Participant Data Disclosure

Reintegration of Ex-Offenders, Adult Reporting System

Adult Offender Record Layout_FINAL 8.7.18.xls

Participant Data Disclosure

OMB: 1205-0455

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Prisoner Reentry Initiative Data Elements
No. DATA ELEMENT NAME DATA ELEMENT DEFINITIONS/INSTRUCTIONS VALID VALUES EDITS
Global Edits

Duplicate Detection

A. If multiple records have the same Social Security Number (field 1), then no record can have a field 46 (Date of Participation) or a field 47 (Date or Exit) between the Date of Program Participation and the Date of Exit plus 90 days of any other record with the same Individual Identifier.

B. If multiple records have the same Individual Identifier, then only the record with the most recent Date of Participation can have a blank Date of Exit.
SECTION I - INDIVIDUAL INFORMATION

SECTION I.A - IDENTIFYING AND DEMOGRAPHIC INFORMATION

1 Social Security Number Record the unique identification number assigned to the individual. At a minimum, this identifier for a person must be the same for every period of participation in the program. XXX-XX-XXXX

(No hyphens)
Mandatory field
2 Direct Referral from Justice System Select Yes if the participant was directly referred by the justice system.
Select No if the participant was not directly referred from the justice system
1 = Yes
2 = No

3 Criminal Justice System Identifier Enter the individual's unique criminal justice system identifier that was assigned to the inidividual while in prison. Text
4 Type of Criminal Justice Identifier Select the appropriate type of criminal justice identifier used in element 2. 1 = Federal ID
State CJ Record ID
2 = State Prison ID
3 = State Parole/ Probation Agency ID
4 = Local Probation Agency ID
5 = Local Jail ID
6 = Other
A. Must not be blank if field 2 (Criminal Justice System Identifier) is not blank.
5 Specify Other Criminal Justice Identifier Specify the type of criminal justice identifier if other was used for element 3. Text A. Must not be blank if field 3 (Type of Criminal Justice Identifier) is 6.
6 Non-Violent Offender Select Yes if the participant is a non-violent offender.

Select No if the participant is not a non-violent offender.
1 = Yes
2 = No

7 Date of Birth Record the individual's date of birth. MM/DD/YYYY
8 Gender Indicate the participant's gender by select Male or Female

Leave blank if the individual does not wish to disclose his/her gender.
1 = Male
2 = Female
Blank = no self-disclosure

9 Ethnicity Hispanic/ Latino Indicate the participant's ethnicity by selecting Yes or No.

Leave blank if the participant does not disclose his/her ethnicity.
1 = Yes
2 = No
Blank = no self-disclosure

10 American Indian or Alaska Native Indicate whether the participant is American Indian or Alaska Native by selecting Yes.

Leave blank if the participant is not American Indian or Alaska Native or refused to report on this element.
1 = Yes
Blank = not reported

11 Asian Indicate whether the participant is Asian by selecting Yes or Not Reported.

Leave blank if the participant is not Asian or refused to report on this element.
1 = Yes
Blank = not reported

12 Black or African American Indicate whether the participant is Black or African American by selecting Yes or Not Reported.

Leave blank if the participant is not Black or African American or refused to report on this element.
1 = Yes
Blank = not reported

13 Hawaiian Native or other Pacific Islander Indicate whether the participant is Hawaiian Native or other Pacific Islander by selecting Yes or Not Reported.

Leave blank if the participant is not Hawaiian Native or other Pacific Islander or refused to report on this element.
1 = Yes
Blank = not reported

14 White Indicate whether the participant is White by selecting Yes or Not Reported.

Leave blank if the participant is not White or refused to report on this element.
1 = Yes
Blank = not reported

SECTION I.B - ENROLLMENT INFORMATION

15 Marital status Enter the participants marital status at time of enrollment 1 = Married
2 = Single
3 = Divorced
4 = Widowed
5 = Separated

16 Justice Status at Enrollment Record 1 if currently in or returning from a correctional facility . Record 2 if currently in or returning from detention or juvenile hall.
Record 3 if currently on or most recently was on probation.
Record 4 if currently in or entering a diversion program.
1 = Correctional Facility 2 = Detention 3 = Probation 4 = Diversion
17 Date of Release from Confinement or Placement on Probation Record the date on which participant was released from confinement or placed on probation. YYYYMMDD
18 Children Enter the number of children under 18 years of age that the participant has, including biological, adopted, step, and foster children. 00
19 Children living with participant Enter the number of the participant's own children under 18 years of age living in the household, including biological, adopted, step, and foster children. 00 A. Must be less than or equal to field 15 (Children).
20 Other dependents living with participant Enter the number of dependents other than children living with the participant. 00
21 Highest School Grade Completed Use the appropriate code to record the highest school grade completed by the individual.

Record 87 if the individual completed the 12th grade and attained a high school diploma.
Record 88 if the individual completed the 12th grade and attained a GED or equivalent.
Record 89 if the individual with a disability received a certificate of attendance/completion.
00 = No school grades completed
01 - 12 = Number of elementary/secondary school grades completed
13-15 = Number of college, or full-time technical or vocational school years completed
16 = Bachelor's degree or equivalent
17 = Education beyond the Bachelor's degree
87 = Attained High School Diploma
88 = Attained GED or Equivalent
89 = Disabled Person Attained a Certificate of Attendance/Completion

22 Eligible Veteran Status Select yes, <= 180 days if the individual is a person who served in the active U.S. military, naval, or air service for a period of less than or equal to 180 days, and who was discharged or released from such service under conditions other than dishonorable.
Select yes, eligible veteran if the individual served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve component under an order to active duty pursuant to section 167 (a), (d), or, (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge.
Select yes, other eligible person if the individual is a person who is
(a) the spouse of any person who died on active duty or of a service-connected disability,
(b) the spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C 101 and the regulations issued thereunder, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days:
(i) missing in action;
(ii) captured in the line of duty by a hostile force; or
(iii) forcibly detained or interned in the line of duty by a foreign government or power; or
(c) the spouse of any person who has a total disability permanent in nature resulting from a
service-connected disability or the spouse of a veteran who died while a disability so evaluated
was in existence.
Select no if the individual does not meet any one of the conditions
described above.
1 = Yes, <= 180 days
2 = Yes, Eligible Veteran
3 = Yes, Other Eligible Person
4 = No

23 Limited English Proficient Select Yes if the individual is a person who has limited ability in speaking, reading, writing or understanding the English language and (a) whose native language is a language other than English, or (b) who lives in a family or community environment where a language other than English is the dominant language.
Select No if the individual does not meet the conditions described above.
1 = Yes
2 = No

24 Individual with a Disability Select Yes if the individual indicates that he/she has any "disability," as defined in Section 3(2)(a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102). Under that definition, a "disability" is a physical or mental impairment that substantially limits one or more of the person's major life activities. (For definitions and examples of "physical or mental impairment" and "major life activities," see paragraphs (1) and (2) of the definition of the term "disability" in 29 CFR 37.4, the definition section of the WIA non-discrimination regulations.)
Select No if the individual indicates that he/she does not have a disability that meets the definition.
Leave blank if the individual does not wish to self-identify.
1 = Yes
2 = No
Blank = no self-identification

25 Health Issues Select Sigificant health issues if the participant has any health issue that could impact the individual's ability to work. Examples of such health issues can include, but are not limited to, untreated high blood pressure, HIV/STDs, asthma, depression, and other metnal/physical health issues.

Otherwise, select No significant health issues.
1 = Significant health issues
2 = No significant health issues

26 Employment Status at Participation Record Employed if the participant is a person who either (a) did any work at all as a paid employee, (b) did any work at all in his or her own business, profession, or farm, (c) worked 15 hours or more as un unpaid worker in an enterprise operated by a member of the family, or (d) is one who was not working, but has a job or business from which he or she was temporarily absent because of illness, bad weather, vacation, labor-management dispute, or personal rea­sons, whether or not paid by the employer for time-off, and whether or not seeking another job.
Record Employed, but Received Notice of Termination of Employment or Military Separation if the participant is a person who, although employed, either (a) has received a notice of termination of employment or the employer has issued a Worker Adjustment and Retraining Notification (WARN) or other notice that the facility or enterprise will close, or (b) is currently on active military duty and has been provided with a firm date of separation from military service.
Record Not Employed if the individual does not meet any one of the conditions described above.
1 = Employed
2 = Employed, but Received Notice of Termination of Employment or Military Separation
3 = Not Employed
A. Must be 1 or 2 if field 23 (Occupation at Enrollment) is >0.

B. Must be 1 or 2 if field 24 (Hours Worked at Enrollment) is >0.

C. Must be 1 or 2 if field 25 (Average Hourly Wage at Enrollment) is >0.

D. Must be 1 or 2 if field 26 (Start Date for Job at Enrollment) is not blank.

E. Must be completed within two weeks of opening the record.
27 Occupation at Enrollment Record the occupational area that best describes the individual's employment at enrollment.

Leave blank if the participant is not employed at participation.

Architecture and Engineering
Arts, Design, Entertainment, Sports, and Media
Building and Grounds Cleaning and Maintenance
Business and Financial Operations
Community and Social Services
Computer and Mathematical Occupations
Construction and Extraction


Education, Training, and Library
Farming, Fishing and Forestry
Food Preparation and Serving R+D related
Healthcare Practitioner and Technical
Healthcare Support


Installation, Maintenance, and Repair
Legal
Life, Physical, and Social Science
Management
Military Specific
Office and Administrative Support
Personal Care and Service
Production
Protective Service
Sales and Related
Transportation and Material Moving

28 Hours Worked at Enrollment Enter the average hours per week that the participant works at the above occupation.

Leave blank if the participant is not employed at participation.
00
Blank = not employed
A. Must be greater than 0 if field 22 (Employment Status at Participation) is 1 or 2.
29 Average Hourly Wage at Enrollment Enter the participant's average hourly wage at the above occupation.

Leave blank if the participant is not employed at participation.
00.00
Blank = not employed
A. Must be greater than 0 if field 22 (Employment Status at Participation) is 1 or 2.
30 Start Date for Job at Enrollment Enter the date on which the participant began to work at the above job.

Leave blank if the participant is not employed at participation.
MM/DD/YYYY
Blank = not employed
A. Must not be blank if field 22 (Employment Status at Participation) is 1 or 2.
31 Housing Status at Enrollment Select Own/Rent Apartment, Room, Or House if, at enrollment, the individual is living in an apartment, room, or house that the he/she owns or rents.

Select Staying at someone's apartment, room, or house (Stable) if, at enrollment, the individual is living in an apartment, room, or house that somebody else owns or rents and if the person is not at risk of being displaced from this housing, i.e the housing situation is long-term.

Select Halfway house/transitional house if, at enrollment, the individual is living in a residence designed to assist persons as they re-enter society and learn to adapt to independent living after having been in prison.

Select Residential treatment if, at enrollment, the individual lives in a residential treatment center. A residential treatment center is a group home that provides room and board, and provides specialized treatment or rehabilitation persons with emotional, psychological, or developmental problems as well as chemical dependencies.

Select Homeless if, at enrollment, the individual lacks a fixed, regular, adequate night time residence. This definition includes any individual who has a primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings. This definition does not include an individual imprisoned or detained under an Act of Congress or State law. An individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that alone, be recorded as homeless.

Select Staying at someone's apartment, room, or house
(Unstable) if, at enrollment, the individual is living in an apartment,
room, or house that somebody else owns or rents and if the person is
at risk of being displaced from this housing, i.e the housing situation is
short-term.
1 = Own/rent apartment, room, or house
2 = Staying at someone's apartment, room, or house (Stable)
3 = Halfway house/ transitional house
4 = Residential treatment
5 = Homeless
6 = Staying at someone's apartment, room, or house (Unstable)
A. Must be completed within two weeks of opening the record.
32 Alcohol Abuse/ Drug Use at Enrollment Select prior to incarceration if the individual used illegal drugs or abused legal drugs or alcohol within 3 months prior to incarceration.
Select prior to enrollment if the individual used illegal drugs or abused legal drugs or alcohol 3 months prior to enrollment.
Select both if the individual used illegal drugs or abused legal drugs or alcohol within 3 months prior to incarceration and 3 months prior to enrollment.
Select no if the individual did not use illegal drugs or abuse alcohol 3 months prior to incarceration or 3 month prior to enrollment.
1 = Prior to incarceration
2 = Prior to enrollment
3 = Both
4 = No
A. Must be completed within two weeks of opening the record.
33 Referral Source Enter the name of the organization or individual who referred the applicant to the PRI program Text
34 Post-Release Status at Enrollment Select parole if the participant is on parole on the date of participation.
Select probation if the participant is on probation on the date of participation.
Select other criminal justice/court supervision if the participant is on post-release supervision other than parole or probation on the date of participation.
Select none if the participant is not on any form of post-release supervision.
1 = Parole
2 = Probation
3 = Other Criminal Justice/Court Supervision
4 = None
A. Must be completed within two weeks of opening the record.
35 Mandated participation Select Yes if participation in the PRI program is mandated by a criminal justice agency or agent as a condition of parole, probation, or other supervision.

Select No if participation in the PRI program is not mandated by a criminal justice agency or agent
1 = Yes
2 = No

SECTION I.C - INFORMATION AT AND PRIOR TO INCARCERATION
This information is collected at enrollment.

36 Employment Status at Incarceration Prior to your most recent incarceration, indicate whether the indiviidual was employed within two weeks of arrest. 1 = Employed full-time
2 = Employed part-time
3 = Not employed

37 Date of Incarceration for Most Recent Crime Prior to Participation Enter the date on which the participant was incarcerated for the most recent crime committed prior to participation. MM/DD/YYYY A. Must be less than field 34 (Date of Release for Most Recent Crime Prior to Participation).
38 Date of Release for Most Recent Crime Prior to Participation Enter the date on which the participant was most recently released from prison prior to participation. MM/DD/YYYY A. Must be less than field 47 (Date of Program Participation).

B. Must be completed within two weeks of opening the record.
39 Institution Enter the name of the institution at which the participant was incarcerated most recently prior to enrollment. Text
40 Type of institution Select the type of institution at which the participant was incarcerated most recently prior to enrollment 1 = Federal prison
2 = State prison
3 = County/city jail

41 Total Time Incarcerated Enter the total number of years and months that the participant has been incarcerated during his/her lifetime. YY/MM A. Must be completed within two weeks of opening the record.
42 Property Crime Select the appropriate type(s) of property crime for the participant's most recent conviction. Property crimes include, but are not limited to, burglary, larceny, motor vehicle theft, and receiving stolen property.

If a participant was convicted for more than one type of offense, select all appropriate offenses.

Leave blank if the participant's most recent conviction was not for a property crime.
1 = Burglary
2 = Larceny
3 = Motor vehicle theft
4 = Receiving stolen property
5 = Other property crime
Blank = not a property crime
A. Must be completed within two weeks of opening the record.
43 Type of Other Property Crime Specify the other property crime.

Leave blank if the participant most recent conviction did not include other property crimes.
Text
Blank = did not include other property crime
A. Must not be blank if field 38 (Property Crime) is 5.
44 Drug Crime Select the appropriate type(s) of drug crimes for the participant's most recent conviction. Drug crimes include, but are not limited to, possession of a controlled substance, traffic in a controlled substance, and possession of drug paraphernalia.

If a participant was convicted for more than one type of offense, select all appropriate offenses.

Leave blank if the participant's most recent conviction was not for a drug crime.
1 = Possession of a controlled substance
2 = Traffic in a controlled substance
3 = Possession of drug paraphernalia
4 = Other drug crime
Blank = not a drug crime
A. Must be completed within two weeks of opening the record.
45 Type of Other Drug Crime Specify the other drug crime.

Leave blank if the participant's most recent conviction did not include other drug crimes.
Text
Blank = did not include other drug crime
A. Must not be blank if field 40 (Drug Crimes) is 4.
46 Public Order Offenses Select the appropriate type(s) of public order offenses for the participant's most recent conviction. Public order offenses include, but are not limited to, commercial vice, gambling, animal cruelty, and driving while intoxicated.

If a participant was convicted for more than one type of offense, select all appropriate offenses.

Leave blank if the participant's most recent conviction was not for a public order offense.
1 = Commercial vice
2 = Gambling
3 = Animal cruelty
4 = Driving while intoxicated
5 = Other public order offense
Blank = not a public order offense
A. Must be completed within two weeks of opening the record.
47 Type of Other Public Order Offenses Specify the other public order offense.

Leave blank if the participant's most recent conviction did not include other public order offenses.
Text
Blank = did not include other public order offense
A. Must not be blank if field 42 (Public Order Offenses) is 5.
48 Other Offenses Select Yes if the participant's most recent conviction was for any offense not included in property, drug, or public order offenses.

1 = Yes
2 = No
A. Must be completed within two weeks of opening the record.
49 Type of Other Offenses Specify the other offenses.

Leave blank if the participant's most recent conviction did not include other offenses.
Text
Blank = did not include other offenses
A. Must not be blank if field 44 (Other Offenses) is 1.
50 Violent Felony Conviction Select Yes if the participant has ever been convicted of a violent felony. 1 = Yes
2 = No
A. Must be completed within two weeks of opening the record.
51 Received DoJ Pre-Release Services Select Yes if the participant indicated that he/she was enrolled in the Department of Justice's pre-release program. 1 = Yes
2 = No
A. Must be completed within two weeks of opening the record.
SECTION II - PROGRAM ACTIVITIES AND SERVICES INFORMATION
SECTION II.A - PROGRAM PARTICIPATION DATA
52 Date of Program Participation Record the date on which the individual begins receiving his/her first service funded by the program following a determination of eligibility to participate in the program.

MM/DD/YYYY

A. Must be less than or equal to field 48 (Date of Exit) and all service fields in section II.B of the record layout.
53 Date Entered Follow-up Services Record that date in which the program begins the follow-up services with the participant, which means the participant has completed services and there is an expectation that no additional services, other than support or follow-up services, will be needed.

This field should not be populated until the case manager expects the participant will receive no more services.
MM/DD/YYYY

A. Must be greater than or equal to field 47 (Date of Participation).

B. Must be greater than or equal all dates provided in the service fields except supportive services (Section II.B).
54 Date of Exit Record the date on which the participant exited the program. For most participants this will be the date that the last service funded by the program or a partner program (excluding supportive services) is received by the participant or the date of incarceration, whichever occurs first.

Once a participant has not received any services funded by the program (excluding supportive services) or a partner program for 90 consecutive calendar days, has no planned gap in service, and is not scheduled for future services, the date of exit is applied retroactively to the last day on which the individual received a service funded by the program or a partner program.

For special "Other Reasons" for exit, to include only death, incapacitation for health reasons, and inabilty to participate because of the need to care for a family member, the date of exit is the date that occassioned the other reason for program exit.

MM/DD/YYYY A. This date will be autogenerated by the system to be the date on which the individual received his/her last service.
55 Prerelease Contact Select Yes if the DoL grantee had any contact with the participant prior to registration
in the program.

Select No if the DoL grantee did not have any contact with the participant prior to registration in the program.

1 = Yes
2 = No

56 Other Reasons for Exit (at time of exit or during 3-quarter measurement period following the quarter of exit) Select Health/Medical if the participant is receiving medical treatment that precludes entry into unsubsidized employment or continued participation in the program. Does not include temporary conditions expected to last for less than 90 days.

Select Deceased if the participant was found to be deceased or no longer living.

Select Family Care if the participant is providing care for a family member that precludes entry into unsubsidized employment or continued participation in the program. Does not include temporary conditions expected to last for less than 90 days.


Leave blank if the none of the above reasons apply.
02 = Health/Medical
03 = Deceased
04 = Family Care
Blank = none of the above
A. Must be blank if field 48 (Date of Exit) and field New (Date Entered Follow-up Services) is blank.




57 Date Entered Math/Reading Remediation Enter the date on which the participant started math/reading remediation.

Math/Reading remediation consists of classroom instruction designed to improve an participant’s reading and/or math skills for those participants who are determined to be basic literacy skills deficient. Basic education skills include reading comprehension, math computation, writing, speaking, listening, problem solving, reasoning, and the capacity to use these skills.
MM/DD/YYYY
58 Provider Type Select Faith-based Provider if the non-emergency medical care is provided by a faith-based organization.

Select Community-based Provider if the non-emergency medical care is provided by a community-based organization.

Select Public Provider if the non-emergency medical care is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

59 Expected Completion Date of Math/Reading Remediation Enter the date on which the participant is expected to complete math/reading Remediation. MM/DD/YYYY A. Must be blank or greater than or equal to field 51 (Date Entered Math/Reading Remediation)
60 Date of Last Math/Reading Remediation Services During the Month Enter the last date during the month in which the participant received math/remediation services.

Note: This field must repeat for every month in which the participant receives math/remediation services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 51 (Date Entered Math/Reading Remediation)
61 Date Ended Math/Reading Remediation Enter the date on which the participant exited math/reading remediation. MM/DD/YYYY A. Must be blank or greater than or equal to field 51 (Date Entered Math/Reading Remediation).

B. Must not be blank if field 55 (Completed Math/Reading Remediation) is 1.
62 Completed Math/Reading Remediation Select Yes if the participant successfully completed math/reading remediation.

Select No if the participant did not successfully complete math/reading remediation.

1 = Yes
2 = No
A. Must not be blank if field 54 (Date Ended Math/Reading Remediation) is a valid date.
63 Date Entered GED Preparation Enter the date on which the participant started GED preparation.

GED preparation is an activity intended to prepare an participant for passing the GED examination.
MM/DD/YYYY
64 Provider Type Select Faith-based Provider if the math/reading remediation is provided by a faith-based organization.

Select Community-based Provider if the math/reading remediation is provided by a community-based organization.

Select Public Provider if the math/reading remediation is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

65 Expected Completion Date of GED Preparation Enter the date on which the participant is expected to complete GED preparation.

MM/DD/YYYY A. Must be blank or greater than or equal to field 56 (Date Entered GED Preparation)
66 Date of Last GED Preparation Services During the Month Enter the last date during the month in which the participant received GED preparation services.

Note: This field must repeat for every month in which the participant receives GED preparation services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 56 (Date Entered GED Preparation)
67 Date Ended GED Preparation Enter the date on which the participant exits GED preparation.

MM/DD/YYYY A. Must be blank or greater than or equal to field 56 (Date Entered GED Preparation).

B. Must not be blank if field 60 (Completed GED Preparation) is 1.
68 Completed GED Preparation Select Yes if the participant successfully completed GED preparation

Select No if the participant did not successfully complete GED preparation.

1 = Yes
2 = No
A. Must not be blank if field 59 (Date Ended GED Preparation) is a valid date.
69 Date Entered Vocational/ Occupational Skills Training Services Enter the date on which the participant started vocational/occupational skills training.

Vocational/ occupational skills training is a type of long term occupational training consisting of specific classroom and work-based study in a specific occupation leading to a degree or certificate.
MM/DD/YYYY
70 Provider Type Select Faith-based Provider if the vocational/occupational skills training is provided by a faith-based organization.

Select Community-based Provider if the vocational/occupational skills training is provided by a community-based organization.

Select Public Provider if the vocational/occupational skills training is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

71 Expected Completion Date of Vocational/ Occupational Skills Training Services Enter the date on which the participant is expected to complete vocational/occupational skills training.

MM/DD/YYYY A. Must be blank or greater than or equal to field 61 (Date Entered Vocational/ Occupational Skills Training Services).
72 Date of Last Vocational/ Occupational Skills Training Services During the Month Enter the last date during the month in which the participant received vocational/occupational skills training services.

Note: This field must repeat for every month in which the participant receives vocational/occupational skills training services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 61 (Date Entered Vocational/ Occupational Skills Training Services).
73 Date Ended Vocational/ Occupational Skills Training Services Enter the date on which the participant exited vocational/occupational skills training.

MM/DD/YYYY A. Must be blank or greater than or equal to field 61 (Date Entered Vocational/ Occupational Skills Training Services).

B. Must not be blank if field 65 (Completed Vocational/ Occupational Skills Training Services) is 1.
74 Completed Vocational/ Occupational Skills Training Services Select Yes if the participant successfully completed vocational/occupational skills training.

Select No if the participant did not successfully complete vocational/ occupational skills training.

1 = Yes
2 = No
A. Must not be blank if field 64 (Date Ended Vocational/ Occupational Skills Training Services) is a valid date.
75 Expected Duration of Vocational/ Occupational Skills Training Select the duration of the vocational/occupational skills training program that the participant has entered 1 = 5 or fewer hours per week
2 = 6 to 15 hours per week
3 = 16 to 25 hours per week
4 = 25 or more hours per week
A. Must not be blank if field 61 (Date Entered Vocational/ Occupational Skills Training Services) is a valid date.
76 Expected Cost of Vocational/ Occupational Skills Training Enter the expected cost of the vocational/occupational skills training program that the participant has entered. 0000.00 A. Must not be blank if field 61 (Date Entered Vocational/ Occupational Skills Training Services) is a valid date.
77 Date Entered On the Job Training (OJT) Enter the date on which the participant started on-the-job training (OJT).

OJT is training provided by an employer that pays the participant while the participant is engaged in productive work. The job provides knowledge or skills essential to the full and adequate performance of the job, provides reimbursement to the employer of up to 50% of the wage rate of the participant, and is limited in duration to a period appropriate to the occupation for which the participant is being trained.
MM/DD/YYYY
78 Provider Type Select Faith-based Provider if the on-the-job training (OJT) is provided by a faith-based organization.

Select Community-based Provider if the on-the-job training (OJT) is provided by a community-based organization.

Select Public Provider if the on-the-job training (OJT) is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

79 Expected Completion Date of On the Job Training (OJT) Enter the date on which the participant is expected to complete on-the-job training (OJT).

MM/DD/YYYY A. Must be blank or greater than or equal to field 68 (Date Entered On the Job Training).
80 Date of Last On the Job Training (OJT) Services During the Month Enter the last date during the month in which the participant received on the job training (OJT) services.

Note: This field must repeat for every month in which the participant receives on the job training (OJT) services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 68 (Date Entered On the Job Training).
81 Date Ended On the Job Training (OJT) Enter the date on which the participant exited on-the-job training (OJT).

MM/DD/YYYY A. Must be blank or greater than or equal to field 68 (Date Entered On the Job Training).

B. Must not be blank if field 72 (Completed On the Job Training ) is 1.
82 Completed On the Job Training (OJT) Select Yes if the participant successfully completed OJT.

Select No if the participant did not successfully complete OJT.

1 =Yes
2 = No
A. Must not be blank if field 71 (Date Ended On the Job Training) is a valid date.
83 Date Entered Other Education Or Job Training Activities Enter the date on which the participant started other education or job training activities .
MM/DD/YYYY
84 Provider Type Select Faith-based Provider if the other education or job training activities is provided by a faith-based organization.

Select Community-based Provider if the other education or job training activities is provided by a community-based organization.

Select Public Provider if the other education or job training activities is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

85 Type of Other Education or Job Training Activities Specify the type of other education or job training activities .

Text A. Must not be blank if field 73 (Date Entered Other Education Or Job Training Activities) is a valid date.
86 Expected Completion Date of Other Education Or Job Training Activities Enter the date on which the participant is expected to complete other education or job training activities .

MM/DD/YYYY A. Must be blank or greater than or equal to field 73 (Date Entered Other Education Or Job Training Activities).
87 Date of Last Other Education or Job Training Activities Services During the Month Enter the last date during the month in which the participant received other education or job training -activities services.

Note: This field must repeat for every month in which the participant receives other education or job training -activities services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 73 (Date Entered Other Education Or Job Training Activities).
88 Date Ended Other Education Or Job Training Activities Enter the date on which the participant exits other education or job training activities .

MM/DD/YYYY A. Must be blank or greater than or equal to field 73 (Date Entered Other Education or Job Training Activities).

B. Must not be blank if field 78 (Completed Other Education Or Job Training Activities) is 1.
89 Completed Other Education Or Job Training Activities Select Yes if the participant successfully completed other education or job training activities

Select No if the participant did not successfully complete other education or job training activities .

1 = Yes
2 = No
A. Must not be blank if field 77 (Date Ended Other Education Or Job Training Activities) is a valid date.
Workforce Preparation Activities
90 Date Entered Subsidized Employment Enter the date on which the participant started subsidized employment.

MM/DD/YYYY
91 Provider Type Select Faith-based Provider if the subsidiized employment is provided by a faith-based organization.

Select Community-based Provider if the subsidiized employment is provided by a community-based organization.

Select Public Provider if the subsidiized employment is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

92 Expected Completion Date of Subsidized Employment Enter the date on which the participant is expected to complete subsidized employment.

MM/DD/YYYY A. Must be blank or greater than or equal to field 79 (Date Entered Subsidized Employment).
93 Date of Last Subsidized Employment Services During the Month Enter the last date during the month in which the participant received subsidized employment services.

Note: This field must repeat for every month in which the participant receives subsidized employment services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 79 (Date Entered Subsidized Employment).
94 Date Ended Subsidized Employment Enter the date on which the participant exited subsidized employment.

MM/DD/YYYY A. Must be blank or greater than or equal to field 79 (Date Entered Subsidized Employment).

B. Must not be blank if field 83 (Completed Subsidized Employment) is 1.
95 Completed Subsidized Employment Select Yes if the participant successfully completed OJT.

Select No if the participant did not successfully complete OJT.

1 = Yes
2 = No
A. Must not be blank if field 82 (Date Ended Subsidized Employment) is a valid date.
96 Date Entered Internship Enter the date on which the participant started internship.

Internship consists of onsite work experience designed to improve an enrollee’s occupational skills and readiness for the world of work.
MM/DD/YYYY
97 Provider Type Select Faith-based Provider if the internship is provided by a faith-based organization.

Select Community-based Provider if the internship is provided by a community-based organization.

Select Public Provider if the internship is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

98 Expected Completion Date of Internship Enter the date on which the participant is expected to complete internship.

MM/DD/YYYY A. Must be blank or greater than or equal to field 84 (Date Entered Internship).
99 Date of Last Internship During the Month Enter the last date during the month in which the participant participated in an internship..

Note: This field must repeat for every month in which the participant is in the internship.
MM/DD/YYYY A. Must be blank or greater than or equal to field 84 (Date Entered Internship).
100 Date Ended Internship Enter the date on which the participant exits internship.

MM/DD/YYYY A. Must be blank or greater than or equal to field 84 (Date Entered Internship).

B. Must not be blank if field 88 (Completed Internship) is 1.
101 Completed Internship Select Yes if the participant successfully completed internship

Select No if the participant did not successfully complete internship.

1 = Yes
2 = No
A. Must not be blank if field 87 (Date Ended Internship) is a valid date.
102 Date Entered Workforce Information Services Enter the date on which the participant started workforce information services.

Workforce information services include, but is not limited to, providing information on state and local labor market conditions; industries, occupations and characteristics of the workforce; area business identified skills needs; employer wage and benefit trends; short- and long-term industry and occupational projections; worker supply and demand; and job vacancies survey results. Workforce information also includes local employment dynamics information such as workforce availability; business turnover rates; job creation; job destruction; new hire rates, worker residency, commuting pattern information; and the identification of high growth and high demand industries.
MM/DD/YYYY
103 Provider Type Select Faith-based Provider if the workforce information services is provided by a faith-based organization.

Select Community-based Provider if the workforce information services is provided by a community-based organization.

Select Public Provider if the workforce information services is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

104 Expected Completion Date of Workforce Information Services Enter the date on which the participant is expected to complete workforce information services.

MM/DD/YYYY A. Must be blank or greater than or equal to field 89 (Date Entered Workforce Information Services).
105 Date of Last Workforce Information Services During the Month Enter the last date during the month in which the participant received workforce information services .

Note: This field must repeat for every month in which the participant receives workforce information services .
MM/DD/YYYY A. Must be blank or greater than or equal to field 89 (Date Entered Workforce Information Services).
106 Date Ended Workforce Information Services Enter the date on which the participant exits workforce information services.

MM/DD/YYYY A. Must be blank or greater than or equal to field 89 (Date Entered Workforce Information Services).

B. Must not be blank if field 93 (Completed Workforce Information Services) is 1.
107 Completed Workforce Information Services Select Yes if the participant successfully completed workforce information services

Select No if the participant did not successfully complete workforce information services.

1 = Yes
2 = No
A. Must not be blank if field 92 (Date Ended Workforce Information Services) is a valid date.
108 Date Entered Work Readiness Training Enter the date on which the participant started work readiness training.

Work readiness training includes world of work awareness, labor market knowledge, occupational information, values clarification and personal understanding, career planning and decision-making, and job search techniques (resumes, interviews, applications, and follow-up letters). It also includes positive work habits, attitudes, and behavior such as punctuality, regular attendance, presenting a neat appearance, getting along and working well with others, exhibiting good conduct, following instructions and completing tasks, accepting constructive criticism from supervisors and co-workers, showing initiative and reliability, and assuming the responsibilities involved in maintaining a job.
MM/DD/YYYY
109 Provider Type Select Faith-based Provider if the work readiness training is provided by a faith-based organization.

Select Community-based Provider if the work readiness training is provided by a community-based organization.

Select Public Provider if the work readiness training is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

110 Expected Completion Date of Work Readiness Training Enter the date on which the participant is expected to complete work readiness training.

MM/DD/YYYY A. Must be blank or greater than or equal to field 94 (Date Entered Work Readiness Training).
111 Date of Last Work Readiness Training Services During the Month Enter the last date during the month in which the participant received work readiness training services.

Note: This field must repeat for every month in which the participant receives work readiness training services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 94 (Date Entered Work Readiness Training).
112 Date Ended Work Readiness Training Enter the date on which the participant exits work readiness training.

MM/DD/YYYY A. Must be blank or greater than or equal to field 94 (Date Entered Work Readiness Training.)

B. Must not be blank if field 98 (Completed Work Readiness Training) is 1.
113 Completed Work Readiness Training Select Yes if the participant successfully completed work readiness training

Select No if the participant did not successfully complete work readiness training.

1 = Yes
2 = No
A. Must not be blank if field 97 (Date Ended Work Readiness Training) is a valid date.
114 Date Entered Career/Life Skills Counseling Enter the date on which the participant started career/life skills counseling.

Career/Life skills counseling is any formal counseling provided on a specific life skill or related to career guidance.
MM/DD/YYYY
115 Provider Type Select Faith-based Provider if the career/life skills counseling is provided by a faith-based organization.

Select Community-based Provider if thecareer/life skills counseling is provided by a community-based organization.

Select Public Provider if the career/life skills counseling is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

116 Expected Completion Date of Career/Life Skills Counseling Enter the date on which the participant is expected to complete career/life skills counseling.

MM/DD/YYYY A. Must be blank or greater than or equal to field 99 (Date Entered Career/Life Skills Counseling).
117 Date of Last Career/Life Skills Counseling Services During the Month Enter the last date during the month in which the participant received career/life skills counseling services.

Note: This field must repeat for every month in which the participant receives career/life skills counseling services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 99 (Date Entered Career/Life Skills Counseling).
118 Date Ended Career/Life Skills Counseling Enter the date on which the participant exits career/life skills counseling.

MM/DD/YYYY A. Must be blank or greater than or equal to field 99 (Date Entered Career/Life Skills Counseling).

B. Must not be blank if field 103 (Completed Career/Life Skills Counseling) is 1.
119 Completed Career/Life Skills Counseling Select Yes if the participant successfully completed career/life skills counseling

Select No if the participant did not successfully complete career/life skills counseling.

1 = Yes
2 = No
A. Must not be blank if field 102 (Date Ended Career/Life Skills Counseling) is a valid date.
120 Date Entered Other Workforce Preparation Activities Enter the date on which the participant started other workforce preparation activities.

MM/DD/YYYY
121 Provider Type Select Faith-based Provider if the other workforce preparation activities is provided by a faith-based organization.

Select Community-based Provider if the other workforce preparation activities is provided by a community-based organization.

Select Public Provider if the other workforce preparation activities is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

122 Type of Other Workforce Preparation Activities Specify the type of other workforce preparation activities.

Text A. Must not be blank if field 104 (Date Entered Other Workforce Preparation Activities) is a valid date.
123 Expected Completion Date of Other Workforce Preparation Activities Enter the date on which the participant is expected to complete other workforce preparation activities.

MM/DD/YYYY A. Must be blank or greater than or equal to field 104 (Date Entered Other Workforce Preparation Activities).
124 Date of Last Other Workforce Preparation Activities Services During the Month Enter the last date during the month in which the participant received other workforce preparation activities services.

Note: This field must repeat for every month in which the participant receives other workforce preparation activities services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 104 (Date Entered Other Workforce Preparation Activities).
125 Date Ended Other Workforce Preparation Activities Enter the date on which the participant exits other workforce preparation activities.

MM/DD/YYYY A. Must be blank or greater than or equal to field 104 (Date Entered Other Workforce Preparation Activities).

B. Must not be blank if field 109 (Completed Other Workforce Preparation Activities) is 1.
126 Completed Other Workforce Preparation Activities Select Yes if the participant successfully completed other workforce preparation activities

Select No if the participant did not successfully complete other workforce preparation activities.

1 = Yes
2 = No
A. Must not be blank if field 108 (Date Ended Other Workforce Preparation Activities) is a valid date.
Community Involvement Activities
127 Date Entered Community Service Enter the date on which the participant started community service.

Community service is an activity in which the participants perform volunteer work that benefits the community
MM/DD/YYYY
128 Provider Type Select Faith-based Provider if the community service is provided by a faith-based organization.

Select Community-based Provider if the community service is provided by a community-based organization.

Select Public Provider if the community service is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

129 Expected Completion Date of Community Service Enter the date on which the participant is expected to complete community service.

MM/DD/YYYY A. Must be blank or greater than or equal to field 110 (Date Entered Community Service).
130 Date of Last Community Service Services During the Month Enter the last date during the month in which the participant received community service services.

Note: This field must repeat for every month in which the participant receives community service services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 110 (Date Entered Community Service).
131 Date Ended Community Service Enter the date on which the participant exits community service.

MM/DD/YYYY A. Must be blank or greater than or equal to field 110 (Date Entered Community Service).

B. Must not be blank if field 114 (Completed Community Service) is 1.
132 Completed Community Service Select Yes if the participant successfully completed community service

Select No if the participant did not successfully complete community service.

1 = Yes
2 = No
A. Must not be blank if field 113 (Date Ended Community Service) is a valid date.
133 Date Entered Other Community Involvement Activities Enter the date on which the participant started other community involvement activities.

MM/DD/YYYY
134 Provider Type Select Faith-based Provider if the other community involvement activities is provided by a faith-based organization.

Select Community-based Provider if the other community involvement activities is provided by a community-based organization.

Select Public Provider if the other community involvement activities is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

135 Type of Other Community Involvement Activities Specify the type of other other community involvement activities.

Text A. Must not be blank if field 115 (Date Entered Other Community Involvement Activities) is a valid date.
136 Expected Completion Date of Other Community Involvement Activities Enter the date on which the participant is expected to complete other community involvement activities.

MM/DD/YYYY A. Must be blank or greater than or equal to field 115 (Date Entered Other Community Involvement Activities).
137 Date of Last Other Community Service Services During the Month Enter the last date during the month in which the participant receive other community involvement activities

Note: This field must repeat for every month in which the participant receives other community involvement activities.
MM/DD/YYYY A. Must be blank or greater than or equal to field 115 (Date Entered Other Community Involvement Activities).
138 Date Ended Other Community Involvement Activities Enter the date on which the participant exits other community involvement activities.

MM/DD/YYYY A. Must be blank or greater than or equal to field 115 (Date Entered Other Community Involvement Activities).
B. Must not be blank if field 120 (Completed Other Community Involvement Activities) is 1.
139 Completed Other Community Involvement Activities Select Yes if the participant successfully completed other community involvement activities.

Select No if the participant did not successfully complete other community involvement activities.

1 = Yes
2 = No
A. Must not be blank if field 119 (Date Ended Other Community Involvement Activities) is a valid date.
Mentoring Activities
140 Date Entered Mentoring Activities Enter the date on which the participant started mentoring activities.

Mentoring is a sustained relationship between a mentor and participant, whether one on one or in a group setting. Through continued involvement, a mentor offers support and guidance in the individual’s development to become a responsible member of the community. A variety of approaches may be used such as coaching, training, discussion, and counseling.
MM/DD/YYYY
141 Provider Type Select Faith-based Provider if the mentoring activities are provided by a faith-based organization.

Select Community-based Provider if the mentoring activities are provided by a community-based organization.

Select Public Provider if the mentoring activities are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

142 Expected Completion Date of Mentoring Activities Enter the date on which the participant is expected to complete mentoring activities.

MM/DD/YYYY A. Must be blank or greater than or equal to field 121 (Date Entered Mentoring Activities).
143 Date of Last Mentoring Activities Services During the Month Enter the last date during the month in which the participant received mentoring activities services.

Note: This field must repeat for every month in which the participant receives mentoring activities services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 121 (Date Entered Mentoring Activities).
144 Date Ended Mentoring Activities Enter the date on which the participant exits mentoring activities.

MM/DD/YYYY A. Must be blank or greater than or equal to field 121 (Date Entered Mentoring Activities).

B. Must not be blank if field 125 (Completed Mentoring Activities) is 1.
145 Completed Mentoring Activities Select Yes if the participant successfully completed mentoring activities

Select No if the participant did not successfully complete mentoring activities.

1 = Yes
2 = No
A. Must not be blank if field 124 (Date Ended Mentoring Activities) is a valid date.
Health Services
146 Date Entered Substance Abuse Treatment Enter the date on which the participant started substance abuse treatment.
MM/DD/YYYY
147 Provider Type Select Faith-based Provider if the substance abuse treatment is provided by a faith-based organization.

Select Community-based Provider if the substance abuse treatment is provided by a community-based organization.

Select Public Provider if the substance abuse treatment is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

148 Expected Completion Date of Substance Abuse Treatment Enter the date on which the participant is expected to complete substance abuse treatment.

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Substance Abuse Treatment.
149 Date of Last Substance Abuse Treatment During the Month Enter the last date during the month in which the participant received substance abuse treatment.

Note: This field must repeat for every month in which the participant receives substance abuse treatment.
MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Substance Abuse Treatment.
150 Date Ended Substance Abuse Treatment Enter the date on which the participant exited substance abuse treatment

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Substance Abuse Treatment.

B. Must not be blank if Completed Substance Abuse Treatment.is 1.
151 Completed Substance Abuse Treatment Select Yes if the participant successfully completed substance abuse treatment.

Select No if the participant did not successfully complete substance abuse treatment.

1 =Yes
2 = No
A. Must not be blank if Date Ended Substance Abuse Treatment is a valid date.
152 Date Entered Mental Health Treatment Enter the date on which the participant started mental health treatment.
MM/DD/YYYY
153 Provider Type Select Faith-based Provider if the mental health treatement is provided by a faith-based organization.

Select Community-based Provider if the mental health treatement is provided by a community-based organization.

Select Public Provider if the mental health treatement is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

154 Expected Completion Date of Mental Health Treatment Enter the date on which the participant is expected to complete mental health treatment.

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Mental Health Treatment.
155 Date of Last Mental Health Treatment During the Month Enter the last date during the month in which the participant received mental health treatment.

Note: This field must repeat for every month in which the participant receives mental health treatment.
MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Mental Health Treatment.
156 Date Ended Mental Health Treatment Enter the date on which the participant exited mental health treatment

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Mental Health Treatment.

B. Must not be blank if Completed Mental Health Treatment.is 1.
157 Completed Mental Health Treatment Select Yes if the participant successfully completed mental health treatment.

Select No if the participant did not successfully complete mental health treatment.

1 =Yes
2 = No
A. Must not be blank if Date Ended Mental Health Treatment is a valid date.
158 Date Entered Emergency Medical Care Enter the date on which the participant started emeregency medical care.
MM/DD/YYYY
159 Provider Type Select Faith-based Provider if the emergency medical care is provided by a faith-based organization.

Select Community-based Provider if the emergency medical care is provided by a community-based organization.

Select Public Provider if the emergency medical care is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

160 Expected Completion Date of Emergency Medical Care Enter the date on which the participant is expected to complete emeregency medical care.

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Emergency Medical Care.
161 Date of Last Emergency Medical Care During the Month Enter the last date during the month in which the participant received emeregency medical care.

Note: This field must repeat for every month in which the participant receives emeregency medical care.
MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Emergency Medical Care.
162 Date Ended Emergency Medical Care Enter the date on which the participant exited emeregency medical care

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Emergency Medical Care.

B. Must not be blank if Completed Emergency Medical Care.is 1.
162 Completed Emergency Medical Care Select Yes if the participant successfully completed emeregency medical care.

Select No if the participant did not successfully complete emeregency medical care.

1 =Yes
2 = No
A. Must not be blank if Date Ended Emergency Medical Care is a valid date.
164 Date Entered Non-Emergency Medical Care Enter the date on which the participant started non-emergency medical care.
MM/DD/YYYY
165 Provider Type Select Faith-based Provider if the non-emergency medical care is provided by a faith-based organization.

Select Community-based Provider if the non-emergency medical care is provided by a community-based organization.

Select Public Provider if the non-emergency medical care is provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

166 Expected Completion Date of Non-Emergency Medical Care Enter the date on which the participant is expected to complete non-emergency medical care.

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Non-Emergency Medical Care.
167 Date of Last Non-Emergency Medical Care During the Month Enter the last date during the month in which the participant received non-emergency medical care.

Note: This field must repeat for every month in which the participant receives non-emergency medical care.
MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Non-Emergency Medical Care.
168 Date Ended Non-Emergency Medical Care Enter the date on which the participant exited non-emergency medical care

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Non-Emergency Medical Care.

B. Must not be blank if Completed Non-Emergency Medical Care.is 1.
169 Completed Non-Emergency Medical Care Select Yes if the participant successfully completed non-emergency medical care.

Select No if the participant did not successfully complete non-emergency medical care.

1 =Yes
2 = No
A. Must not be blank if Date Ended Non-Emergency Medical Care is a valid date.
170 Date Entered Other Health Services Enter the date on which the participant started other health services.
MM/DD/YYYY
171 Provider Type Select Faith-based Provider if the other health services are provided by a faith-based organization.

Select Community-based Provider if the other health services are provided by a community-based organization.

Select Public Provider if the other health services are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

172 Expected Completion Date of Other Health Services Enter the date on which the participant is expected to complete other health services.

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Other Health Services.
173 Date of Last Other Health Services During the Month Enter the last date during the month in which the participant received other health services.

Note: This field must repeat for every month in which the participant receives other health services.
MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Other Health Services.
174 Date Ended Other Health Services Enter the date on which the participant exited other health services

MM/DD/YYYY A. Must be blank or greater than or equal to Date Entered Other Health Services.

B. Must not be blank if Completed Other Health Services.is 1.
175 Completed Other Health Services Select Yes if the participant successfully completed other health services.

Select No if the participant did not successfully complete other health services.

1 =Yes
2 = No
A. Must not be blank if Date Ended Other Health Services is a valid date.
Supportive Services
176 Date Entered Transportation Services Enter the date on which the participant started transportation services. Transportation services include assistance or cash paid to participants for the purpose of transportation. MM/DD/YYYY
177 Provider Type Select Faith-based Provider if the transportation services are provided by a faith-based organization.

Select Community-based Provider if the transportation services are provided by a community-based organization.

Select Public Provider if the transportation services are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

178 Date of Last Transportation Services During the Month Enter the last date during the month in which the participant received transportation services .

Note: This field must repeat for every month in which the participant receives transportation services .
MM/DD/YYYY A. Must be blank or greater than or equal to field 126 (Date Entered Transportation Services).
179 Date Ended Transportation Services Enter the date on which the participant exits transportation services.

MM/DD/YYYY A. Must be blank or greater than or equal to field 126 (Date Entered Transportation Services).
180 Date Entered Child Care Services Enter the date on which the participant started child care services. Child care services provide participants during program participation with child care that can be inside or outside the home, as well as after-school programs. It usually includes supervision and shelter. MM/DD/YYYY
181 Provider Type Select Faith-based Provider if the child care services are provided by a faith-based organization.

Select Community-based Provider if the child care services are provided by a community-based organization.

Select Public Provider if the child care services are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

182 Date of Last Child Care Services During the Month Enter the last date during the month in which the participant received child care services .

Note: This field must repeat for every month in which the participant receives child care services .
MM/DD/YYYY A. Must be blank or greater than or equal to field 129 (Date Entered Child Care Services).
183 Date Ended Child Care Services Enter the date on which the participant exits child care services.

MM/DD/YYYY A. Must be blank or greater than or equal to field 129 (Date Entered Child Care Services).
184 Date Entered Needs Related Payments Enter the date on which the participant started needs related payments.

Needs-related payments provide financial assistance to participants for the purpose of enabling individuals to participate in training
MM/DD/YYYY
185 Provider Type Select Faith-based Provider if the needs-related payments are provided by a faith-based organization.

Select Community-based Provider if the needs-related payments are provided by a community-based organization.

Select Public Provider if the needs-related payments are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

186 Date of Last Needs Related Payments During the Month Enter the last date during the month in which the participant received needs related payments services.

Note: This field must repeat for every month in which the participant receives needs related payments services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 132 (Date Entered Needs Related Payments).
187 Date Ended Needs Related Payments Enter the date on which the participant exits needs related payments.
MM/DD/YYYY A. Must be blank or greater than or equal to field 132 (Date Entered Needs Related Payments).
188 Date Entered Follow-up Mentoring Services Enter the date on which the participant started follow-up mentoring services.

Follow-up mentoring services are on-going mentoring that occurs after exit.
MM/DD/YYYY
189 Provider Type Select Faith-based Provider if the mentoring services are provided by a faith-based organization.

Select Community-based Provider if the mentoring services are provided by a community-based organization.

Select Public Provider if the mentoring services are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

190 Last Date of Follow-up Mentoring Services During Month Enter the last date during the month in which the participant received follow-up mentoring services.

Note: This field must repeat for every month in which the participant receives follow-up mentoring services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 135 (Date Entered Follow-up Mentoring Services).
191 Date Ended Follow-up Mentoring Services Enter the last date on which the participant received follow-up mentoring services. MM/DD/YYYY A. Must be blank or greater than or equal to field 135 (Date Entered Follow-up Mentoring Services).
192 Date Entered Other Follow-up Services Enter the date on which the participant started other follow-up services.

Other follow-up services are on-going mentoring that occurs after exit.
MM/DD/YYYY
193 Provider Type Select Faith-based Provider if the other follow-up services are provided by a faith-based organization.

Select Community-based Provider if the other follow-up services are provided by a community-based organization.

Select Public Provider if the other follow-up services are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

194 Last Date of Other Follow-up Services During Month Enter the last date during the month in which the participant received other follow-up services.

Note: This field must repeat for every month in which the participant receives other follow-up services.
MM/DD/YYYY A. Must be blank or greater than or equal to field 138 (Date Entered Other Follow-up Services).
195 Date Ended Other Follow-up Services Enter the last date on which the participant received other follow-up services. MM/DD/YYYY A. Must be blank or greater than or equal to field 138 (Date Entered Other Follow-up Services).
196 Date Entered Other Supportive Services Enter the date on which the participant started other supportive services. Other supportive services includes all supportive services not listed above. MM/DD/YYYY
197 Provider Type Select Faith-based Provider if the other supportive services are provided by a faith-based organization.

Select Community-based Provider if the other supportive services are provided by a community-based organization.

Select Public Provider if the other supportive services are provided by a public organization.
1 = Faith-based Provider
2 = Community-based Provider
3 = Public Provider

198 Date of Last Other Supportive Services During the Month Enter the last date during the month in which the participant received other supportive services .

Note: This field must repeat for every month in which the participant receives other supportive services .
MM/DD/YYYY A. Must be blank or greater than or equal to field 141 (Date Entered Other Supportive Services).
199 Date Ended Other Supportive Services Enter the date on which the participant exits other supportive services. MM/DD/YYYY A. Must be blank or greater than or equal to field 141 (Date Entered Other Supportive Services).
SECTION III - PROGRAM OUTCOMES INFORMATION
SECTION III.A - FOLLOW-UP
SECTION III.B - SHORT-TERM OUTCOME STATUS
200 Alcohol Abuse/ Drug Use at 6 Months Based on asking the participant at 6 month date after enrollment:

Select has not abused alcohol or used drugs in the last month if the individual has not abused legal drugs or alcohol or used illegal drugs within the sixth month after enrollment

Select occasional alcohol abuse or drug use in the last month if the individual occasionally abuses legal drugs or alcohol or occasionally uses illegal drugs within the sixth month after enrollment

Select regular (weekly) alcohol abuse or drug use in the last month if, on a weekly basis, the individual abuses legal drugs or alcohol or uses illegal drugs within the sixth month after enrollment.
1 = Has not abused alcohol or used drugs within the last month
2 = Occasional alcohol abuste or drug use within the last month
3 = Regular (weekly) alcohol abuse or drug use within the last montht
A. Must be 1 or 2 if field 28 (Alcohol Abuse/ Drug Use at Enrollment) is 1, 2, or 3 and the report period is after the end of the second quarter after the exit quarter.

201 Housing Status at 6 Months Select Own/Rent Apartment, Room, Or House if, 6 months after enrollment, the individual is living in an apartment, room, or house that the he/she owns or rents.

Select Staying at someone's apartment, room, or house (Stable) if, 6 months after enrollment, the individual is living in an apartment, room, or house that somebody else owns or rents and if the person is not at risk of being displaced from this housing, i.e the housing situation is long-term.

Select Halfway house/transitional house if, 6 months after enrollment, the individual is living in a residence designed to assist persons as they re-enter society and learn to adapt to independent living after having been in prison.

Select Residential treatment if, 6 months after enrollment, the individual lives in a residential treatment center. A residential treatment center is a group home that provides room and board, and provides specialized treatment or rehabilitation persons with emotional, psychological, or developmental problems as well aschemical dependencies.

Select Homeless if, 6 months after enrollment, the individual lacks a fixed, regular, adequate night time residence. This definition includes any
individual who has a primary night time residence that is a publicly or privately operated shelter for temporary accommodation; an institution
providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or ordinarily used as a
regular sleeping accommodation for human beings. This definition does not include an individual imprisoned or detained under an Act of Congress
or State law. An individual who may be sleeping in a temporary accommodation while away from home should not, as a result of that alone, be
recorded as homeless.

Select Staying at someone's apartment, room, or house
(Unstable) if, 6 months after enrollment, the individual is living in an
apartment, room, or house that somebody else owns or rents and if
the person is at risk of being displaced from this housing, i.e the
housing situation is short-term.
1 = Own/rent apartment, room, or house
2 = Staying at someone's apartment, room, or house (Stable)
3 = Halfway house/ transitional house
4 = Residential Treatment
5 = Homeless
6 = Staying at someone's apartment, room, or house (Unstable)

202 Date of Initial Placement Into Unsubsidized Employment Enter the date on which the participant started the initial unsubsidized employment MM/DD/YYYY
203 Employer Name for Initial Placement Into Unsubsidized Employment Enter the employer's name for the participant's initial placement into unsubsidized employment. Text A. Must not be blank if field 148 (Date of Initial Placement Into Unsubsidized Employment) has a valid date.
204 Employer Contact for Initial Placement Into Unsubsidized Employment Enter the contact information for the employer for the participant's placement into unsubsidized employment. Text
205 Last Date of Employment for Initial Placement into Unsubsidized Employment Enter the last date on which the participant worked for the employer. MM/DD/YYYY A. Must be blank or greater than or equal to field 148 (Date of Initial Placement Into Unsubsidized Employment).
206 Hourly Wage at Placement for Initial Placement into Unsubsidized Employment Enter the hourly wage for the initial unsubsidized unemployment at placement. 00.00 A. Must be greater than 0 if field 148 (Date of Initial Placement Into Unsubsiized Employment) has a valid date.
207 Number of Hours Worked During the 1st Full Week in Initial Placement into Unsubsidized Employment. Enter the number of hours worked during the first full week for the initial job placement. 00 A. Must be greater than 0 if field 148 (Date of Initial Placement Into Unsubsiized Employment) has a valid date.
208 Date of Placement Into Unsubsidized Employment #1 Enter the date on which the participant started the unsubsidized employment. MM/DD/YYYY A. Must be blank or greater than or equal to field 148 (Date of Initial Placement Into Unsubsidized Employment).
209 Employer Name for Placement Into Unsubsidized Employment #1 Enter the employer's name for the participant's placement into unsubsidized employment. Text A. Must not be blank if field 154 (Date of Placement Into Unsubsidized Employment #1) has a valid date.
210 Employer Contact for Placement Into Unsubsidized Employment #1 Enter the contact information for the employer for the participant's placement into unsubsidized employment. Text
211 Last Date of Employment for Placement into Unsubsidized Employment #1 Enter the last date on which the participant worked for the employer. MM/DD/YYYY A. Must be blank or greater than or equal to field 154 (Date of Placement Into Unsubsidized Employment #1).
212 Hourly Wage at Placement for Placement into Unsubsidized Employment #1 Enter the hourly wage for the unsubsidized unemployment at placement. 00.00 A. Must be greater than 0 if field 154 (Date of Placement Into Unsubsiized Employment #1) has a valid date.
213 Number of Hours Worked During the 1st Full Week in Placement into Unsubsidized Employment #1 Enter the number of hours worked during the first full week for the placement into unsubsidized employment.. 00 A. Must be greater than 0 if field 154 (Date of Placement Into Unsubsiized Employment #1) has a valid date.
214 Repeat Fields 154 to 159 for Additional Jobs Grantees must be able to collect the above job information for as many jobs as the participant has.
Same Edits as for fields 154 to 159.
215 Case Dismissed after Successfully Completing Diversion Program Record 1 if case was dismissed after successfully completing diversion program. Record 2 if case was not dismissed after successfully completing diversion program. 1 = Yes
0 = No

216 Re-Arrested/ Re-Incarcerated Select the appropriate choice from below:

Re-arrested for a new crimeif the participant is arrested for a new crime.

Re-incarcerated for a revocation of the parole or probation order for violations of terms of sentence.

Otherwise violated the terms and condition of their sentence if the participant violates his/her parole or probation and is not re-incarcerated. (Note: This option does not count towards the recidivism rate.)

Select No if none of the above conditions apply.

This field repeats as needed.
1 = Re-arrested for a new crime
2 = Re- incarcerated for a revocation of the parole or probation order for violations of terms of sentence
3 = Otherwise violated the terms and condition of their sentence
4 = No

217 Date Re-Arrested/ Re-Incarcerated Enter the date on which the participant was re-arrested for a new crime or re-incarcerated for a violation of parole or probation.

This field repeats as needed for repeated.
MM/DD/YYYY A. Must not be blank if field 161 (Re-Arrested/Re-Incarcerated) is 1 or 2.
218 Convicted for Crime Committed after Enrollment Select Yes if the participant was convicted of the crime for which they were arrested after enrollment.
Select No if the participant was not convicted of the crime for which they were arrested after enrollment.
1 = Yes
2 = No


219 Convicted for Violent Felony after Enrollment Select Yes if the participant was convicted of a violent felony committed after enrollment.
Select No if the participant was not convicted of a violent felony commited after enrollment.
1 = Yes
2 = No


220 Date Re-arrested and Released Enter the date on which the participant was released from custody if the arrest charges were not upheld and the participant was not convicted of the crime for which they were arrested MM/DD/YYYY
221 Date Entered Registered Apprenticeship Enter the date on which the participant entered a Registered Apprenticeship Program.

Leave blank if the participant did not enter a Registered Apprenticeship Program.
MM/DD/YYYY
Blank = did not enter Registered Apprenticeship Program

222 Date Entered Post-Secondary Education Enter the date on which the participant enrolled in post-secondary education during program participation..

Leave blank if the participant does not enter post-secondary education during program participation.
MM/DD/YYYY
Blank = did not enter post-secondary education

SECTION III.C - POST-PROGRAM EMPLOYMENT AND JOB RETENTION DATA
223 Employed in 1st Quarter After Exit Quarter Select Yes if the participant was employed in the first quarter after the quarter of exit.
Select No if the participant was not employed in the first quarter after the quarter of exit.
1 = Yes
2 = No

A. Must be blank if field 48 (Date of Exit) and field new (Date Entered Follow-up Services) is blank.

B. Must be 1 or 2 if field 167 (Successful Follow-up for 1st Quarter After the Exit Quarter Employment and Wage Information) is 1.
224 Type of Employment Match 1st Quarter After Exit Quarter Use the appropriate code to identify the method used in determining the individual's employment status in the first quarter following the quarter of exit. If the individual is found in more than once source of employment, record the data source for which the individual's earnings are greatest.

1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.
A. If field 164 (Employed in 1st Quarter after Exit Quarter) is 1, this field will be auto-generated as 5 because of lack of wage records.

B. If field 164 (Employed in 1st Quarter after Exit Quarter) is 2 or blank, this field will be auto-generated as blank.
225 Date of Follow-up for 1st Quarter After the Exit Quarter Employment and Wage Information Enter the date on which the grantee attempted to contact the participant or employer to obtain information on employment and earnings for the 1st quarter after the exit quarter post-program.

Repeat for each follow-up attempt.
MM/DD/YYYY

A. Must not be blank if field 164 (Employed in 1st Quarter After Exit Quarter) is 1.

B. Must not be blank if field 167 (Successful Follow-up for 1st Quarter After the Exit Quarter Employment and Wage Information) is 1 or 2.
226 Successful Follow-up for 1st Quarter After the Exit Quarter Employment and Wage Information Enter Yes if the grantee successfully contacted the participant to collect employment and earnings information for the 1st quarter after the exit quarter.

Enter No if the grantee did not successfully contact the participant to collect this information.

Repeat for each follow-up attempt.
1 = Yes
2 = No
A. Must not be blank if field 166 (Date of Follow-up for 1st Quarter After the Exit Quarter Employment and Wage Information) is a valid date.
227 Employed in 2nd Quarter After Exit Quarter Select Yes if the participant was employed in the second quarter after the quarter if exit.
Select No if the participant was not employed in the second quarter after the quarter of exit.
1 = Yes
2 = No
A. Must be blank if field 48 (Date of Exit) and field new (Date Entered Follow-up Services) is blank.

B. Must be 1 or 2 if field 167 (Successful Follow-up for 1st Quarter After the Exit Quarter Employment and Wage Information) is 1.
228 Type of Employment Match 2nd Quarter After Exit Quarter Use the appropriate code to identify the method used in determining the individual's employment status in the second quarter following the quarter of exit. If the individual is found in more than once source of employment, record the data source for which the individual's earnings are greatest.

1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.
A. If field 168 (Employed in 2nd Quarter after Exit Quarter) is 1, this field will be auto-generated as 5 because of lack of wage records.

B. If field 168 (Employed in 2nd Quarter after Exit Quarter) is 2 or blank, this field will be auto-generated as blank.
229 Hours Worked First Full Week for the 2nd Quarter After the Exit Quarter. Enter the number of hours worked in the first full week of employment during the 2nd quarter after the exit quarter. 00 A. Must be >0 if field 168 (Employed in 2nd Quarter After Exit Quarter) is 1.
230 Hourly Wages First Full Week of Work for the 2nd Quarter After the Exit Quarter Enter the hourly wage for the job listed in the above element for in the first full week of employment during the 2nd quarter after the exit quarter. 00.00 A. Must be >0 if field 168 (Employed in 2nd Quarter After Exit Quarter) is 1.
231 Date of Follow-up for 2nd Quarter After the Exit Quarter Employment and Wage Information Enter the date on which the grantee attempted to contact the participant to obtain information on employment and earnings for the 2nd quarter after the exit quarter post-program.

Repeat for each follow-up attempt.
MM/DD/YYYY

A. Must not be blank if field 168 (Employed in 2nd Quarter After Exit Quarter) is 1.

B. Must not be blank if field 173 (Successful Follow-up for 2nd Quarter After the Exit Quarter Employment and Wage Information) is 1.
232 Successful Follow-up for 2nd Quarter After the Exit Quarter Employment and Wage Information Enter yes if the grantee successfully contacted the participant to collect employment and earnings information for the 2nd quarter after the exit quarter.

Enter no if the grantee did not successfully contact the participant to collect this information.

Repeat for each follow-up attempt.
1 = Yes
2 = No
A. Must not be blank if field 172 (Date of Follow-up for 2nd Quarter After the Exit Quarter Employment and Wage Information) is a valid date.
233 Employed in 3rd Quarter After Exit Quarter Select Yes if the participant was employed in the third quarter after the quarter of exit.
Select No if the participant was not employed in the third quarter after the quarter of exit.
1 = Yes
2 = No
A. Must be blank if field 48 (Date of Exit) and field new (Date Entered Follow-up Services) is blank.

B. Must be 1 if field 176 (Hours Worked First Full Week for the 3rd Quarter After the Exit Quarter) is > 0.
234 Type of Employment Match 3rd Quarter After Exit Quarter Use the appropriate code to identify the method used in determining the individual's employment status in the third quarter following the quarter of exit. If the individual is found in more than once source of employment, record the data source for which the individual's earnings are greatest.

1 = UI Wage Records (In-State & WRIS)
2 = Federal Employment Records (OPM, USPS)
3 = Military Employment Records (DOD)
4 = Other Administrative Wage Records
5 = Supplemental through case management, participant survey, and/or verification with the employer
Blank = Not Employed.
A. If field 174 (Employed in 3rd Quarter after Exit Quarter) is 1, this field will be auto-generated as 5 because of lack of wage records.

B. If field 174 (Employed in 3ed Quarter after Exit Quarter) is 2 or blank, this field will be auto-generated as blank.
235 Hours Worked First Full Week for the 3rd Quarter After the Exit Quarter. Enter the number of hours worked in the first full week of employment during the 3rd quarter after the exit quarter. 00 A. Must be >0 if field 174 (Employed in 3rd Quarter After Exit Quarter) is 1.
236 Hourly Wages First Full Week of Work for the 3rd quarter after the exit quarter Enter the hourly wage for the job listed in the above element for in the first full week of employment during the 3rd quarter after the exit quarter. 00.00 A. Must be >0 if field 174 (Employed in 3rd Quarter After Exit Quarter) is 1.
237 Date of Follow-up for 3rd Quarter After the Exit Quarter Employment and Wage Information Enter the date on which the grantee attempted to contact the participant to obtain information on employment and earnings for the 3rd quarter after the exit quarter post-program.

Repeat for each follow-up attempt.
MM/DD/YYYY

A. Must not be blank if field 174 (Employed in 3rd Quarter After Exit Quarter) is 1.

B. Must not be blank if field 179 (Successful Follow-up for 3rd Quarter After the Exit Quarter Employment and Wage Information) is 1.
238 Successful Follow-up for 3rd Quarter After the Exit Quarter Employment and Wage Information Enter Yes if the grantee successfully contacted the participant to collect employment and earnings information for the 3rd quarter after the exit quarter.

Enter No if the grantee did not successfully contact the participant to collect this information.

Repeat for each follow-up attempt.
1 = Yes
2 = No
A. Must not be blank if field 178 (Date of Follow-up for 3rd Quarter After the Exit Quarter Employment and Wage Information) is a valid date.
SECTION II.D - POST-PROGRAM WAGE DATA
These fields are to be used for wage record data only.

239 Wages 1st Quarter After Exit Quarter Record total earnings from wage records for the first quarter after the quarter of exit.
Enter 999999.99 if data is not yet available.
000000.00 A. This field will not be included in the system until grantees obtain access to wage records.
240 Wages 2nd Quarter After Exit Quarter Record total earnings from wage records for the second quarter after the quarter of exit.
Enter 999999.99 if data is not yet available.
000000.00 A. This field will not be included in the system until grantees obtain access to wage records.
241 Wages 3rd Quarter After Exit Quarter Record total earnings from wage records for the third quarter after the quarter of exit.
Enter 999999.99 if data is not yet available.
000000.00 A. This field will not be included in the system until grantees obtain access to wage records.


242 Attained Diploma, GED, or Certificate #1 Select individual attained a secondary school diploma individual attained a secondary school (high school) diploma recognized by the State.
Select individual attained a GED or high school equivalency diploma if the individual attained a GED or high school equivalency diploma recognized by the State.
Select individual attained a certificate in recognition of attainment of technical or occupational skills if the individual attained a certificate in recognition of attainment of technical or occupational skills.
Select individual did not attain a diploma, GED, or certificate if the individual did not attain a diploma, GED, or certificate.
Select individual attained an AA or AS if individual attained an associate's degree.
Select individual attained a BA or BS if individual attained an bachelor's degree.
1 = Individual attained a secondary school (high school) diploma.
2 = Individual attained a GED or high school equivalency diploma.
3 = Individual attained a certificate in recognition of an individual's attainment of technical or occupational skills.
4 = Individual did not attain a diploma, GED, or certificate
5 = Individual attained an AA or AS
6 = Individual attained an BA or BS
A. Must not be 1 or 2 if field 18 (Highest School Grade Completed) is 16, 17, 87, 88, or 90.
243 Date Attained Degree or Certificate #1 Record the date on which the individual attained a diploma, GED, or certificate.

Leave "blank" if the individual did not attain a diploma, GED, or certificate.
MM/DD/YYYY
Blank = did not attain diploma, GED, or certificate
A. Must be greater than field 47 (Date of Participation) if field 183 (Attained Diploma, GED, or Certificate #1) is 1, 2, 3, 5, or 6.

B. Must be blank if field 183 (Attained Diploma, GED, or Certificate #1) is blank or 4.
244 Specify the Name of Certificate #1 Specify the name of the first certificate achieved.

Leave blank if no certificate was achieved.
Text
Blank = no certificate achieved
A. Must not be blank if field 183 (Attained Diploma, GED, or Certificate #1) is 3.
245 Attained Diploma, GED, or Certificate #2 Select individual attained a secondary school diploma individual attained a secondary school (high school) diploma recognized by the State.
Select individual attained a GED or high school equivalency diploma if the individual attained a GED or high school equivalency diploma recognized by the State.
Select individual attained a certificate in recognition of attainment of technical or occupational skills if the individual attained a certificate in recognition of attainment of technical or occupational skills.
Select individual did not attain a diploma, GED, or certificate if the individual did not attain a diploma, GED, or certificate.
Select individual attained an AA or AS if individual attained an associate's degree.
Select individual attained a BA or BS if individual attained an bachelor's degree.
1 = Individual attained a secondary school (high school) diploma.
2 = Individual attained a GED or high school equivalency diploma.
3 = Individual attained a certificate in recognition of an individual's attainment of technical or occupational skills.
4 = Individual did not attain a diploma, GED, or certificate
5 = Individual attained an AA or AS
6 = Individual attained an BA or BS
A. Must not be 1 or 2 if field 18 (Highest School Grade Completed) is 16, 17, 87, 88, or 90.
246 Date Attained Degree or Certificate #2 Record the date on which the individual attained a diploma, GED, or certificate.

Leave "blank" if the individual did not attain a diploma, GED, or certificate.
MM/DD/YYYY
Blank = did not attain diploma, GED, or certificate
A. Must be greater than field 47 (Date of Participation) if field 186 (Attained Diploma, GED, or Certificate #2) is 1, 2, 3, 5, or 6.

B. Must be blank if field 186 (Attained Diploma, GED, or Certificate #2) is blank or 4.
247 Specify the Name of Certificate #2 Specify the name of the second certificate achieved.

Leave blank if no certificate was achieved.
Text
Blank = no certificate achieved
A. Must not be blank if field 186 (Attained Diploma, GED, or Certificate #2) is 1, 2, or 3.
File Typeapplication/vnd.ms-office
AuthorPeacock
Last Modified ByLah, David - ETA
File Modified2018-08-07
File Created2004-01-02

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