Education Stabilization Fund- Elementary and Secondary School Emergency Relief Fund (ESSER) Recipient Data Collection Form

Conducted by: OMB No. 1810-XXXX Expires XX/XX/XXXX

U.S. Department of Education

Education Stabilization Fund- Elementary and Secondary School Emergency Relief Fund

(ESSER Fund) Recipient Data Collection Form

Final Version: December 2020

ESSER Fund Reporting Form

State Educational Agency: _____<auto fill from G5>_____________

PR/Award number: _____<auto fill from G5>_____________

State Director: _<auto fill from G5>__________

Position: _<auto fill from G5>__________(editable)

Office: _<auto fill from G5>__________(editable)

Mailing Address: _<auto fill from G5>__________(editable)

Telephone: _<auto fill from G5>__________(editable)

Email address: _<auto fill from G5>__________

Instructions: States and outlying areas that received Elementary and Secondary School Emergency Relief (ESSER) or Education Stabilization Fund (ESF)-State Education Agencies (ESF-SEA) funds should fill out this form. References to ESSER include ESF-SEA. To fulfill the annual ESSER fund reporting requirements, answer all questions based on the reporting period shown in the Annual Reporting table below.

Annual Reporting: This report should be completed based on activities in the applicable reporting period.

Annual Report	Due Date	Applicable Reporting Period
First Annual Report	February 1, 2021	March 13, 2020 - September 30, 2020
Second Annual Report	February 1, 2022	October 1, 2020- September 30, 2021
Third Annual Report	February 1, 2023	October 1, 2021- September 30, 2022

Section 1- Overall ESSER Fund Grant for SEA

1. The total grant amount allocated to the State educational agency (SEA) is____<auto fill from G5>______

2. The total amount of the grant expended is____________<auto fill from G5>_________________

Section 2- SEA Reserve (up to 10% of total allocation)

1. The total amount reserved ______________(This value may not exceed 10% of the value reported in Section 1.a for ESSER; for ESF-SEA funds a “reasonable and necessary” amount). The SEA Reserve funds includes each of the following:________

   1. The total amount the SEA retained for administrative costs ____________(This value may not exceed ½ of 1% of total ESSER award in Section 1.a)

   2. The total amount of funds the SEA retained for state activities from the SEA Reserve, other than funds for administrative costs __________

   3. The total amount of funds awarded to non-SEA entities, for example through grants and contracts, from the SEA Reserve____________

2. If the SEA has awarded funds from the SEA Reserve, provide information on the entities awarded ESSER funds from the SEA Reserve in the tables below.

1. Did the SEA award SEA Reserve Funds to local educational agencies (LEAs)? Y/N. If ‘Y’, then complete the table below:

Name of LEA awarded SEA Reserve funds	DUNS #	Total amount awarded to the LEA from the SEA Reserve	Who is the LEA serving with these funds? (select one)	Amount expended by the LEA for Public Schools	Amount expended by the LEA for equitable services for Non-public School students and teachers	Total amount expended by the LEA from the SEA Reserve	Uses of SEA Reserve funds (Y/N)
<auto fill from State’s Federal Funding Accountability and Transparency Act (FFATA) reporting>	<auto fill from FFATA>	<auto fill from FFATA>	a) Students and teachers in both Title I and Non-Title I schools; or b) Only students and teachers in Title I Schools			<autofill from sum of previous two columns)	1. Purchasing educational technology (including hardware, software, and connectivity), which may include assistive technology or adaptive equipment. <Skip logic If yes, go to 2a(i); if no, continue.> 2. Activities focused specifically to addressing the unique needs of low-income children or students, children with disabilities, English learners, racial and ethnic minorities, students experiencing homelessness, and foster care youth 3. Providing mental health services and supports. 4. Sanitization and minimizing the spread of infectious diseases, including cleaning supplies and staff training to address sanitization and minimizing the spread of infectious diseases. 5. Summer learning and supplemental afterschool programs. 6. Other (uses of funds not included above). If yes, please describe:__________
…
LEA award not reported in FFATA because it did not meet the dollar threshold						<autofill from sum of previous two columns)
…

[NOTE to reviewers: in the online data collection instrument, questions 2a(i) and 2a(ii) below will be appended to question 2a above for each LEA matching the skip logic condition.]

<Skip logic: If the LEA used SEA Reserve funds for the first “use of funds” purpose, then ask>

1. Did this LEA use SEA Reserve funds to provide home Internet access for any students?

Did this LEA use SEA Reserve funds to provide home Internet access for any students? (Y/N)	If yes, what types of home Internet services were provided by the district using SEA Reserve funds? Internet Service type:	Yes/No
	Mobile hotspots with paid data plans
	Internet connected devices with paid data plans
	District pays for the cost of home Internet subscription for student
	District provides home Internet access through a district-managed wireless network
	Other; If yes, please specify:___________

2. Among students enrolled on September 30, 2020, what proportion of students by district had a dedicated LEA-provided device funded by SEA Reserve funds for the following grade bands? For the purposes of this survey, include desktop, laptop, and tablet computers (including Chromebooks and iPads). Do not include smartphone devices. “Elementary” is defined as “a school classified as elementary by state and local practice and composed of any span of grades not above grade 8” and “Secondary” is defined as “a school comprising any span of grades beginning with the next grade following an elementary or middle school (usually 7, 8, or 9) and ending with or below grade 12. Both junior high schools and senior high schools are included.”

Did this LEA use LEA Reserve funds to provide dedicated learning devices to any students? (Y/N)	Grade level	Students with dedicated device provided by the LEA (Numerator)	Students enrolled on September 30, 2020 (Denominator)	Proportion of students with an LEA-provided device
	Elementary			<autofill numerator/denominator>
	Secondary			<autofill numerator/denominator>

<Return to 2^nd category of uses of funds in Q2a.>

2. Did the SEA award SEA Reserve Funds to any entities other than LEAs? Y/N. If ‘Y’, then complete the table below:

Name of non-LEA entities awarded SEA Reserve funds	DUNS #	Total amount awarded to the entity from the SEA Reserve	Of total funds awarded, amount expended by the entity from the SEA Reserve	Uses of SEA Reserve Funds (Y/N)
<auto fill from FFATA>	<auto fill from FFATA>			1. Purchasing educational technology (including hardware, software, and connectivity), which may include assistive technology or adaptive equipment. <Skip logic: if yes, continue with question 2b(i); if no, continue> 2. Activities focused specifically to addressing the unique needs of low-income children or students, children with disabilities, English learners, racial and ethnic minorities, students experiencing homelessness, and foster care youth 3. Providing mental health services and supports. 4. Sanitization and minimizing the spread of infectious diseases, including cleaning supplies and staff training to address sanitization and minimizing the spread of infectious diseases. 5. Summer learning and supplemental afterschool programs. 6. Other (uses of funds not included above). If yes, please describe:__________
…
Non-LEA entity award not reported in FFATA because it did not meet the dollar threshold
…

[NOTE to reviewers: in the online data collection instrument, question 2b(i) below will be appended to question 2b above for each non-LEA entity matching the skip logic condition.]

<Skip logic: If the non-LEA entity used SEA Reserve funds for the first “use of funds” purpose, then ask>

1. Did this non-LEA entity use SEA Reserve funds to provide home Internet access for any students?

Did this non-LEA entity use SEA Reserve funds to provide home Internet access for any students? (Y/N)	If yes, what types of home Internet services were provided by the non-LEA entity using SEA Reserve funds? Internet Service type:	Yes/No
	Mobile hotspots with paid data plans
	Internet connected devices with paid data plans
	District pays for the cost of home Internet subscription for student
	District provides home Internet access through a district-managed wireless network
	Other; If yes, please specify:___________

<Return to 2^nd category of uses of funds in the Q2b>

Section 3- Mandatory Subgrants to LEAs, Section 18003(c) (at least 90% of the ESSER Fund grant)

3. Provide the amount of LEA expenditures of ESSER subgrant funds. (If the SEA operates as a unitary system then report for the entire SEA. The total amount reported for subgrant amounts to LEAs may not exceed total grant amount (Section 1) minus total amount reserved (Section 2, Question 1).)

LEA name	DUNS#	Total subgrant amount awarded to the LEA	Amount expended by the LEA on Public Schools	Amount expended by the LEA on equitable services for Non-public School students and teachers	Activities by Uses of Funds categories	Total Amount Expended by Activity (Please respond to the categories in the order they are presented. If funds were used for multiple activities, include them in the first category that applies.)
<auto fill from FFATA>	<auto fill from FFATA>	<auto fill from FFATA>			TOTAL	<Auto-Calculate: Sum Rows>
					Purchasing educational technology (including hardware, software, and connectivity), which may include assistive technology or adaptive equipment.	<Skip logic: If >0 ask question 3(i); If =0 continue.>
					Activities focused specifically to addressing the unique needs of low-income children or students, children with disabilities, English learners, racial and ethnic minorities, students experiencing homelessness, and foster care youth.
					Providing mental health services and supports.
					Sanitization and minimizing the spread of infectious diseases, including cleaning supplies and staff training to address sanitization and minimizing the spread of infectious diseases.
					Summer learning and supplemental afterschool programs.
					Other (uses of funds not included above). If yes, please describe:__________
…
LEA award not reported in FFATA because it did not meet the dollar threshold
…

[NOTE to reviewers: in the online data collection instrument, questions 3(i) and 3(ii) below will be appended to question in 3 above for each LEA matching the skip logic condition.]

<Skip logic: If total amount expended for “purchasing educational technology” >0, then ask>

1. Did this LEA use ESSER funds to provide home Internet access for any students?

Did the LEA use ESSER funds to provide home Internet access for any students? (Y/N)	If yes, what types of home Internet services were provided by the district using ESSER funds? Internet Service type:	Yes/No
	Mobile hotspots with paid data plans
	Internet connected devices with paid data plans
	District pays for the cost of home Internet subscription for student
	District provides home Internet access through a district-managed wireless network
	Other; If yes, please specify:___________

2. Among students enrolled on September 30, 2020, what proportion of students by district had a dedicated LEA-provided device funded by ESSER for the following grade bands? For the purposes of this survey, include desktop, laptop, and tablet computers (including Chromebooks and iPads). Do not include smartphone devices. “Elementary” is defined as “a school classified as elementary by state and local practice and composed of any span of grades not above grade 8” and “Secondary” is defined as “a school comprising any span of grades beginning with the next grade following an elementary or middle school (usually 7, 8, or 9) and ending with or below grade 12. Both junior high schools and senior high schools are included.”

Did the LEA use ESSER funds to provide dedicated learning devices to any students? (Y/N)	Grade level	Students with dedicated device provided by the LEA (Numerator)	Students enrolled on September 30, 2020 (Denominator)	Proportion of students with an LEA-provided device
	Elementary			<autofill numerator/denominator>
	Secondary			<autofill numerator/denominator>

<Return to 2^nd category of uses of funds in Q3>

Section 4- Student Participation and Engagement

4. If the LEA used ESSER Act funds to develop, initiate and/or implement remote learning, please mark all methods used to document student participation and engagement during remote learning: (mark yes for methods used for 50% or more of the students within the grade level in the LEA). “Elementary” is defined as “a school classified as elementary by state and local practice and composed of any span of grades not above grade 8” and “Secondary” is defined as “a school comprising any span of grades beginning with the next grade following an elementary or middle school (usually 7, 8, or 9) and ending with or below grade 12. Both junior high schools and senior high schools are included.”

LEA name	DUNS#	Grade level	Methods	Yes/No
<Populated from previous question responses>	<Populated from previous responses>	Elementary	Submission of assignments
			Participation in assessments
			Tracking student logins to online learning platforms
			Participation in individual coaching or check ins
			Participation in email, text or other electronic communication
			Participation in help lines or hot lines for help with remote learning.
			Participation in synchronous online classes
			Other
		Secondary	Submission of assignments
			Participation in assessments
			Tracking student logins to online learning platforms
			Participation in individual coaching or check ins
			Participation in email, text or other electronic communication
			Participation in help lines or hot lines for help with remote learning.
			Participation in synchronous online classes
			Other
…

Section 5- Full-Time Equivalent (FTE) Positions

[Note to reviewers: these questions will be appended to the LEA and non-LEA entities tables above in the online data collection tool.]

5. Provide the number of full-time equivalent (FTE) positions for the LEA, or non-LEA Entity as of the listed reporting dates. (The number of FTE positions includes all staff regardless of whether the position is funded by Federal, State, local, or other funds—and equals the sum of the number of full-time positions plus the full-time equivalent of the number of part-time positions.)

Name of LEA/non-LEA Entity	DUNS#	Full-time equivalent (FTE) positions as of September 30, 2018	Full-time equivalent (FTE) positions as of September 30, 2019	Full-time equivalent (FTE) positions as of March 13, 2020	Full-time equivalent (FTE) positions on September 30, 2020
<Pre-populate LEA and non-LEA Entity from data provided in previous tables>	<Pre-populate from data provided in previous tables>
…

Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1810-xxxx. Public reporting burden for this collection of information is estimated to average 5 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Under the PRA, participants are required to respond to this collection to obtain or retain a benefit. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this individual collection, or if you have comments or concerns regarding the status of your individual form, please contact Joanne Bogart, US. Department of Education, 400 Maryland Avenue, SW, Washington, DC 20202.

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