Work Colleges Expenditure Report Form and Instructions

OMB No: 1845-XXXX

Expires: XX/XX/XXXX

The deadline for submitting 2017-2018 Work Colleges Program Expenditure Report electronically and delivering the signed copy to the U.S. Department of Education is Monday October 1, 2018.

Electronic Submission: The deadline for electronic submission of the expenditure report is 11:59 P.M. (ET) on October 1, 2018. Transmissions must be completed and accepted by 12:00 midnight (ET).

Signature: This form must be signed manually, see instructions. The eSignature option has been discontinued.

Mailing Instructions: If the signed copy of the expenditure report is sent through the U.S. Postal Service, it must be postmarked by October 1, 2018 and mailed to:

United States Department of Education
Federal Student Aid
Grants & Campus-Based Division
CTP Program
830 First Street, NE, Rm 63C5
Washington, DC 20202-5453

If the signed copy of the report is hand delivered by a commercial courier, use the address provided above except use 20002 as the zip code and it must be delivered by 4:30 P.M. (ET) on
October 1, 2018.

Paperwork Burden Statement

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 valid OMB control number for this information collection is 1845-XXXX.  Public reporting burden for this collection of information is estimated to average 2 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  The obligation to respond to this collection is mandatory in accordance with the 1998 Amendments to the Higher Education Act of 1965 (Pub. L. 105-244 Sec. 424) and the Higher Education Opportunity Act of 2008 (Pub. L. 110-315). If you have comments or concerns regarding the status of your individual submission of this form, please contact the Grants & Campus-Based Division Call Center directly at 877/801-7168 or email [email protected].

2017-2018 WORK COLLEGES PROGRAM EXPENDITURE REPORT

Award Year July 1, 2017 through June 30, 2018

Name of Institution: [prefilled by COD] State: [prefilled by COD] OPEID: [prefilled by COD]

1. Final Adjusted 2017-2018 Work Colleges authorization $
   
   

2. Total federal funds available for the 2017-2018 Work Colleges Program
   (Lines 1 + 2a + 2b + 2c + 2d) minus (Lines 2e + 2f + 2g) $ [Calculated]
   
   

   1. Total amount of 2017-2018 Federal Work-Study (FWS)
      funds transferred to and spent in the Work Colleges Program $
      
      

   2. 2018-2019 Work Colleges funds carried back and spent in
      2017-2018 $
      
      

   3. Additional 2018-2019 Work Colleges funds carried back and
      spent for 2018 summer employment $
      
      

   4. 2016-2017 Work Colleges funds carried forward to be spent in
      2017-2018 $
      
      

   5. 2017-2018 Work Colleges funds carried forward to be spent in
      2018-2019 $
      
      

   6. 2017-2018 Work Colleges funds carried back and spent in
      2016-2017 $
      
      

   7. Additional 2017-2018 Work Colleges funds carried back and
      spent for 2017 summer employment $
      
      

3. Total funds spent for Work Colleges earned compensation
   (Lines 3a + 3b) $ [Calculated]
   
   

   1. Total funds spent for Work Colleges Community Service

earned compensation $

2. Total funds spent for Work Colleges non-Community Service

earned compensation $

4. Total federal funds spent for Work Colleges earned compensation

(Lines 4a + 4c) $ [Calculated]

1. Total federal funds spent for Work Colleges
   Community Service earned compensation $___________
   
   

2. Total non-federal funds spent for Work Colleges
   Community Service earned compensation $___________

3. Total federal funds spent for Work Colleges

non-Community Service earned compensation $___________

4. Total non-federal funds spent for Work Colleges

non-Community Service earned compensation $___________

5. Total funds spent for Work Colleges Job Location and Development (JLD) activities
   (Lines 5a + 5b) $ [Calculated]
   
   

   1. Total federal funds spent for Work Colleges
      JLD Activities $
      
      

   2. Total non-federal funds spent for Work Colleges
      JLD Activities $___________
      
      

6. Total funds spent for administrative cost allowance (ACA) and other Work
   Colleges Program allowable expenses, including staff salaries, related travel,
   printing, and mailing costs
   (Lines 6a + 6b) $ [Calculated]
   
   

   1. Total federal funds spent for ACA and other Work Colleges
      expenses $
      
      

   2. Total non-federal funds spent for ACA and other Work
      Colleges expenses $
      
      

7. Total federal funds spent for the 2017-2018 Work Colleges Program
   (Lines 4a + 4c + 5a + 6a) $ [Calculated]
   
   

8. Total non-federal funds spent for the 2017-2018 Work Colleges Program
   (Lines 4b + 4d + 5b + 6b) $ [Calculated]
   
   

9. Expended 2017-2018 Work Colleges authorization
   (Lines 2e + 2f + 2g + 7) minus (Lines 2a + 2b + 2c + 2d) $ [Calculated]
   
   

10. Unexpended 2017-2018 Work Colleges authorization
    (Line 1 – Line 9) $ [Calculated]
    
    

I understand that by signing my name below I am certifying that the information above is true and accurate and that it is subject to review by the U.S. Department of Education.

Signature Date Signed

Title: [prefilled by COD] Typed Name: [prefilled by COD]

Telephone No.: [prefilled by COD]

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