Planning Form 9103-2a (track changes)

U.S. Department of Labor OMB Control No. 1205-0439

Employment and Training Administration Expiration Date: 9/30/2016

Planning Form (Disaster-Temporary Jobs), ETA 9103-12(a)

National Emergency Grant National Dislocated Worker Grant Electronic Application System

All quarterly entries are CUMULATIVE over all previous quarters.

PERFORMANCE FACTOR	PROGRAM YEAR QUARTER
	ADMIN	PROGRAM	QTR1	QTR2	QTR3	QTR4	QTR5	QTR6	QTR7
PLANNED PARTICIPANTS IMPLEMENTATION SCHECULE
Employed in Temporary Disaster Relief Assistance
Receiving Intensive Services
Receiving Supportive Services
Exits Completed NDWG Services
Entering Employment At Exit Employed at Completion of NDWG Services
Total Planned Participants
PLANNED GRANTEE EXPENDITURES
Supportive Services
Administrative
Other
Total: Program Management and Oversight
Indirect*
Other*
Total Expenditures: Grantee Level
PLANNED PROJECT OPERATOR EXPENDITURES
Participant Wages
Participant Fringe Benefits
Career Services
Supportive Services
Other
Administrative
NRP Processing
Other*
Total: Program Management and Oversight
Total: Expenditures: Project Operator Level
Total: Expenditures: Grantee and Project Operator Level

Public Burden Statement:

Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control number. Respondents’ obligation to complete this form is required to obtain or retain benefits ( PL: 107-210). Public reporting burden for this collection of information is estimated to average 90 minutes 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. This is public information and there is no expectation of confidentiality. Send comments regarding this burden estimate to the U.S. Department of Labor, Office of National Response, Room C-5311, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0439).

ETA Form 9103-1 (March 2004)

Previous versions usable