Quarterly Performance Report Form 9104 (track changes)

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

Employment and Training Administration Expiration Date: 97/3031/20163

Quarterly Performance Report Form ETA 9104

National Dislocated Worker Emergency Grant Electronic Application System

Grantee:

Grant #:

Project Type:

Project:

Grant Quarter:

Performance Period Covered by this Report:

PARTICIPANT DATA
Received ing Intensive Career Services
ReceivedEnrolled In NEG-Funded Training Services
Participated in Work-Based LearningReceiving NEG-Funded Supportive Services
Received ing NEG-Funded Supportive Services
Received Needs-Related Payments (NRPs)
ExitsCompleted NDWG Services
Entering Employment At ExitEmployed at Completion of NDWG Services
ExitEmployed in Work-Based Learning at Completion of NDWG Services
Total Participants
EXPENDITURE DATA: GRANTEE
Supportive Services
Program Management & Oversight
Admin (Excluding NRP Processing) istration, excl. NRP Processing*
NRP Processing
Other
Total—Program Management and Oversight
Indirect
Other
Total Expenditures: Grantee Level
EXPENDITURE DATA: PROJECT OPERATOR
Core and IntensiveNDWG-Funded Career Services
NDWEG-Funded Training
NDWG-Funded Work-Based Learning
NDWEG-Funded Supportive Services
NDWG-Funded NRPs
Other
Admin (Excluding NRP Processing)Program Management & Oversight
NRP ProcessingOther
Total—Program Management & Oversight
Other
Total Expenditures: Project Operator Level
Total Expenditures: Grantee and Project Operator

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 30 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 1205-0371).

ETA Form 9107 (March 2004)