ETA 9103-2a Planning Form (Disaster-Temporary Jobs)

National Dislocated Workers Emergency Grant Application and Reporting Procedures

Planning Form ETA 9103-2a_FINAL 9.5.19

Workforce Innovation and Opportunity Act: National Emergency Grant (NEG) Assistance-Application and Reporting Procedures

OMB: 1205-0439

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

Employment and Training Administration Expiration Date: XX/XX/XXXX


Planning Form (Disaster-Temporary Jobs), ETA 9103-2a

National Dislocated Worker Grant Electronic Application System


All quarterly entries are CUMULATIVE over all previous quarters.


PERFORMANCE FACTOR

PROGRAM YEAR QUARTER

ADMIN

PROGRAM

QTR1

QTR2

QTR3

QTR4

QTR5

QTR6

QTR7

PLANNED PARTICIPANTS

Employed in Temporary Disaster Relief Assistance










Receiving Supportive Services










Completed NDWG Services










Employed at Completion of NDWG Services










Total Planned Participants










PLANNED GRANTEE EXPENDITURES









Administrative










Other










Total: Program Management and Oversight










Indirect*










Total Expenditures: Grantee Level










PLANNED PROJECT OPERATOR EXPENDITURES







Participant Wages










Participant Fringe Benefits










Career Services










Supportive Services










Other










Administrative










NRP Processing










Total: Program Management and Oversight










Total: Expenditures: Project Operator Level




















Total: Expenditures: Grantee and Project Operator Level











Public Burden Statement:

Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control number. Respondents’ obligation to complete this form is required to obtain or retain benefits (PL: 113-128 sec 170). Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This is public information and there is no expectation of confidentiality. Send comments regarding this burden estimate to the U.S. Department of Labor, Office of National Response, Room C-5311, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0439).

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