Reading Remediation Services During the Month Enter the first date during the month in which the participant received reading remediation services.

Note: This field must repeat for every month in which the participant receives math/reading remediation services.
MM/DD/YYYY

50 Date Ended Reading Remediation Enter the date on which the participant exited reading remediation. MM/DD/YYYY

51 Completed Reading Remediation Select Yes if the participant successfully completed reading remediation.

Select No if the participant did not successfully complete reading remediation.

1 = Yes
2 = No


52 Date Entered Math Remediation Enter the date on which the participant started math remediation.

Math remediation consists of classroom instruction designed to improve an participant’s math skills for those participants who are determined to be basic literacy skills deficient.
MM/DD/YYYY

53 Date of First Math Remediation Services During the Month Enter the first date during the month in which the participant received math remediation services.

Note: This field must repeat for every month in which the participant receives math remediation services.
MM/DD/YYYY

54 Date Ended Math Remediation Enter the date on which the participant exited math remediation. MM/DD/YYYY

55 Completed Math Remediation Select Yes if the participant successfully completed math remediation.

Select No if the participant did not successfully complete math remediation.

1 = Yes
2 = No


56 Date Entered Tutoring Enter the date on which the participant started Tutoring services.

MM/DD/YYYY

57 Date of first Tutoring Services During the Month Enter the first date during the month in which the participant received Tutoring services.

Note: This field must repeat for every month in which the participant receives tutoring services.
MM/DD/YYYY

58 Date Ended Tutoring Services Enter the date on which the participant exited Tutoring Services.

MM/DD/YYYY

59 Completed Tutoring Select Yes if the participant successfully completed vocational/occupational skills training.

Select No if the participant did not successfully complete vocational/ occupational skills training.
1 = Yes
2 = No


60 Date Entered Credit Retrieval Classes Enter the date on which the participant started credit retrieval classes.
MM/DD/YYYY

61 Date of First Credit Retrieval Classes During the Month Enter the first date during the month in which the participant received credit retrieval classes.

Note: This field must repeat for every month in which the participant receives credit retrieval classes.
MM/DD/YYYY

62 Date Ended Credit Retrieval Classes Enter the date on which the participant exited credit retrieval classes.

MM/DD/YYYY

63 Completed Credit Retrieval Classes Select Yes if the participant successfully completed credit retrieval classes.

Select No if the participant did not successfully complete credit retrieval classes.
1 = Yes
2 = No


64 Date Entered Academic Counseling Enter the date on which the participant began receiving academic counseling, including assistance in compiling high school credits earned at different schools.

MM/DD/YYYY

65 Date of First Academic Counseling During the Month Enter the first date during the month in which the participant received academic counseling.

Note: This field must repeat for every month in which the participant receives academic counseling.
MM/DD/YYYY

66 Date Ended Academic Counseling Enter the date on which the participant exited Academic Counseling.

MM/DD/YYYY

67 Completed Academic Counseling Select Yes if the participant successfully completed academic counseling.

Select No if the participant did not successfully complete academic counseling.
1 = Yes
2 = No


68 Date Entered Twilight, Continuation, or Alternative School. Enter the date on which the participant entered Twilight, Continuation, or Alternative School. This should be for an enrollment that is paid for whole or in part by the grant. Otherwise, the enrollment should be counted as an outcome below. This should be for a school leading to a high school diploma. Otherwise, it should be counted as a GED program below.
MM/DD/YYYY

69 Date First Attended Twilight, Continuation, or Alternative School During the Month. Enter the first date during the month in which the participant attended Twilight, Continuation, or Alternative School.

Note: This field must repeat for every month in which the participant attends Twilight, Continuation, or Alternative School.
MM/DD/YYYY

70 Date Ended Twilight, Continuation, or Alternative School. Enter the date on which the participant exited the Twilight, Continuation, or Alternative School.
MM/DD/YYYY

71 Completed Twilight, Continuation, or Alternative School Select Yes if the participant successfully completed Twilight, Continuation, or Alternative School.

Select No if the participant did not successfully complete Twilight, Continuation, or Alternative School.
1 = Yes
2 = No


72 Date Entered GED Instruction Enter the date on which the participant started GED Instruction.

MM/DD/YYYY

73 Date of first GED Preparation Services During the Month Enter the first date during the month in which the participant received GED preparation services.

Note: This field must repeat for every month in which the participant receives GED preparation services.
MM/DD/YYYY

74 Date Ended GED Preparation Enter the date on which the participant exited GED preparation.

MM/DD/YYYY

75 Completed GED Preparation Select Yes if the participant successfully completed GED preparation

Select No if the participant did not successfully complete GED preparation.

1 = Yes
2 = No


76 Date Entered ESL Classes Enter the date on which the participant started ESL Classes.

MM/DD/YYYY

77 Date of first ESL Classes During the Month Enter the first date during the month in which the participant attended ESL Classes.

Note: This field must repeat for every month in which the participant attends ESL Classes.
MM/DD/YYYY

78 Date Ended ESL Classes Enter the date on which the participant exited ESL Classes.

MM/DD/YYYY

79 Completed ESL Classes Select Yes if the participant successfully completed ESL Classes.

Select No if the participant did not successfully complete ESL Classes.
1 = Yes
2 = No


80 Date Entered Vocational/ Occupational Skills Training Services Enter the date on which the participant started vocational/occupational skills training.

Vocational/ occupational skills training is training consisting of specific classroom and work-based study in a specific occupation leading to a degree or industry-recognized certificate. Vocational/occupational training provided whole or in part with DOL grant funds or other DOL funds should be entered here as a program activity. Long-term vocational/occupational training provided with non-DOL funds should be entered as a program outcome in Line 202 below.
MM/DD/YYYY

81 Date of First Vocational/ Occupational Skills Training Services During the Month Enter the first date during the month in which the participant received vocational/occupational skills training services.

Note: This field must repeat for every month in which the participant receives vocational/occupational skills training services.
MM/DD/YYYY

82 Date Ended Vocational/ Occupational Skills Training Services Enter the date on which the participant exited vocational/occupational skills training.

MM/DD/YYYY

83 Completed Vocational/ Occupational Skills Training Services Select Yes if the participant successfully completed vocational/occupational skills training.

Select No if the participant did not successfully complete vocational/ occupational skills training.

1 = Yes
2 = No


84 Expected Duration of Vocational/ Occupational Skills Training Select the duration of the vocational/occupational skills training program that the participant has entered 1 = 5 or fewer hours per week
2 = 6 to 15 hours per week
3 = 16 to 25 hours per week
4 = 25 or more hours per week


85 Occupational Skills Training Code Enter the 8 digit O*Net 4.0 (or later versions) code that best describes the training occupation for which the participant received training services.

Record 00000000 or leave "blank" if occupational code is not available or not known.

Additional Notes: If all 8 digits of the occupational skills code are not collected, record as many digits as are available. If the individual recieves multiple training services, use the occupational skills training code for the most recent training.
00000000

86 Date Entered College Bound Program. Enter the date on which the participant started College Bound programs. MM/DD/YYYY

87 Date of first College Bound Activities During the Month Enter the first date during the month in which the participant received College Bound services.
Note: This field must repeat for every month in which the participant receives College Bound services .
MM/DD/YYYY

88 Date Ended College Bound Activities Enter the date on which the participant exited College Bound activities.
MM/DD/YYYY

Workforce Preparation Activities

89 Date Entered Work Experience Enter the date on which the participant started work experience.
MM/DD/YYYY

90 Date of First Work Experience During the Month Enter the first date during the month in which the enrollee participated in work experience.

Note: This field must repeat for every month in which the enrollee participates in work experience.
MM/DD/YYYY

91 Date Ended Work Experience Enter the date on which the participant exited work experience.

MM/DD/YYYY

92 Completed Work Experience Select Yes if the participant successfully completed work experience.

Select No if the participant did not successfully complete work experience.

1 = Yes
2 = No


93 Date Entered Subsidized Internship Enter the date on which the participant started a subsidized internship. MM/DD/YYYY

94 Date of First Subsidized Internship During the Month Enter the first date during the month in which the enrollee participated in a subsidized internship.

Note: This field must repeat for every month in which the participant is in a subsidized internship.
MM/DD/YYYY

95 Date Ended Subsidized Internship Enter the date on which the participant exits the subsidized internship.

MM/DD/YYYY

96 Completed Subsidized Internship Select Yes if the participant successfully completed subsidized internship

Select No if the participant did not successfully complete subsidized internship.

1 = Yes
2 = No


97 Date Entered Unsubsidized Internship Enter the date on which the participant started unsubsidized internship.

MM/DD/YYYY

98 Date of First Unsubsidized Internship During the Month Enter the first date during the month in which the participant participated in unsubsidized internship..

Note: This field must repeat for every month in which the participant is in the internship.
MM/DD/YYYY

99 Date Ended Unsubsidized Internship Enter the date on which the participant exits unsubsidized internship.

MM/DD/YYYY

100 Completed Unsubsidized Internship Select Yes if the participant successfully completed unsubsidized internship

Select No if the participant did not successfully complete unsubsidized internship.

1 = Yes
2 = No


101 Date Entered Work Readiness Training Enter the date on which the participant started work readiness training.

MM/DD/YYYY

102 Date of First Work Readiness Training Services During the Month Enter the first date during the month in which the participant received work readiness training services.

Note: This field must repeat for every month in which the participant receives work readiness training services.
MM/DD/YYYY

103 Date Ended Work Readiness Training Enter the date on which the participant exits work readiness training.

MM/DD/YYYY

104 Completed Work Readiness Training Select Yes if the participant successfully completed work readiness training

Select No if the participant did not successfully complete work readiness training.

1 = Yes
2 = No


105 Date Entered Pre-Apprenticeship Program Enter the date on which the participant started a pre-apprenticeship program

A pre-apprenticeship program means an organized plan under which apprenticeship candidates will be selected for a short (a few weeks) intensified training period in a school or training center, with the intent to place them into regular apprenticeship upon completion or soon after completion of pre-apprenticeship.
MM/DD/YYYY

106 Date of First Pre-Apprenticeship ProgramServices During the Month Enter the first date during the month in which the participant received pre-apprenticeship program services.

Note: This field must repeat for every month in which the participant receives pre-apprenticeship program services.
MM/DD/YYYY

107 Date Ended Pre-Apprenticeship Program Enter the date on which the participant exits pre-apprenticeship program.

MM/DD/YYYY

108 Completed Pre-Apprenticeship Program Select Yes if the participant successfully completed pre-apprenticeship program

Select No if the participant did not successfully complete pre-apprenticeship program.

1 = Yes
2 = No


109 Date Entered Career/Life Skills Counseling Enter the date on which the participant started career/life skills counseling.

Career/Life skills counseling includes helping enrollees develop career plans, teaching them values and to take responsibility for their actions, and teaching them decision-making skills.
MM/DD/YYYY

110 Date of First Career/Life Skills Counseling Services During the Month Enter the first date during the month in which the participant received career/life skills counseling services.

Note: This field must repeat for every month in which the participant receives career/life skills counseling services.
MM/DD/YYYY

111 Date Ended Career/Life Skills Counseling Enter the date on which the participant exits career/life skills counseling.

MM/DD/YYYY

112 Completed Career/Life Skills Counseling Select Yes if the participant successfully completed career/life skills counseling

Select No if the participant did not successfully complete career/life skills counseling.

1 = Yes
2 = No


113 Date Entered Job Placement Services Enter the date on which the participant started job placement services.

MM/DD/YYYY

114 Date of First Job Placement Services During the Month Enter the first date during the month in which the enrollee participated in unsubsidized internship..

Note: This field must repeat for every month in which the participant is in the internship.
MM/DD/YYYY

115 Date Ended Job Placement Services Enter the date on which the participant exits job placement services.

MM/DD/YYYY

116 Completed Job Placement Services Select Yes if the participant successfully completed job placement services.

Select No if the participant did not successfully complete job placement services.

1 = Yes
2 = No


Community Service and Leadership Development Activities

117 Date Entered Community Service/ Restorative Justice Enter the date on which the participant started community service/restorative justice.

MM/DD/YYYY

118 Date of First Community Service/ Restorative Justice Services During the Month Enter the first date during the month in which the enrollee participated in community service/restorative justice.

Note: This field must repeat for every month in which the enrollee participates in community service/restorative justice.
MM/DD/YYYY

119 Date Ended Community Service/ Restorative Justice Enter the date on which the participant exits community service/restorative justice.

MM/DD/YYYY

120 Completed Community Service/ Restorative Justice Select Yes if the participant successfully completed community service

Select No if the participant did not successfully complete community service.

1 = Yes
2 = No


121 Date Entered Leadership Development Activities Enter the date on which the participant started leadership development activities.

MM/DD/YYYY

122 Date of First Leadership Development Activities During the Month Enter the first date during the month in which the participant participated in leadership development activities.
Note: This field must repeat for every month in which the participant participates in leadership development activities.
MM/DD/YYYY

123 Date Ended Leadership Development Activities Enter the date on which the participant exits leadership development activities.

MM/DD/YYYY

124 Completed Leadership Development Activities Select Yes if the participant successfully completed leadership development activities.
Select No if the participant did not successfully complete leadership development activities.

1 = Yes
2 = No


Mentoring Activities

125 Date Entered Mentoring Activities Enter the date on which the participant started mentoring activities.

Mentoring is a sustained relationship between a mentor and participant, whether one on one or in a group setting. Through continued involvement, a mentor offers support and guidance in the individual’s development to become a responsible member of the community. A variety of approaches may be used such as coaching, training, discussion, and counseling.
MM/DD/YYYY

126 Date of First Mentoring Activities Services During the Month Enter the first date during the month in which the participant received mentoring activities services.

Note: This field must repeat for every month in which the participant receives mentoring activities services.
MM/DD/YYYY

127 Date Ended Mentoring Activities Enter the date on which the participant exits mentoring activities.

MM/DD/YYYY

128 Completed Mentoring Activities Select Yes if the participant successfully completed mentoring activities

Select No if the participant did not successfully complete mentoring activities.

1 = Yes
2 = No


HEALTH SERVICES

129 Date Entered Substance Abuse Treatment Enter the date on which the participant started substance abuse treatment.
MM/DD/YYYY

130 Provider Type Select Faith-based Provider if the substance abuse treatment is provided by a faith-based organization.

Select Community-based Provider if the substance abuse treatment is provided by a community-based organization.

Select Public Provider if the substance abuse treatment is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider


131 Date of First Substance Abuse Treatment During the Month Enter the first date during the month in which the participant received substance abuse treatment.

Note: This field must repeat for every month in which the participant receives substance abuse treatment.
MM/DD/YYYY

132 Date Ended Substance Abuse Treatment Enter the date on which the participant exited substance abuse treatment

MM/DD/YYYY

133 Completed Substance Abuse Treatment Select Yes if the participant successfully completed substance abuse treatment.

Select No if the participant did not successfully complete substance abuse treatment.

1 =Yes
2 = No


134 Date Entered Mental Health Services Enter the date on which the participant started mental health services. MM/DD/YYYY

135 Date of First Mental Health Services During the Month Enter the first date during the month in which the participant received mental health services.

Note: This field must repeat for every month in which the participant receives mental health services.
MM/DD/YYYY

136 Date Ended Mental Health Services Enter the date on which the participant exited mental health services

MM/DD/YYYY

137 Completed Mental Health Services Select Yes if the participant successfully completed mental health services.

Select No if the participant did not successfully complete mental health treatment.

1 =Yes
2 = No


138 Date Entered Emergency Medical Care Enter the date on which the participant started emergency medical care.
MM/DD/YYYY

139 Date of First Emergency Medical Care During the Month Enter the first date during the month in which the participant received emergency medical care.

Note: This field must repeat for every month in which the participant receives emergency medical care.
MM/DD/YYYY

140 Date Ended Emergency Medical Care Enter the date on which the participant exited emergency medical care

MM/DD/YYYY

141 Completed Emergency Medical Care Select Yes if the participant successfully completed emergency medical care.

Select No if the participant did not successfully complete emergency medical care.

1 =Yes
2 = No


142 Date Entered Non-Emergency Medical Care Enter the date on which the participant started non-emergency medical care.
MM/DD/YYYY

143 Date of First Non-Emergency Medical Care During the Month Enter the first date during the month in which the participant received non-emergency medical care.

Note: This field must repeat for every month in which the participant receives non-emergency medical care.
MM/DD/YYYY

144 Date Ended Non-Emergency Medical Care Enter the date on which the participant exited non-emergency medical care

MM/DD/YYYY

145 Completed Non-Emergency Medical Care Select Yes if the participant successfully completed non-emergency medical care.

Select No if the participant did not successfully complete non-emergency medical care.

1 =Yes
2 = No


146 Date Entered Other Health Services Enter the date on which the participant started other health services.
MM/DD/YYYY

147 Date of First Other Health Services During the Month Enter the first date during the month in which the participant received other health services.

Note: This field must repeat for every month in which the participant receives other health services.
MM/DD/YYYY

148 Date Ended Other Health Services Enter the date on which the participant exited other health services

MM/DD/YYYY

149 Completed Other Health Services Select Yes if the participant successfully completed other health services.

Select No if the participant did not successfully complete other health services.

1 =Yes
2 = No


Supportive Services

150 Date Entered Transportation Services Enter the date on which the participant started transportation services. Transportation services include assistance or cash paid to participants for the purpose of transportation. MM/DD/YYYY

151 Date of First Transportation Services During the Month Enter the first date during the month in which the participant received transportation services .

Note: This field must repeat for every month in which the participant receives transportation services .
MM/DD/YYYY

152 Date Ended Transportation Services Enter the date on which the participant exited transportation services.

MM/DD/YYYY

153 Date Entered Child Care Services Enter the date on which the participant started child care services. Child care services provide participants during program participation with child care that can be inside or outside the home, as well as after-school programs. It usually includes supervision and shelter. MM/DD/YYYY

154 Date of First Child Care Services During the Month Enter the first date during the month in which the participant received child care services .

Note: This field must repeat for every month in which the participant receives child care services .
MM/DD/YYYY

155 Date Ended Child Care Services Enter the date on which the participant exits child care services.

MM/DD/YYYY

156 Date Entered Other Supportive Services Enter the date on which the participant started other supportive services. MM/DD/YYYY

157 Types of Other Supportive Services Enter the types of other supportive services provided. Text

158 Date of First Other Supportive Services During the Month Enter the first date during the month in which the participant received other supportive services .

Note: This field must repeat for every month in which the participant receives other supportive services .
MM/DD/YYYY

159 Date Ended Other Supportive Services Enter the date on which the participant exited other supportive services. MM/DD/YYYY

160 Date Entered Follow-up Services Enter the date on which the participant started follow-up services.

Follow-up services are those that occur after an individual is placed or otherwise leaves the program and no longer wants or needs other services. Note that there is no formal exit from the program and enrollees may always return for any and all services, with the exception of enrollees who grantees determine they can no longer serve for safety reasons.
MM/DD/YYYY

161 First Date of Follow-up Services During Month Enter the first date during the month in which the participant received other follow-up services.

Note: This field must repeat for every month in which the participant receives other follow-up services.
MM/DD/YYYY

162 Date Ended Follow-up Services Enter the last date on which the participant received follow-up services. MM/DD/YYYY

SECTION III - PROGRAM OUTCOMES INFORMATION

SECTION III.A - SHORT-TERM OUTCOME STATUS

163 Date of Return to Regular High School or Entered Continuation or Alternative School Enter the date on which the participant returned to regular high school or entered a continuation or alternaqtive school that awards high school diplomas. MM/DD/YYYY

164 Reached 12 Month Point since Return to Regular High School or Entered Continuation or Alternative School Computer will automatically generate whether enrollees has reached the 12-month point since returning to regular high school or entering continuation or alternative school. 1 = Yes, reached 12-month point since returning to regular high school or entering continuation or alternative school. 2 = No, has not reached 12-month point since returning to regular high school or entering continuation or alternative school.

165 Has Remained in Regular High School, Continuation School, or Alternative School for 12 Months. Indicate whether enrollee has remained in regular high school, continuation school, or alternative school for 12 months. 1 = Yes, enrollee has remained in regular high school, continuation school, or alternative school for 12 months. 2 = No, enrollee did not remain in regular high school, continuation school, or alternative school for 12 months.

166 Date of Initial Placement Into Unsubsidized Employment Enter the date on which the participant started the initial unsubsidized employment MM/DD/YYYY

167 Employer Name for Initial Placement Into Unsubsidized Employment Enter the employer's name for the participant's initial placement into unsubsidized employment. Text

168 Employer Contact for Initial Placement Into Unsubsidized Employment Enter the contact information for the employer for the participant's placement into unsubsidized employment. Text

169 Hourly Wage at Placement for Initial Placement into Unsubsidized Employment Enter the hourly wage for the initial unsubsidized unemployment at placement. 00.00

170 Number of Hours Worked During the 1st Full Week in Initial Placement into Unsubsidized Employment. Enter the number of hours worked during the first full week for the initial job placement. 00

171 Date of Placement Into Unsubsidized Employment #2 Enter the date on which the participant started the second placement into unsubsidized employment. MM/DD/YYYY

172 Employer Name for Placement Into Unsubsidized Employment #2 Enter the employer's name for the participant's second placement into unsubsidized employment. Text

173 Employer Contact for Placement Into Unsubsidized Employment #2 Enter the contact information for the employer for the participant's second placement into unsubsidized employment. Text

174 Hourly Wage at Placement for Placement into Unsubsidized Employment #2 Enter the hourly wage for the second unsubsidized unemployment at placement. 00.00

175 Number of Hours Worked During the 1st Full Week in Placement into Unsubsidized Employment #2 Enter the number of hours worked during the first full week for the placement into the second unsubsidized employment.. 00

176 Repeat Fields as needed for Additional Jobs Grantees must be able to collect the above job information for as many jobs as the participant has.


177 Date Entered Post-Secondary Education Enter the date on which the participant enrolled in post-secondary education.

MM/DD/YYYY
Blank = did not enter post-secondary education


178 Date Entered Long-Term Vocational or Occupational Training Enter the date on which the participant enrolled in long-term vocational or occupational training. Vocational/ occupational skills training is training consisting of specific classroom and work-based study in a specific occupation leading to a degree or industry-recognized certificate. Long-term vocational or occupationtal training should only be included here if it is provided with non-DOL funds. Vocational or occupational training provided with DOL grant funds or other DOL funds should be entered as a program activity in Line 88 above.

MM/DD/YYYY Blank = Did not enter long-term vocational or occupational training.

179 Date Entered Registered Apprenticeship Program Enter the date on which the participant enrolled in registered apprenticeship.

MM/DD/YYYY Blank = Did not enter a registered apprenticeship program.

180 Employer Name for Placement Into Registered Apprenticeship Program Enter the employer's name for the participant's placement into a registered apprenticeship . Text

181 Employer Contact for Placement Into Registered Apprenticeship Program Enter the contact information for the employer for the participant's placement into a registered apprenticeship Text

182 Hourly Wage at Placement for Placement into Registered Apprenticeship Program Enter the hourly wage for the registered apprenticeship at placement. 00.00

183 Number of Hours Worked During the 1st Full Week in Placement into Registered Apprenticeship Program Enter the number of hours worked during the first full week for the placement into a registered apprenticeship. 00

184 Remained in Unsubsidized Job, Vocational Training, Post-Secondary Education, or Apprenticeghip Placement for 3 or More Months. Indicate whether the enrollee has remained in an unsubsidized job, vocational training, post-secondary education, or apprenticeghip placement for 3 or more months. 1 = Yes 2 = No

185 Date the Enrollee is Arrested for a New Crime Committed After Enrollment into Your Program Enter the date the enrollee is arrested for a new crime committed after enrollment into your program. Leave blank if enrollee has not been arrested for a new crime committed after enrollment into your program. MM/DD/YYYY Blank = Was not arrested for a new crime

186 Date the Enrollee is Convicted of a New Crime Committed After Enrollment into Your Program Enter the date the enrollee is convicted of a new crime committed after enrollment into your program. Leave blank if enrollee has not been convicted of a new crime committed after enrollment into your program. MM/DD/YYYY Blank = Was not convicted of a new crime

187 Whether the Enrollee has Reached the 12-Month Point Point Since Being Released from a Corrcetional Facility or Being Placed on Probation The computer will automatically generate whether the enrollee has reached the 12-month point since being released from a correctional facility or detention or being placed on probation. 1 =Yes, Reached 12-Month Point
2 = No, Have Not Reached 12-Month Point


188 Arrested for a New Crime within 12-Month of Being Released from a Correctional Facility or Being Placed on Probation The computer will automatically generate whether the enrollee has been arrested for a new crime within 12-months of being released from a correctional facility or detention or being placed on probation. 1 = Yes, Has been arrested for a new crime withn 12 months of being released from a corrcetional facility or detention or being placed on probation. . 2 = No, Has not been arrested for a new crime within 12 months of being released from a corrcetional facility or detention or being placed on probation.

189 Convicted of a New Crime within 12-Month of Being Released from a Correctional Facility or Being Placed on Probation The computer will automatically generate whether the enrollee has been convicted of a new crime within 12-months of being released from a correctional facility or detention or being placed on probation. 1 = Yes, Has been convicted of a new crime withn 12 months of being released from a corrcetional facility or detention or being placed on probation. . 2 = No, Has not been convicted of a new crime within 12 months of being released from a corrcetional facility or detention or being placed on probation.

190 Date the Enrollee is Incarcertaed after Conviction for a New Crime Committed After Enrollment into Your Program Enter the date the enrollee is incarcerated after conviction for a new crime committed after enrollment into your program. Leave blank if enrollee has not been incarccerated after conviction for a new crime committed after enrollment into your program. Not that being placed in pre-trial confinment in not counted in this measure. MM/DD/YYYY Blank = Was not incarcerated for a new crime

191 Date Cited for Violating Terms of Probation or Parole Enter the date the enrollee is cited for violating the terms of probation or parole after entering your program. MM/DD/YYYY Blank = Was not cited for violating probation or parole after entering your program.

192 Date Incarcerated for Violating Terms of Probation or Parole Enter the date the enrollee is incarcerated for violating the rems of probation or parole after entering your program. MM/DD/YYYY Blank = Was not incarecerated for violating probation or parole after entering your program.

193 Received Legal Services for Expungement Select Yes if the participant received legal services to expunge their records.

Select No if the participant did not receive legal services to expunge their records.
1 =Yes 2 = No

194 Record Expunged Select Yes if the participant's record has been expunged. Select No if the participant's juvenile record has not been expunged. 1 = Yes 2 = No

195 Placed in Diversion Program Select Yes if the participant was placed in a diversion program. Select No if the participant was not placed in a diversion program. 1 = Yes 2 = No

196 Case Dismissed as result of Diversion Program Select Yes if the participant's case was dismissed as the result of a diversion program. Select No if the participant's case was not dismissed as the result of a diversion program. 1 = Yes 2 = No

SECTION III.B FOLLOW-UP EMPLOYMENT STATUS

197 Employment and Education Status at 3 Month Follow-up. Use the appropriate code to identify the employment and education status of the enrollee at follow-up 3 months after the end of the third month in which the participant did not receive any services other than follow-up services. 1 = Employed full-time and not attending school 2 = Employed part-time and not attending school
3 = Employed full-time and attending high school 4 = Employed full-time and attending post-secondary school 5 = Employed part-time and attending high school 6 = Employed part-time and attending post-secondary school 7 = Not employed but attending high school
8 = Not employed but attending post-secondary school
9 = Neither working nor in school Blank = Not contacted at follow-up



198 Method for Determining Employment Status at 3-Month Follow-up. Use the appropriate code to identify the method used in determining the individual's employment status at 3-month follow-up.
1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.


199 Date of 3-Month Follow-up Attempt Enter the date on which the grantee attempted to contact the participant or employer to obtain information on employment and earnings at 3-Month follow-up.

Repeat for each follow-up attempt.
MM/DD/YYYY



200 Date of 3-Month Follow-up Interview with Enrollee. Enter the date the grantee successfully contacted the participant to collect employment and earnings information at 3-Month follow-up.

MM/DD/YYYY Blank = Grantee did not successfully contact the the enrollee for 3-Month follow-up employment and earnings information.

201 Employment and Education Status at 6-Month Follow-up Use the appropriate code to identify the employment and education status of the enrollee at follow-up 6 months after the end of the third month in which the participant did not receive any program services other than follow-up services. 1 = Employed full-time and not attending school 2 = Employed part-time and not attending school
3 = Employed full-time and attending high school 4 = Employed full-time and attending post-secondary school 5 = Employed part-time and attending high school 6 = Employed part-time and attending post-secondary school 7 = Not employed but attending high school
8 = Not employed but attending post-secondary school
9 = Neither working nor in school Blank = Not contacted at follow-up



202 Method for Determining Employment Status at 6-Month Follow-up. Use the appropriate code to identify the method used in determining the individual's employment status at 6-month follow-up.
1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.


203 Date of 6-Month Follow-up Attempt Enter the date on which the grantee attempted to contact the participant or employer to obtain information on employment and earnings at 6-Month follow-up.

Repeat for each follow-up attempt.
MM/DD/YYYY



204 Date of 6-Month Follow-up Interview with Enrollee. Enter the date the grantee successfully contacted the participant to collect employment and earnings information at 6-month follow-up.

MM/DD/YYYY Blank = Grantee did not successfully contact the the enrollee for 3-Month follow-up employment and earnings information.

205 Employment and Education Status at 9-Month Follow-up Use the appropriate code to identify the employment and education status of the enrollee at follow-up 9 months after the end of the third month in which the participant did not receive any services other than follow-up services. 1 = Employed full-time and not attending school 2 = Employed part-time and not attending school
3 = Employed full-time and attending high school 4 = Employed full-time and attending post-secondary school 5 = Employed part-time and attending high school 6 = Employed part-time and attending post-secondary school 7 = Not employed but attending high school
8 = Not employed but attending post-secondary school
9 = Neither working nor in school Blank = Not contacted at follow-up



206 Method for Determining Employment Status at 9-Month Follow-up. Use the appropriate code to identify the method used in determining the individual's employment status at 9-month follow-up.
1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.


207 Date of 9-Month Follow-up Attempt Enter the date on which the grantee attempted to contact the participant or employer to obtain information on employment and earnings at 9-Month follow-up.

Repeat for each follow-up attempt.
MM/DD/YYYY



208 Date of 9-Month Follow-up Interview with Enrollee. Enter the date the grantee successfully contacted the participant to collect employment and earnings information at 9-Month follow-up.

MM/DD/YYYY Blank = Grantee did not successfully contact the the enrollee for 3-Month follow-up employment and earnings information.

209 Employment and Education Status at 12-Month Follow-up Use the appropriate code to identify the employment and education status of the enrollee at follow-up 12 months after the end of the third month in which the participant did not receive any services other than follow-up services. 1 = Employed full-time and not attending school 2 = Employed part-time and not attending school
3 = Employed full-time and attending high school 4 = Employed full-time and attending post-secondary school 5 = Employed part-time and attending high school 6 = Employed part-time and attending post-secondary school 7 = Not employed but attending high school
8 = Not employed but attending post-secondary school
9 = Neither working nor in school Blank = Not contacted at follow-up



210 Method for Determining Employment Status at 12-Month Follow-up. Use the appropriate code to identify the method used in determining the individual's employment status at 12-month follow-up.
1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.


211 Date of 12-Month Follow-up Attempt Enter the date on which the grantee attempted to contact the participant or employer to obtain information on employment and earnings at 12-Month follow-up.

Repeat for each follow-up attempt.
MM/DD/YYYY



212 Date of 12-Month Follow-up Interview with Enrollee. Enter the date the grantee successfully contacted the participant to collect employment and earnings information at 12-Month follow-up.

MM/DD/YYYY Blank = Grantee did not successfully contact the the enrollee for 3-Month follow-up employment and earnings information.

SECTION IIIC - POST-PROGRAM WAGE DATA


213 Wage at 3-Month Follow-up Record the wage per hour of the enrollee at the job job held at 3-month follow-up.
Enter 99.99 if data is not available or the enrollee is not working at 3-month follow-up.
00.00

214 Wage at 6-Month Follow-up Record the wage per hour of the enrollee at the job job held at 6-month follow-up.
Enter 99.99 if data is not available or the enrollee is not working at 6-month follow-up.
00.00

215 Wage at 9-Month Follow-up Record the wage per hour of the enrollee at the job job held at 9-month follow-up.
Enter 99.99 if data is not available or the enrollee is not working at 9-month follow-up.
00.00

216 Wage at 12- Month Follow-up Record the wage per hour of the enrollee at the job job held at 12-month follow-up.
Enter 99.99 if data is not available or the enrollee is not working at 9-month follow-up.
00.00

SECTION III.D - EDUCATION DIPLOMA, GED, AND CREDENTIAL DATA

217 Attained Diploma, GED, or Certificate #1 Select attained a secondary school diploma individual attained a secondary school (high school) diploma recognized by the State.
Select attained a GED or high school equivalency diploma if the individual attained a GED or high school equivalency diploma recognized by the State.
Select attained a certificate in recognition of attainment of technical or occupational skills if the individual attained a certificate in recognition of attainment of technical or occupational skills.
Select did not attain a diploma, GED, or certificate if the individual did not attain a diploma, GED, or certificate.
1 = Attained a secondary school (high school) diploma.
2 = Attained a GED or high school equivalency diploma.
3 = Attained a certificate in recognition of attainment of technical or occupational skills.
4 = Did not attain a diploma, GED, or certificate.


218 Date Attained Degree or Certificate #1 Record the date on which the individual attained a diploma, GED, or certificate.

Leave "blank" if the individual did not attain a diploma, GED, or certificate.
MM/DD/YYYY
Blank = did not attain diploma, GED, or certificate


219 Specify the Name of Certificate #1 Specify the name of the first certificate achieved.

Leave blank if no certificate was achieved.
Text
Blank = no certificate achieved


220 Attained Diploma, GED, or Certificate #2 Select attained a secondary school diploma individual attained a secondary school (high school) diploma recognized by the State.
Select attained a GED or high school equivalency diploma if the individual attained a GED or high school equivalency diploma recognized by the State.
Select attained a certificate in recognition of attainment of technical or occupational skills if the individual attained a certificate in recognition of attainment of technical or occupational skills.
Select did not attain a diploma, GED, or certificate if the individual did not attain a diploma, GED, or certificate.
1 = Attained a secondary school (high school) diploma.
2 = Attained a GED or high school equivalency diploma.
3 = Attained a certificate in recognition of attainment of technical or occupational skills.
4 = Did not attain a diploma, GED, or certificate


221 Date Attained Degree or Certificate #2 Record the date on which the individual attained a diploma, GED, or certificate.

Leave "blank" if the individual did not attain a diploma, GED, or certificate.
MM/DD/YYYY
Blank = did not attain diploma, GED, or certificate


222 Specify the Name of Certificate #2 Specify the name of the second certificate achieved.

Leave blank if no certificate was achieved.
Text
Blank = no certificate achieved


SECTION III.E - ADDITIONAL LITERACY AND NUMERACY ASSESSMENT DATA From WIA Specs

223 Category of Reading Assessment Record 1 if the participant was assessed using approved tests for Adult Basic Education (ABE)
Record 2 if the participant was assessed using approved tests for English-As-A-Second Language (ESL)
Record 0 or leave "blank" if the individual was not assessed in literacy or numeracy.
1 = ABE
2 = ESL
From WIA Specs

224 Type of Reading Assessment Test Use the appropriate code to record the type of assessment test that was administered to the youth participant.
Record 0 or leave "blank" if the individual was not assessed in literacy.
1 = TABE 7-8, 9-10
2 = CASAS
3 = ABLE
4 = WorkKeys
5 = SPL
6 = BEST
7 = BEST Plus
8 = Other Approved Assessment Tool
From WIA Specs

225 Date Administered Reading Pre-Test Record the date on which the pre-assessment test was administered to the youth participant.
Leave "blank" if the individual was not assessed in literacy.
YYYYMMDD From WIA Specs

226 Reading Pre-Test Score Record the raw scale score achieved by the youth participant on the pre-assessment test.
Record 000 or leave "blank" if the individual was not assessed in literacy.
000 From WIA Specs

227 Reading Pre-Test Educational Functioning Level Record the educational functioning level that is associated with the youth participant's raw scale score.
Record 0 or leave "blank" if the individual was not assessed in literacy.
1 = Beginning ABE/ESL Literacy
2 = Beginning ABE/ESL Basic Education
3 = Low Intermediate ABE/ESL Education
4 = High Intermediate ABE/ESL Education
5 = Low Adult Secondary Education/Advanced ESL
6 = High Adult Secondary Education/Advanced ESL
From WIA Specs

228 Category of Math Assessment Record 1 if the participant was assessed using approved tests for Adult Basic Education (ABE)
Record 2 if the participant was assessed using approved tests for English-As-A-Second Language (ESL)
Record 0 or leave "blank" if the individual was not assessed in literacy or numeracy.
1 = ABE
2 = ESL
From WIA Specs

229 Type of Math Assessment Test Use the appropriate code to record the type of assessment test that was administered to the youth participant.
Record 0 or leave "blank" if the individual was not assessed in numeracy.
1 = TABE 7-8, 9-10
2 = CASAS
3 = ABLE
4 = WorkKeys
5 = SPL
6 = BEST
7 = BEST Plus
8 = Other Approved Assessment Tool
From WIA Specs

230 Date Administered Math Pre-Test Record the date on which the pre-assessment Reading test was administered to the youth participant.
Leave "blank" if the individual was not assessed in numeracy.
YYYYMMDD From WIA Specs

231 Math Pre-Test Score Record the raw scale score achieved by the youth participant on the pre-assessment test.
Record 000 or leave "blank" if the individual was not assessed in numeracy.
000 From WIA Specs

232 Math Pre-Test Educational Functioning Level Record the educational functioning level that is associated with the youth participant's raw scale score.
Record 0 or leave "blank" if the individual was not assessed in numeracy.
1 = Beginning ABE/ESL Literacy
2 = Beginning ABE/ESL Basic Education
3 = Low Intermediate ABE/ESL Education
4 = High Intermediate ABE/ESL Education
5 = Low Adult Secondary Education/Advanced ESL
6 = High Adult Secondary Education/Advanced ESL
From WIA Specs

233 Date Administered Reading Post-Test (Year #1) Record the date on which the Reading post-test was administered to the youth during his/her first year of participation in the program. If multiple post-tests were administered, record the most recent date on which the functional area post-test was administered.
Leave "blank" if the youth did not receive a post-test during his/her first year of participation in the program.
YYYYMMDD From WIA Specs

234 Reading Post-Test Score (Year #1) Record the Reading raw scale score achieved by the youth participant.
Record 000 or leave "blank" if the youth did not receive a post-test during his/her first year of participation in the program.
000 From WIA Specs

235 Reading Post-Test Educational Functioning Level (Year #1) Record the Reading educational functioning level that is associated with the youth participant's raw scale score.
Record 0 or leave "blank" if the youth did not receive a post-test during his/her first year of participation in the program.
1 = Beginning ABE/ESL Literacy
2 = Beginning ABE/ESL Basic Education
3 = Low Intermediate ABE/ESL Education
4 = High Intermediate ABE/ESL Education
5 = Low Adult Secondary Education/Advanced ESL
6 = High Adult Secondary Education/Advanced ESL
From WIA Specs

236 Date Administered Math Post-Test (Year #1) Record the date on which the post-test was administered to the youth during his/her first year of participation in the program. If multiple post-tests were administered, record the most recent date on which the functional area post-test was administered.
Leave "blank" if the youth did not receive a post-test during his/her first year of participation in the program.
YYYYMMDD From WIA Specs

237 Math Post-Test Score (Year #1) Record the raw scale score achieved by the youth participant.
Record 000 or leave "blank" if the youth did not receive a post-test during his/her first year of participation in the program.
000 From WIA Specs

238 Math Post-Test Educational Functioning Level (Year #1) Record the educational functioning level that is associated with the youth participant's raw scale score.
Record 0 or leave "blank" if the youth did not receive a post-test during his/her first year of participation in the program.
1 = Beginning ABE/ESL Literacy
2 = Beginning ABE/ESL Basic Education
3 = Low Intermediate ABE/ESL Education
4 = High Intermediate ABE/ESL Education
5 = Low Adult Secondary Education/Advanced ESL
6 = High Adult Secondary Education/Advanced ESL
From WIA Specs

239 Date Administered Reading Post-Test (Year #2) Record the date on which the Reading post-test was administered to the youth during his/her second year of participation in the program. If multiple post-tests were administered, record the most recent date on which the functional area post-test was administered.
Leave "blank" if the youth did not receive a post-test during his/her second year of participation in the program.

Additional Note: These fields are only reported for youth who remain basic skills deficient and continue to participate in the program for a second full year. At the completion of the second year, the individual should be post-tested and the information reported in these fields. To determine an increase of one or more levels, the individual's post-test scores from the second year in the program will be compared to the scores from the test that was administered at the latest point during the first year.
YYYYMMDD From WIA Specs

240 Reading Post-Test Score (Year #2) Record the Reading raw scale score achieved by the youth participant.
Record 000 or leave "blank" if the youth did not receive a post-test during his/her second year of participation in the program.
000 From WIA Specs

241 Reading Educational Functioning Level (Year #2) Record the Reading educational functioning level that is associated with the youth participant's raw scale score.
Record 0 or leave "blank" if the youth did not receive a post-test during his/her second year of participation in the program.
1 = Beginning ABE/ESL Literacy
2 = Beginning ABE/ESL Basic Education
3 = Low Intermediate ABE/ESL Education
4 = High Intermediate ABE/ESL Education
5 = Low Adult Secondary Education/Advanced ESL
6 = High Adult Secondary Education/Advanced ESL
From WIA Specs

242 Date Administered Math Post-Test (Year #2) Record the date on which the Math post-test was administered to the youth during his/her second year of participation in the program. If multiple post-tests were administered, record the most recent date on which the functional area post-test was administered.
Leave "blank" if the youth did not receive a post-test during his/her second year of participation in the program.

Additional Note: These fields are only reported for youth who remain basic skills deficient and continue to participate in the program for a second full year. At the completion of the second year, the individual should be post-tested and the information reported in these fields. To determine an increase of one or more levels, the individual's post-test scores from the second year in the program will be compared to the scores from the test that was administered at the latest point during the first year.
YYYYMMDD From WIA Specs

243 Math Post-Test Score (Year #2) Record the Math raw scale score achieved by the youth participant.
Record 000 or leave "blank" if the youth did not receive a post-test during his/her second year of participation in the program.
000 From WIA Specs

244 Math Post-Test Educational Functioning Level (Year #2) Record the Math educational functioning level that is associated with the youth participant's raw scale score.
Record 0 or leave "blank" if the youth did not receive a post-test during his/her second year of participation in the program.
1 = Beginning ABE/ESL Literacy
2 = Beginning ABE/ESL Basic Education
3 = Low Intermediate ABE/ESL Education
4 = High Intermediate ABE/ESL Education
5 = Low Adult Secondary Education/Advanced ESL
6 = High Adult Secondary Education/Advanced ESL
From WIA Specs

245 Information on Additional Functional Areas The collection of ABE/ESL assessment data for youth who are basic skills deficient is organized according to the Type of Assessment Test and Functional Area, providing space for the collection of up to 2 annual post-test scores in each functional area.













Public Burden  Statement




This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0xxx, expiring xx/xx/xxxx. 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 purpose of the information collection is collect data from youthful offender grantees including post-program data on outcomes to be made available to relevant congressional committees and during budget and allocation hearings. Public reporting burden for collecting information on this form per enrollee, which is required to obtain or retain benefits (PL 105-220 Sections 185 and 189), is estimated to average .2 hours for the enrollee’s time and 1.6 hours for the grantee’s time, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employment and Training Administration, OWI Division of Youth Services, c/o Richard Morris, Washington, D.C. 20210 (Paperwork Reduction Project 1205-XXXX).
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

© 2024 OMB.report | Privacy Policy