Cost Data Collection, Program Costs Questionnaire

OMB Control No.: xxxx-xxxx

Expiration Date: xx/xx/20xx

PROGRAM COSTS QUESTIONNAIRE

PART 1: [WIB/LWIA] CENTRAL OFFICE STAFFING

Table 1 collects information on staff at the WIB central office who performed any centralized administrative or supervisory functions and whose salary was paid with WIA Adult and/or Dislocated Worker (A/DW) funds in PY2011. This includes any staff whose salaries were paid partially by WIA A/DW programs and partially by another program, such as WIA Youth Activities. These staff typically work in the LWIA’s central office, and are not usually assigned to a specific American Job Center (AJC). For example, you will list [insert one or two names of LWIA administrative-level staff] in this table, but you will not include [insert name of an AJC manager].

Detailed descriptions of the items requested are below, by column number.

1. Please list everyone who performed centralized administrative or supervisory functions and whose salary was paid, at least in part, with WIA A/DW funds in PY2011. These staff might include—but are not limited to—local workforce area or WIB executive leadership and staff, IT staff, and administrative assistants in the central office. Please note staff initials, rather than full names.

2. Record the person’s job title.

3. Record the total hours per week that each person works.

4. Record the person’s annual salary.

5. Record the person’s fringe benefits rate; that is, the cost the LWIA pays toward each person’s fringe benefits (health insurance, disability insurance, retirement contributions, etc.) as a percentage of the person’s annual earnings.

6. Record the percentage of each person’s salary that is paid for by WIA A/DW programs.

(7)-(10) The final four columns collect information on the percentage of time each person is engaged in key activities: (7) program administration time (for example, performing administrative functions, supervising program operations); (8) working on customer issues (for example, meeting with customers/case management, facilitating workshops, entering data on customers into MIS, completing paperwork for specific customers); (9) staffing the resource room in a American Job Center or mobile unit; and (10) all other activities. Please enter approximately what percentage of their time each person spent in these activities in a typical week. Note that the four columns should sum to 100.

E

Public reporting burden for this collection of information is estimated to average 12 hours, including the time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments concerning this burden estimate or any other aspect of this collection of information to the Department of Labor, Employment and Training Administration, WIA Evaluation Room N-5641, 200 Constitution Ave. NW, Washington, DC, 20210. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The OMB control number for this information collection is xxxx-xxxx. Expiration Date xx/xx/20xx.

xample: The IT Manager at the main [WIB/LWIA] office, Jane Smith, works 40 hours per week. Her $35,000 annual salary is paid for 25% by WIA Youth funds and 75% by WIA A/DW funds. The value of her fringe benefits is equal to 20% of her annual salary. Although Jane predominantly works in the central office, she spends one afternoon (4 hours) per week delivering a workshop on how to use Excel at the nearby [local name for AJCs].

The completed entry for Jane Smith is in the first row of Table 1. Please complete the rest of the table for all appropriate staff.

Table 1: WIA Administrative/Supervisory Staff Salaries, Fringe Benefits, and Time Spent on the Adult and Dislocated Worker Programs

(1) Staff*	(2) Job Title	(3) Hours per Week	(4) Annual Salary	(5) Fringe Benefits Rate	(6) % of Salary Paid by WIA A/DW Programs	(7) % of time spent on administration/ supervision	(8) % of time spent working on customer issues	(9) % of time spent proctoring the resource room	(10) % of time spent on all other activities
J. S.	IT Manager	40	35,000	20	75	90	10	0	0

*Staff might include—but are not limited to— [WIB/LWIA] executive leadership and staff, IT staff, and administrative assistants in the central office.

PART 2: [local name for AJCs] STAFF

Table 2 collects information on staff working in [local name for AJCs], mobile units, satellite centers, and call centers in PY2011. The table is divided into two sections – top and bottom. At the top of the table, please list those [local name for AJCs] staff that have supervisory or management responsibilities, such as the [local name for AJCs] director and a lead [local name for front line staff].

At the bottom of the table, list all other staff who work with WIA customers. This includes the following types of staff:

1. Those who staff the resource room, irrespective of which program(s) pay their salaries.

2. Those who deliver workshops, irrespective of which program(s) pay their salaries.

3. Those who provide one-on-one counseling or case management and whose salaries are paid, at least in part, by WIA A/DW funds. This does not include TANF, Vocational Rehabilitation, or any other staff who do not work directly for the WIA A/DW programs but whose customers may be WIA A/DW customers.

4. Any other staff whose salaries were paid, at least in part, by WIA A/DW funds but who were not entered under any of the previously listed categories. This could include greeters, job developers, and administrative staff such as office managers.

Detailed descriptions of the items requested are below, by column number. Note that you should not enter information in this table for anyone who was already entered in Table 1.

1. In the top section of the table, please list [local name for AJCs] staff that have supervisory or management responsibilities. These might include—but are not limited to—American Job Center administrators, WIA program managers, and case manager supervisors. In the bottom section of the table, please list all other staff who work with WIA customers as described above. These staff might include—but are not limited to—WIA case managers and job developers, [local name for AJCs] greeters, and resource room attendants (including those whose salaries are not funded by WIA). Please note staff initials, rather than full names.

2. Record the person’s job title.

3. Record the total hours per week that each person works.

4. Record the person’s annual salary.

5. Record the person’s fringe benefits rate; that is, the cost the LWIA pays toward each person’s fringe benefits (health insurance, disability insurance, retirement contributions, etc.) as a percentage of the person’s annual earnings.

6. Record the percentage of each person’s salary that is paid for by WIA A/DW programs.

(7)-(10) The final four columns collect information on the percentage of time each person is engaged in key activities: (7) program administration time (for example, performing administrative functions, supervising program operations); (8) working on customer issues (for example, meeting with customers/case management, facilitating workshops, entering data on customers into MIS, completing paperwork for specific customers); (9) staffing the resource room in a American Job Center or mobile unit; and (10) all other activities. Please enter approximately what percentage of their time each person spent in these activities in a typical week. Note that the four columns should sum to 100.

Example: A [local name for front line staff] at [sample AJC], Jerri Jones, works 30 hours per week. Her $25,000 annual salary is paid for 50% by WIA Youth funds and 50% by WIA A/DW funds. The value of her fringe benefits is equivalent to 15% of her annual salary. Jerri spends most of her time working directly on customer issues; for example, she has one-on-one meetings with customers, facilitates a couple of workshops, and makes a lot of follow-up phone calls. However, she spends two afternoons a week (a total of 8 hours) proctoring the resource room.

The completed entry for Jerri Jones is in the first row of Table 2. Note that, because Jerri only works 30 hours per week, the percentage of time spent in the resource room is 100 x (8/30) hours. Please complete the rest of the table for all appropriate staff.

Table 2: Program Staff Salaries, Fringe, and Time Spent on the Adult and Dislocated Worker Programs

(1) Staff*	(2) Job Title	(3) Hours per Week	(4) Annual Salary	(5) Fringe Benefits Rate	(6) % of Salary Paid by WIA A/DW Programs	(7) % of time spent on administration/ supervision	(8) % of time spent working on customer issues	(9) % of time spent proctoring the resource room	(10) % of time spent on all other activities
[local name for AJCs] Managers and Supervisors
All Other [local name for AJCs] Staff who Work with WIA customers*
J. J.	Case Manager	30	25,000	15	50	0	73 (=100 x (22/30))	27 (=100 x (8/30))	0

* Staff might include—but are not limited to—case managers, job developers, greeters, and resource room attendants.

PART 3: OVERHEAD COSTS

This section collects information on the overhead costs associated with the [WIB/LWIA] administrative offices, the American Job Centers, and any satellite or mobile units in PY2011.

Overhead costs are ongoing expenses related to operating your WIA programs, such as rent and utility payments for the space occupied by your offices and centers, as well as office supplies, and furniture and computer costs. These costs may also include things like computer software subscriptions (such as Microsoft Office Suite) and internet/phone service. Overhead costs do not include costs associated with implementing very specific activities, such as workshops or assessments.

Depending on the way you already collect or report this information, you can provide this information for the [WIB/LWIA] as a whole (that is, for the [WIB/LWIA], the [local name for AJCs], and satellite centers combined) by answering 1 and 2 immediately below. Alternatively, you may report overhead separately for each central office, [local name for AJCs], and satellite center in Table 3.

1. How much did [WIB/LWIA] expend on overhead in PY 2011? ___________________________

• Please list the items (such as rent, utilities, software licensing fees) that are accounted for in this overhead expenditure amount.

1. ______________________________________________________

2. ______________________________________________________

3. ______________________________________________________

4. ______________________________________________________

5. ______________________________________________________

6. ______________________________________________________

7. ______________________________________________________

8. ______________________________________________________

9. ______________________________________________________

2. Approximately what percentage of these expenditures were paid for with WIA A/DW funds? ___________________________

If entering separately for each administrative office, [local name for AJCs], and satellite center, please complete Table 3. Please be sure to include all the relevant entities. Detailed descriptions of the items requested are below, by column number.

1. Please list the name of each administrative office, [local name for AJCs], and satellite center in the local area.

2. Record the overhead expenditures for the entity designated in column (1).

3. List the items that are included in the total overhead expenditure amount listed in column (2). For example, rent, utilities, office supplies.

4. Record the percentage of overhead expenditures paid by WIA A/DW funds.

Table 3: Overhead Costs by Location

(1) Administrative office, [local name for AJCs], Satellite, Outreach Center (specify)	(2) Total Overhead Expenditures	(3) Items Included in Overhead Expenditure Amount	(4) % of Overhead Paid by WIA A/DW Funds

PART 4: TRAINING AND RELATED SERVICES

Table 4 collects information on training funds expended in PY 2011. This includes ITAs as well as expenditures on on-the-job training, customized training, and several other common types of training. Detailed descriptions of the items requested are below, by column number.

1. Column 1 has been pre-filled with the most commonly offered types of training offered in local areas nationwide.

2. Record the total amount of money spent in PY 2011. If your local area does not offer the pre-filled type of training, record a zero.

3. List the total number of adults and dislocated workers that were served by the expended funds.

If the [WIB/LWIA] expended other funds for training that are not already listed in the table (for example, for internships, as part of a NEG), please add them to the bottom of the first column and complete the remaining columns for each.

Table 4: Training Expenditures, PY 2012

(1) Funding/Training Type	(2) Total Amount Spent in PY 2011	(3) Total Number of Adults and Dislocated Workers Served in PY 2011
Individual Training Accounts
On-the-Job Training
Customized Training
Self-employment assistance/entrepreneurial training
Short-term or low cost prevocational skills training, not funded by an ITA
Classroom training for special circumstances (that is, training paid for outside of the ITA structure)
Other (specify):
Other (specify):
Other (specify):

PART 5: OTHER SERVICE COSTS

This section collects information on the costs of other services offered to WIA A/DW customers. We are interested in information about five types of services: (1) workshops; (2) peer support groups (also known as job clubs or peer networking groups); (3) structured assessments, such as WorkKeys, TABE, and SAGE; (4) supportive services; and (5) basic education.

Section A: Workshops

Table 5 collects information on all the workshops that were available to WIA customers at all the [name of AJCs] in [WIB/LWIA] in PY 2011. Workshops should be included regardless of whether they are offered to all WIA A/DW customers or only to those who are determined eligible for intensive/training services.

We recognize that not all workshops are offered in all [local name for AJCs] in the [WIB/LWIA], and that certain aspects of the workshops—such as how many times it is offered per year and how many people attend—may also vary across [local name for AJCs] or by service providers. Please make your best estimate of the totals across all [local name for AJCs] in the [WIB/LWIA] or, if you prefer, you may report them separately by [local name for AJCs] or service provider. Detailed descriptions of the items requested are below, by column number.

1. Please add any workshops that are missing from the list. If you are recording workshops by [local name for AJCs] or by service provider, please also enter its name.

2. Record the average duration of the workshop (in hours). For example, if the workshop typically meets for 2 hours, record 2. If the workshop meets for 3 days, 2 hours each day, enter 6.

3. Record about how many total times the workshop was offered in PY 2011.

4. Indicate how many staffpersons usually deliver the workshop each time it is offered. That is, how many staffpersons are typically present when a workshop session is offered?

5. Record about how many people in total attended the workshop in PY2011.

6. Record the total amount in fees collected from customers attending the workshop in PY2011.

7. Record the total amount expended on workshop-specific supplies, such as workbooks or workshop-specific computer software (for example, software that is not already available for use in the Resource Room). Fees for printing or copying workshop materials should only be included if they are printed/copied outside the [local name for AJCs].

Example: The Upper Springfield Workforce Investment Area consists of four American Job Centers, two of which are operated by Training Solutions and two of which are operated by Jobs for All. Both operators offer Basic Excel, Basic Word, and Resume Writing, once per month in each center, meeting for 3 hours. In addition, the two Training Solutions centers offer an intensive Job Search workshop every other month which lasts for a full day. Each basic workshop is facilitated by one staffperson, but typically two staffpeople are on hand for the intensive Job Search workshop.

Neither the Basic Excel nor the Basic Word workshop has any fees or associated materials costs, since the software is already available in the resource room and the centers do not incur an additional fee to use it for the workshops. However, the Resume Writing workshop has supply expenditures of $5,000 per year for high quality resume paper; this is partially offset by a fee of $5 that each customer must pay. In addition, Training Solutions typically spends about $1,000 per year in materials for the Job Search workshop. A completed table for Upper Springfield would look like the following example.

Sample Completed Workshops Cost Table

(1) Name of Workshop (add [local name for AJCs] or provider name, if applicable)	(2) Average Duration (hours)	(3) Number of Times Offered Per Year	(4) Number of Staff Delivering Workshop	(5) Number of Attendees Per Year	(6) Total customer fees collected, if any	(7) Annual workshop supply expenditures (dollars)
Basic Excel	3	48 (=12 times 4 American Job Centers)	1	100	0	0 (the software is not specific to the workshop)
Basic Word	3	48 (=12 times 4)	1	200	0	0
Resume Writing	3	48 (=12 times 4)	1	500	2500	5000
Job Search—offered by Training Solutions	8	12 (=6 times 2)	2	30	0	1000

Please complete Table 5 following this example.

Table 5: Workshops

(1) Name of Workshop (add [local name for AJCs] or provider name, if applicable) [pre-filled by study team]	(2) Average Duration (hours)	(3) Number of Times Offered Per Year	(4) Number of Staff Delivering Workshop	(5) Number of Attendees Per Year	(6) Total customer fees collected, if any	(7) Annual workshop supply expenditures (dollars)

Section B: Peer support groups

Table 6 collects information on peer support groups, also known as job clubs or peer networking groups, that were available to WIA customers at all the [name of AJCs] in [WIB/LWIA] in PY 2011. We recognize that not all [local name for AJCs] in the [WIB/LWIA] necessarily offer peer support groups, and that certain aspects of the groups—such as how many times they meet per year and how many people attend—may also vary across [local name for AJCs] or by service providers.

Please make your best estimate of the totals across all [local name for AJCs] in the [WIB/LWIA] or, if you prefer, you may report them separately by [local name for AJCs] or service provider. Detailed descriptions of the items requested are below, by column number. This information is very similar to that collected for workshops.

1. Please add any peer support groups that are missing from the list. If you are recording peer support groups by [local name for AJCs] or by service provider, please also enter its name.

2. Record the average duration of the peer support group (in hours). For example, if the group typically meets for 2 hours, record 2. If the group meets for 2 days, 1 hours each day, enter 2.

3. Record about how many total times the group met in PY 2011.

4. Indicate how many staffpersons usually moderate or supervise the group each time it meets. That is, how many staffpersons are typically present when a peer support group is meeting?

5. Record about how many people in total attended these groups in PY2011.

Table 6: Peer Support Groups

(1) Group (add [local name for AJCs] or provider name, if applicable) [pre-filled by study team]	(2) Average Duration (hours)	(3) Number of Meetings Per Year	(4) Number of Staff At Meetings	(5) Number of Attendees Per Year

Section C: Assessments

Table 7 collects information on all the structured assessments that were available to WIA A/DW customers at all the [local name for AJCs] in [WIB/LWIA] in PY 2011. Structured assessments should be included regardless of whether they are offered to all WIA A/DW customers or only to those who are determined eligible for intensive/training services. Note that informal assessments of customer skills or suitability for training are not included; rather we are interested in paper-and-pencil or computer-based tests that customers can take to assess their skills and career readiness or determine what types of careers they would be well-suited to.

We recognize that the same set of structured assessments might not be offered in all [local name for AJCs] or by all service providers in the [WIB/LWIA]. Please make your best estimate of the totals across all [local name for AJCs] and service providers in the [WIB/LWIA] or, if you prefer, you may report them separately by [local name for AJCs] or service provider. Detailed descriptions of the items requested are below, by column number.

1. Please add any assessments offered in PY 2011 that are missing from the list. If you are recording assessments by [local name for AJCs] or by service provider, please also enter its name.

2. Record the approximate annual expenditures on assessment supply costs, such as workbooks, answer sheets, or per-assessment licensing fees.

3. Record how many customers took each assessment in PY 2011.

4. Record the fee to score each assessment, if there is one.

The first row of Table 6 provides an example of how to fill in this table. Please complete the rest of the table as appropriate.

Table 7: Assessment Costs

(1) Assessment Name [pre-filled by liaisons]	(2) Approximate Annual Expenditures on Assessment Supplies in PY2011	(3) Approximate Number of Assessment Takers in PY2011	(4) Per-Assessment Scoring Fee
TABE	$500	1,000	0

Section D: Supportive Services

1. How much did the [local name for AJCs] expend on supportive services for WIA A/DW customers in PY 2011? __________________________

2. About how many WIA A/DW customers received these supportive services? __________________________

Section E: Adult Basic Education

Table 8 collects information on adult basic or remedial education courses that were offered to WIA Adults and Dislocated Workers within the American Job Center system in PY2012. This includes courses that were offered by partner agencies such as Wagner-Peyser.

• In Column 1, list all the adult basic/remedial education courses that were offered to WIA Adults and Dislocated Workers in PY 2012.

• In Column 2, note which program (i.e., WIA, TANF, ES) offered the course.

• In Column 3, estimate the average cost for a customer to attend the course. This includes the cost of providing the course, but not any fee paid by the customer.

• In the final column, note who typically pays for a customer to attend the program. This could be the customer himself, WIA, or a partner agency.

Table 8: Basic/Remedial Education

Course [pre-filled by liaisons]	Program that Offered the Course	Average Per Customer Cost of Course	Funding Source(s)

D.1