ETA 9091 Annual Report Form

Workforce Investment Act Management Information and Reporting System

Blank 9091 Final.xlsx

WIA Management Information and Reporting System

OMB: 1205-0420

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OMB No. 1205-0420












Expires: 5/31/2016














State Name:





Date Submitted:

















WIA Title IB Annual Report Form (ETA 9091)














Table A - Workforce Investment Act Customer Satisfaction Results














Customer Satisfaction Negotiated Performance Level Actual Performance Level - American Customer Satisfaction Index Number of Surveys Completed Number of Customers Eligible for the Survey Number of Customers Included in the Sample Response Rate
Participants





Employers




















Table B - Adult Program Results















Negotiated Performance Level Actual Performance Level
Entered Employment Rate

Numerator
Denominator
Employment Retention Rate

Numerator
Denominator
Six-Months Average Earnings

Numerator
Denominator
Employment and Credential Rate*

Numerator
Denominator















Table C - Outcomes for Adult Special Populations














Reported Information Public Assistance Recipients Receiving Intensive or Training Services Veterans Individuals With Disabilities Older Individuals
Entered Employment Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Employment Retention Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Six-Months Average Earnings
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Employment and Credential Rate*
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator















Table D - Outcome Information by Service Level for the Adult Program














Reported Information Individuals Who Only Received Core Services Individuals Who Only Received Core and Intensive Services Individuals Who Received Training Services
Entered Employment Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Employment Retention Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Six-Months Average Earnings
Numerator
Numerator
Numerator
Denominator Denominator Denominator















Table E - Dislocated Worker Program Results















Negotiated Performance Level Actual Performance Level
Entered Employment Rate

Numerator
Denominator
Employment Retention Rate

Numerator
Denominator
Six-Months Average Earnings

Numerator
Denominator
Employment and Credential Rate*

Numerator
Denominator















Table F - Outcomes for Dislocated Worker Special Populations














Reported Information Veterans Individuals With Disabilities Older Individuals Displaced Homemakers
Entered Employment Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Employment Retention Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Six-Months Average Earnings
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Employment and Credential Rate*
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator















Table G - Outcome Information by Service Level for the Dislocated Worker Program














Reported Information Individuals Who Received Only Core Services Individuals Who Only Received Core and Intensive Services Individuals Who Received Training Services
Entered Employment Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Employment Retention Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Six-Months Average Earnings
Numerator
Numerator
Numerator
Denominator Denominator Denominator















Table H.1 - Youth (14-21) Program Results















Negotiated Performance Level Actual Performance Level
Placement in Employment or Education Rate

Numerator
Denominator
Attainment of Degree or Certificate Rate

Numerator
Denominator
Literacy and Numeracy Gains

Numerator
Denominator















Table H.1.A - Outcomes for Youth Special Populations*














Reported Information Public Assistance Recipients Veterans Individuals With Disabilities Out-of-School Youth
Placement in Employment or Education Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Attainment of Degree or Certificate Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Literacy and Numeracy Gains
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator




























Table H.2 - Older Youth Results (19-21)*















Negotiated Performance Level Actual Performance Level
Entered Employment Rate

Numerator
Denominator
Employment Retention Rate

Numerator
Denominator
Earnings Change

Numerator
Denominator
Employment and Credential Rate

Numerator
Denominator















Table I - Outcomes for Older Youth Special Populations*














Reported Information Public Assistance Recipients Veterans Individuals With Disabilities Out-of-School Youth
Entered Employment Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Employment Retention Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Earnings Change
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator
Employment and Credential Rate
Numerator
Numerator
Numerator
Numerator
Denominator Denominator Denominator Denominator















Table J - Younger Youth Results (14-18)*















Negotiated Performance Level Actual Performance Level
Skill Attainment Rate

Numerator
Denominator
Diploma or Equivalent Attainment Rate

Numerator
Denominator
Retention Rate

Numerator
Denominator















Table K - Outcomes for Younger Youth Special Populations














Reported Information Public Assistance Recipients Individuals With Disabilities Out-of-School Youth
Skill Attainment Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Diploma or Equivalent Attainment Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Retention Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator















Table L - Other Reported Information















12 Month Employment Retention Rate 12 Mo. Earnings Change (Adults and Older Youth)

or

12 Mo. Earnings Replacement (Dislocated Workers)
Placements for Participants in Nontraditional Employment Wages At Entry Into Employment For Those Individuals Who Entered Unsubsidized Employment Entry Into Unsubsidized Employment Related to the Training Received of Those Who Completed Training Services
Adults
Num
Num
Num
Num
Num
Den Den Den Den Den
Dislocated Workers
Num
Num
Num
Num
Num
Den Den Den Den Den
Older Youth*
Num
Num
Num
Num

Den Den Den Den
















Table M - Participation Levels















Total Participants Served Total Exiters
Adults

Dislocated Workers

Total Youth 2

Older Youth

Younger Youth

Total





























Table N - Cost of Program Activities














Program Activity Total Federal Spending
Local Adults
Local Dislocated Workers
Local Youth
Rapid Response (up to 25%) WIA Section 134(a)(2)(B)
Statewide Required Activities (Up to 15%) WIA Section 134 (a)(2)(B)
Statewide Allowable Activities WIA Section 134 (a)(2)(B) Program Activity Description






















Total of All Federal Spending Listed Above















Table O - Local Performance (Include this chart for each local area in the state)














Local Area Name

________________________
Total Participants Served Adults
Dislocated Workers
Older Youth (19 - 21)
Younger Youth (14 - 18)
ETA Assigned #

________________________
Total Exiters Adults
Dislocated Workers
Older Youth (19 - 21)
Younger Youth (14 - 18)
Reported Information Negotiated Performance Level Actual Performance Level
Customer Satisfaction Program Participants

Employers

Entered Employment Rates Adults

Dislocated Workers

Older Youth

Retention Rates Adults

Dislocated Workers

Older Youth

Younger Youth

Six-Months Average Earnings Adults

Dislocated Workers

Six-Months Earnings Increase (Older Youth) Older Youth

Credential/Diploma Rates Adults

Dislocated Workers

Older Youth

Younger Youth

Skill Attainment Rate Younger Youth

Placement in Employment or Education Youth (14 - 21)

Attainment of Degree or Certificate Youth (14 - 21)

Literacy or Numeracy Gains Youth (14 - 21)

Description of Other State Indicators of Performance (WIA Section 136(d) (1) - insert additional rows if there are more than two other state indicators of performance).







Overall Status of Local Performance Not Met Met Exceeded


















Table P - Veteran Priority of Service















Total Percent Served
Covered Entrants Who Reached the End of the Entry Period

Covered Entrants Who Received a Service During the Entry Period

Covered Entrants Who Received a Staff-Assisted Service During the
Entry Period

















Table Q - Veterans' Outcomes by Special Populations














Reported Information Post 9/11 Era Veterans Post 9/11 Era Veterans who Received at least Intensive Services TAP Workshop Veterans
Entered Employment Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Employment Retention Rate
Numerator
Numerator
Numerator
Denominator Denominator Denominator
Six-Months Average Earnings
Numerator
Numerator
Numerator
Denominator Denominator Denominator














OMB Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB number. Obligation to respond is required to obtain or retain benefits (Workforce Investment Act [Section 185(a)(2)] and Wagner-Peyser Act [29 USC 49i]). The 80 hour public reporting burden for this collection of information, which is to assist with planning and program management and to meet Congressional and statutory requirements, includes time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. Send comments regarding this burden estimate, or any other aspect of this collection, including suggestions for reducing burden, to the U.S. Department of Labor, Employment and Training Administration, Office of Policy Development and Research, Room N-5641, 200 Constitution Avenue, NW, Washington, DC 20210.
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