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ICR 201909-1205-004 · OMB 1205-0439 · Object 94663901.

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application/msword
U
provost.jeanette
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2019-09-09
2026-09-13
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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).