Conducted by: OMB No. 1810-0749 Expires XX/XX/XXXX
U.S. Department of Education
Education Stabilization Fund- Elementary and Secondary School Emergency Relief Fund
(ESSER I/ESSER II/ARP ESSER) Recipient Data Collection Form
Final Version: TBD
State Educational Agency: _____<auto fill from G5>_____________
ESSER I PR/Award number: _____<auto fill from G5>_____________
ESSER II PR/Award number: _____<auto fill from G5>_____________
ARP ESSER 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>__________
These definitions are provided for the purposes of this reporting activity.
ARP (ARP ESSER) - American Rescue Plan
Awarded- An SEA awards funds when it makes a subgrant to an LEA or, in the case of the SEA Reserve, when it enters into a subgrant or contract with a subrecipient.
CARES (ESSER I) - Coronavirus Aid, Relief, and Economic Security Act
CRRSA (ESSER II) - Coronavirus Response and Relief Supplemental Appropriations
ESSER I- (CARES) Elementary and Secondary School Emergency Relief fund authorized under Section 18003 of Division B
of the Coronavirus Aid Relief, and Economic Security (CARES) Act
ESSER II- (CRRSA) Elementary and Secondary School Emergency Relief fund authorized under Section 313 of the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act
Evidence-based- The ARP Act defines the term “evidence-based” as having the meaning in section 8101(21) of the ESEA. Accordingly, “evidence-based” includes several tiers of evidence. Specifically, “evidence-based,” when used with respect to an SEA, LEA, or school activity, means an activity, strategy, or intervention that:
• Demonstrates a statistically significant effect on improving student outcomes or other relevant outcomes based on—
-Strong evidence from at least one well-designed and well-implemented experimental
study (“tier 1”);
-Moderate evidence from at least one well-designed and well-implemented quasi experimental study (“tier 2”); or
-Promising evidence from at least one well-designed and well-implemented correlational
study with statistical controls for selection bias (“tier 3”); or
• Demonstrates a rationale based on high-quality research findings or positive evaluation that such activity, strategy, or intervention is likely to improve student outcomes or other relevant outcomes and includes ongoing efforts to examine the effects of such activity, strategy, or intervention (“tier 4”).
Given the novel context created by the COVID-19 pandemic, an activity need not have generated such evidence during the COVID-19 pandemic to be considered evidence-based.
Expended- The actual spending of money; an outlay. For purposes of this reporting, reimbursements that are made in the current reporting period that reimburse expenditures made prior to the start of the reporting period and on or after March 13, 2020, are considered “expenditures” for this reporting period.
Full-Service Community School- The term ‘‘full-service community school’’ means a public elementary school or secondary school that—participates in a community-based effort to coordinate and integrate educational, developmental, family, health, and other comprehensive services through community-based organizations and public and private partnerships; and provides access to such services in school to students, families, and the community, such as access during the school year (including before- and after-school hours and weekends), as well as during the summer.
G5- U.S. Department of Education’s grant management and payment system
LEA- Local Educational Agency
Planned Uses of Funds- Remaining funds that have been earmarked or budgeted for specific purposes are considered “Planned Uses” of Remaining Funds. The Department acknowledges these plans may change; please provide the State’s most current information regarding budgeted or earmarked uses of remaining funds.
Qualified Educator - For the purposes of this document “qualified” means an educator has met all requirements to earn a state license or certification in the area they are assigned to teach (and does not include substitute or provisional license or certification).
Remaining Funds- The balance remaining after all expenditures through the end of the reporting period have been subtracted from the total award.
SEA- State Educational Agency
SEA Reserve funds- An SEA may retain 10 percent or less of its ESSER I and II grants (the “SEA Reserve”), to address emergency needs as determined by the SEA resulting from COVID-19, which may be addressed through the use of subgrants or contracts, and up to ½ of 1 percent of its total ESSER I and II award for administrative costs, which must come from the SEA reserve. An SEA must reserve at least 7 percent of its ARP ESSER award for mandatory set-asides for evidence-based interventions, as described below, and up to 3 percent for emergency needs as determined by the SEA (the “SEA Reserve”). An SEA may also reserve up to ½ of 1 percent of its total ARP ESSER award for administrative costs, which must come from the 3 percent for emergency needs.
Supporting Physical Health and Safety
Building and facilities upgrades and maintenance, including ventilation systems and new construction
Assistance with meals for students
Cleaning and/or sanitization supplies
Temporary classroom space to support social distancing
Temporary transportation services to support social distancing to and from school
Capacity-building to improve disaster preparedness and response efforts, including coordination with State, local, Tribal, and territorial public health departments and other relevant agencies to improve coordinated responses to prevent, prepare for, and respond to the coronavirus.
Other health protocols not described above and aligned to guidance from the Centers for Disease Control and Prevention (CDC) such as: vaccines for staff and/or students, COVID-19 testing for staff and/or students, contact-tracing, masks
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs
Extended learning and/or summer learning
High-dosage intensive tutoring
Additional staffing and/or activities to assess and support social-emotional well-being, including mental health, for students, educators and/or families
Additional staffing and/or activities to identify and/or respond to unique student needs and/or provide targeted support for vulnerable students (including low-income children or students, students with disabilities, English learners, racial and ethnic minorities, students experiencing homelessness, and children and youth in foster care)
Universal screening, academic assessments, and intervention data systems, such as early warning systems and/or opportunity to learn data systems.
Improved coordination of services for students with multiple types of needs, such as full-service community schools or improved coordination with partner agencies, such as foster care services
Early Childhood Programs
Hardware and software
Wi-Fi, broadband or other connectivity
Curriculum adoption and learning materials
Core staff capacity building / training to increase instructional quality and advance equity
Investments in talent pipelines for teachers and/or classified staff
Operational Continuity and Other Allowed Uses
Any activity not described above that is authorized by the McKinney-Vento Homeless Assistance Act
Any activity not described above that is authorized by the Elementary and Secondary Education Act of 1965.
Any activity not described above that is authorized by the Individuals with Disabilities Education Act.
Any activity not described above that is authorized by the Adult Education and Family Literacy Act.
Any activity not described above that is authorized by the Carl D. Perkins Career and Technical Education Act of 2006.
Other activities not described above that are necessary to maintain the operation of and continuity of services in local educational agencies and continuing to employ existing staff of the local educational agency
Annual Reporting: This report should be completed based on activities in the applicable reporting periods for ESSER I, ESSER II and ARP ESSER, respectively. Due dates will be determined close to the date of publication of the final template in the Federal Register.
ESSER I under the Coronavirus Aid, Relief, and Economic Security (CARES) Act
Annual Report |
Due Date |
Applicable Reporting Period |
Second Annual Report |
Early 2022 |
October 1, 2020- September 30, 2021 |
Third Annual Report |
Early 2023 |
October 1, 2021- September 30, 2022 |
Fourth Annual Report |
Early 2024 |
October 1, 2022- September 30, 2023 |
ESSER II under the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act
Annual Report |
Due Date |
Applicable Reporting Period |
First Annual Report |
Early 2022 |
October 1, 2020 - September 30, 2021 |
Second Annual Report |
Early 2023 |
October 1, 2021- September 30, 2022 |
Third Annual Report |
Early 2024 |
October 1, 2022- September 30, 2023 |
Fourth Annual Report |
Early 2025 |
October 1, 2023– September 30, 2024 |
ARP ESSER under the American Rescue Plan (ARP) Act
Annual Report |
Due Date |
Applicable Reporting Period |
First Annual Report |
Early 2022 |
October 1, 2020- September 30, 2021 |
Second Annual Report |
Early 2023 |
October 1, 2021- September 30, 2022 |
Third Annual Report |
Early 2024 |
October 1, 2022- September 30, 2023 |
Fourth Annual Report |
Early 2025 |
October 1, 2023– September 30, 2024 |
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ESSER I (CARES Act) |
ESSER II (CRRSAA) |
ARP ESSER |
a. The total grant amount allocated to the State Educational Agency (SEA)1 |
<auto fill from G5> |
<auto fill from G5> |
<autofill from G5> |
b. The total amount of the grant expended by the SEA and all State subrecipients in the prior reporting period. |
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c. The total amount of the grant expended by the SEA and all State subrecipients in this reporting period. |
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d. The total amount of remaining grant funds Subtract all expenditures (rows b and c) from the total grant amount (row a). |
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<auto fill from G5>-b2 |
<auto fill from G5>-b3 |
e. Amount of remaining funds planned for specific purpose (see definition of planned uses of remaining funds) |
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ESSER I (CARES Act) |
ESSER II (CRRSAA) |
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a. The total amount reserved by the SEA
(This value may not exceed 10% of the value reported in Section 1.1a for the associated fund) |
This value may not exceed 10% of the value reported in Section 1.1a for ESSER I
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This value may not exceed 10% of the value reported in Section 1.1a for ESSER II |
This value may not exceed 10%, and must not be less than 7%, of the value reported in Section 1.1a for ARP ESSER |
b. The total amount the SEA retained for implementation of evidence-based interventions aimed specifically at addressing lost instructional time (“learning loss”), such as summer learning, extended day, comprehensive afterschool programs, or extended year programs |
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This value must be at least 5% of the value reported in Section 1.1a for ARP ESSER |
c. The total amount retained for the allocation of evidence-based summer enrichment programs |
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This value must be at least 1% of the value reported in Section 1.1a for ARP ESSER and in addition to any amount reported in 1.2b for summer enrichment programs
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d. The total amount retained for the allocation of evidence-based comprehensive afterschool programs |
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This value must be at least 1% of the value reported in Section 1.a for ARP ESSER and in addition to any amount reported in 1.2b for comprehensive afterschool programs
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e. The total amount the SEA retained for administrative costs
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(This value may not exceed ½ of 1% of the value reported in Section 1.a for ESSER I)
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(This value may not exceed ½ of 1% of the value reported in Section 1.a for ESSER II)
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(This value may not exceed 1/2 of 1% of the value reported in Section 1.a for ARP ESSER) |
f. The total amount the SEA retained for emergency needs |
(This value may not exceed 10% of the value reported in Section 1.a for ESSER I)
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(This value may not exceed 10% of the value reported in Section 1.a for ESSER II)
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(This value may not exceed 3% of the value reported in Section 1.a for ARP ESSER)
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g. The total amount of SEA Reserve funds awarded to non-SEA entities (LEA and non-LEA entities), for example through grants and contracts, from the SEA Reserve |
<auto-sum from tables below> |
<auto-sum from tables below> |
<auto-sum from tables below> |
1.2b After submitting its ARP ESSER State Plan, did the SEA make any changes to how it will evaluate the effectiveness of the selected interventions will respond to students’ academic, social, emotional and mental health needs? (Y/N)
If yes, please describe.
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(3,000 character limit) |
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2.1 SEA Reserve Awards
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ESSER I (CARES Act) |
ESSER II (CRRSAA) |
ARP ESSER |
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Learning Loss Activities Set-Aside |
Summer Enrichment Set-Aside |
Afterschool Programs Set-Aside |
Other SEA Reserve |
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a. Did the SEA award SEA Reserve Funds to local educational agencies (LEAs)? |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
b. Did the SEA award SEA Reserve Funds to non-LEA entities? |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
Y/N |
2.2a SEA: Identifying Students for Support
How did the SEA identify, or require LEAs or other subgrantees to identify for the use of SEA Reserve awards, which students were most impacted by the COVID-19 pandemic? (Mark Y/N to each)
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2.2b How did the SEA allocate ARP ESSER funds to ensure support for students most impacted by the COVID-19 pandemic? (Please describe the formula or decision-making rubric to allocate funds)
(3,000 character limit) |
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Sub-Section 3: ESSER I SEA Reserve Funds
Name of LEA awarded ESSER I SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
NCES LEA ID: <Auto-fill from CCD>
Total amount awarded to the LEA from the ESSER I SEA Reserve: <Auto-fill from FFATA>
2.3a ESSER I SEA Reserve Awards to LEAs
Name of LEA awarded ESSER I SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Total amount awarded to the LEA from the ESSER I SEA Reserve |
Total amount expended by the LEA from the ESSER I SEA Reserve |
Uses of ESSER I SEA Reserve funds (Y/N) |
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Addressing Physical Health and Safety |
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
Operational Continuity and Other Uses |
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2.3b Planned Uses of Remaining ESSER I SEA Reserve Awards to LEAs
Name of LEA awarded ESSER I SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Remaining SEA Reserve Funds <Auto-fill from above> |
Planned Uses of Remaining ESSER I SEA Reserve funds (% of Remaining Funds) Note: Categories must sum to 100% of Remaining Funds
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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ESSER I SEA Reserve Funds to non-LEA entities
<skip logic, if “Did the SEA award ESSER I Reserve Funds to any entities other than LEAs = ‘Y’, then present autofills and table below:>
Name of non-LEA entity awarded ESSER I SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
NCES LEA ID: <Auto-fill from CCD>
Total amount awarded to the non-LEA from the ESSER I SEA Reserve: <Auto-fill from FFATA>
2.3d ESSER I SEA Reserve Awards to Non-LEAs
Name of non-LEA awarded ESSER I SEA Reserve funds |
DUNS # |
SAM # |
Total amount awarded to the non-LEA from the ESSER I SEA Reserve |
Total amount expended by the non-LEA from the ESSER I SEA Reserve |
Uses of ESSER I SEA Reserve funds (Y/N) |
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Addressing Physical Health and Safety |
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
Operational Continuity and Other Uses |
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2.3e Planned Uses of Remaining ESSER I SEA Reserve Awards to Non-LEAs
Name of non-LEA awarded ESSER I SEA Reserve funds |
DUNS # |
SAM # |
Remaining ESSER I SEA Reserve Funds <Auto-fill from above> |
Planned Uses of Remaining ESSER I SEA Reserve funds (% of Remaining Funds) Note: Categories must sum to 100% of Remaining Funds |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
Sub-Section 2.4: ESSER II SEA Reserve Funds
Name of LEA awarded ESSER II SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
NCES LEA ID: <Auto-fill from CCD>
Total amount awarded to the LEA from the ESSER II SEA Reserve: <Auto-fill from FFATA>
2.4a ESSER II SEA Reserve Awards to LEAs
Name of LEA awarded ESSER II SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Total amount awarded to the LEA from the ESSER II SEA Reserve |
Total amount expended by the LEA from the ESSER II SEA Reserve |
Uses of ESSER II SEA Reserve funds (Y/N) |
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Addressing Physical Health and Safety |
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
Operational Continuity and Other Uses |
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2.4b Planned Uses of Remaining ESSER II SEA Reserve Awards to LEAs
Name of LEA awarded ESSER II SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Remaining ESSER II SEA Reserve Funds <Auto-fill from above> |
Planned Uses of Remaining ESSER II SEA Reserve funds (% of Remaining Funds) Note: Categories must sum to 100% of Remaining Funds |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
ESSER II SEA Reserve Funds to non-LEA entities:
<skip logic, if “Did the SEA award ESSER II Reserve Funds to any entities other than LEAs = ‘Y’, then present autofills and table below:>
Name of non-LEA awarded ESSER II SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
NCES LEA ID: <Auto-fill from CCD>
Total amount awarded to the non-LEA from the ESSER II SEA Reserve: <Auto-fill from FFATA>
2.4c ESSER II SEA Reserve Awards to Non-LEAs
Name of non-LEA awarded ESSER II SEA Reserve funds |
DUNS # |
SAM # |
Total amount awarded to the non-LEA from the ESSER II SEA Reserve |
Total amount expended by the non-LEA from the ESSER II SEA Reserve |
Uses of ESSER II SEA Reserve funds (Y/N) |
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Addressing Physical Health and Safety |
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
Operational Continuity and Other Uses |
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2.4d Planned Uses of Remaining ESSER II SEA Reserve Awards to Non-LEAs
Name of non-LEA awarded ESSER II SEA Reserve funds |
DUNS # |
SAM # |
Remaining ESSER II SEA Reserve Funds <Auto-fill from above> |
Planned Uses of Remaining ESSER II SEA Reserve funds (% of Remaining Funds) Note: Categories must sum to 100% of Remaining Funds |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
Sub-Section 2.5: ARP ESSER SEA Reserve Funds
Name of LEA awarded ARP ESSER SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
NCES LEA ID: <Auto-fill from CCD>
Total amount awarded to the LEA from the ARP ESSER SEA Reserve: <auto-calculate from table 2.5a>
2.5a ARP ESSER SEA Reserve Awards to LEAs
Name of LEA awarded ARP ESSER SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Total Amount Awarded from ARP ESSER SEA Reserve Fund |
Total Amount Expended from ARP ESSER SEA Reserve Fund |
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<skip logic, if 1d>0 in table above, then present autofills and table below:>
Name of LEA awarded ARP ESSER SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
NCES LEA ID: <Auto-fill from CCD>
Total amount awarded to the LEA from the ARP ESSER SEA Reserve: <Auto-fill from FFATA>
2.5b ARP ESSER SEA Reserve Awards – Other Use
Name of LEA awarded ARP ESSER SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Total amount reserved by the LEA from the ARP ESSER SEA Reserve – “other”
<Auto-fill from 1d above> |
Total amount expended by the LEA from the ARP ESSER SEA Reserve – “other”
<Auto-fill from 2d above> |
Uses of ARP ESSER SEA Reserve funds (Y/N) |
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Addressing Physical Health and Safety |
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
Operational Continuity and Other Uses |
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2.5c Planned Uses of Remaining ARP ESSER SEA Reserve Awards – Other Use
Name of LEA awarded ARP ESSER SEA Reserve funds |
DUNS # |
SAM # |
NCES ID# |
Remaining ARP ESSER SEA Reserve Funds - Other <Auto-fill from above> |
Planned Uses of Remaining ARP ESSER SEA Reserve funds (% of Remaining Funds) (Note: Categories must sum to 100% of Remaining “Other SEA Reserve” Funds) |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
ARP ESSER SEA Reserve Funds to non-LEA entities:
<skip logic, if “Did the SEA award ARP ESSER Reserve Funds to any entities other than LEAs = ‘Y’, then present autofills and table below:>
Name of non-LEA entity awarded ARP ESSER SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
Total amount awarded to the non-LEA from the ARP ESSER SEA Reserve: <Auto-fill from FFATA>
2.5d ARP ESSER SEA Reserve Awards to non-LEAs
Name of non-LEA awarded ARP ESSER SEA Reserve funds |
DUNS # |
SAM # |
Total Amount Awarded from ARP ESSER SEA Reserve Fund |
Total Amount Expended from ARP ESSER SEA Reserve Fund |
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<skip logic, if 3d>0 in table above, then present autofills and table below:>
Name of non-LEA awarded ARP ESSER SEA Reserve Funds: <Auto-fill from FFATA>
DUNS #: <Auto-fill from FFATA>
SAM #:
Total amount awarded to the non-LEA from the ARP ESSER SEA Reserve: <Auto-fill from FFATA>
2.5e ARP ESSER SEA Reserve Awards – Other Use
Name of non-LEA awarded ARP ESSER SEA Reserve funds |
DUNS # |
SAM # |
Total amount reserved by the non-LEA from the ARP ESSER SEA Reserve – “other”
<Auto-fill from 3d above> |
Total amount expended by the non-LEA from the ARP ESSER SEA Reserve – “other”
<Auto-fill from 4d above> |
Uses of ARP ESSER SEA Reserve funds (Y/N) |
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Addressing Physical Health and Safety |
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
Operational Continuity and Other Uses |
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2.5f Planned Uses of Remaining ARP ESSER SEA Reserve Awards – Other Use
Name of non-LEA awarded ARP ESSER SEA Reserve funds |
DUNS # |
SAM # |
Remaining ARP ESSER SEA Reserve Funds - Other <Auto-fill from above> |
Planned Uses of Remaining ARP ESSER SEA Reserve funds (% of Remaining Funds) (Note: Categories must sum to 100% of Remaining “Other SEA Reserve” Funds) |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
2.5g. Please describe the specific initiatives and services provided by the SEA using the ARP ESSER SEA Reserve funds during the applicable reporting period:
(3,000 character limit) |
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2.5h Please describe the specific initiatives and services planned by the SEA using the remaining ARP ESSER SEA Reserve funds:
(3,000 character limit) |
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3.a Provide the amount of the mandatory subgrant awarded to each LEA from the ESSER I, ESSER II, and ARP ESSER awards, respectively:
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ESSER I (CARES) |
ESSER II (CRRSAA) |
ARP ESSER |
LEA Name |
DUNS# |
SAM # |
NCES ID# |
Total subgrant amount awarded to LEA |
Total subgrant amount awarded to LEA |
Total subgrant amount awarded to LEA |
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3.b1 Provide the amount of the LEA expenditures by ESSER Subgrant fund and activity. (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).)
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ESSER I (CARES Act) |
ESSER II (CRRSAA) |
ARP ESSER |
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LEA name |
DUNS# |
SAM # |
NCES ID# |
Activities
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Total Amount Expended by Activity |
Total Amount Expended by Activity |
Total Amount Expended by Activity |
Total Amount
Expended
toward 20% set-aside requirements for evidence-based activities
that support disproportionately impacted student groups |
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Supporting Physical Health and Safety |
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Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
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Operational Continuity and Other Allowed Uses |
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<Skip logic; if >0 for any fund in row p above, then:>
3.b2 ESSER Funds to Provide Internet Access
Did this LEA use ESSER mandatory subgrants to provide home Internet access for any students? (ESSER refers to ESSER I, ESSER II and ARP ESSER awards)
Did this 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 |
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3.b3 Planned Uses of Remaining ESSER I Funds
What are the LEA’s planned uses of remaining ESSER I mandatory subgrant funds? (Provide the percentage of remaining funds planned for the below expenditure categories.
All categories must sum to 100% of remaining ESSER I mandatory subgrant funds.)
Name of LEA awarded ESSER I Mandatory LEA Subgrant |
DUNS # |
SAM # |
NCES ID# |
Remaining ESSER I Funds <Auto-fill from above> |
Planned Uses of Remaining ESSER I Mandatory Subgrant Funds |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
3.b4 Planned Uses of Remaining ESSER II Funds
What are the LEA’s planned expenditures of remaining ESSER II mandatory subgrant funds? (Provide the percentage of remaining funds planned for the below expenditure categories.
All categories must sum to 100% of remaining ESSER I mandatory subgrant funds.)
Name of LEA awarded ESSER II Mandatory LEA Subgrant |
DUNS # |
SAM # |
NCES ID# |
Remaining ESSER II Funds <Auto-fill from above> |
Planned Uses of Remaining ESSER II Mandatory Subgrant Funds |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
3.b5 Planned Uses of Remaining ARP ESSER Funds
What are the LEA’s planned uses of remaining ARP ESSER mandatory subgrant funds? (Provide the percentage of remaining funds planned for the below expenditure categories.
All categories must sum to 100% of remaining ESSER I mandatory subgrant funds.)
Name of LEA awarded ARP ESSER Mandatory LEA Subgrant |
DUNS # |
SAM # |
NCES ID# |
Remaining ARP ESSER Funds <Auto-fill from above> |
Planned Uses of Remaining ARP ESSER Mandatory Subgrant Funds |
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% Remaining Funds Planned for
Addressing Physical Health and Safety
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% Remaining Funds Planned for
Meeting Students’ Academic, Social, Emotional, Mental Health, and Other Needs |
% Remaining Funds Planned for
Operational Continuity and Other Uses |
% Remaining Funds
Not Yet Planned for Specific Use |
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<auto-calculated> |
3.b6 Maintaining Safe In-Person Instruction
Did the LEA expend ESSER funds on any of the items below (note, ESSER refers to ESSER I, ESSER II, and ARP ESSER funds): (Mark Y/N for each)
Promoting vaccination
Consistent and correct mask use
Physical distancing
Screening testing to promptly identify cases, clusters, and outbreaks
Ventilation
Handwashing and respiratory etiquette
Staying home when sick and getting tested
Contact tracing, in combination with isolation and quarantine
Cleaning and disinfection
3.b7 Reengaging Students
Did the LEA seek to reengage students with poor attendance or participation? (Mark Y or N)
Y/N
<skip logic: if Y, then:>
3.b8 Reengaging Students Activities
How did the LEA seek to reengage students with poor attendance or participation? (Mark Y/N for each)
Direct outreach to families
Engaging the school district homeless liaison
Partnering with community-based organizations
Offering home internet service and/or devices
Implementing new curricular strategies to improve student engagement
Offering credit recovery and/or acceleration strategies
Other (please describe): _(1500 character limit)____________
3.b9 Total ESSER Support for Staff Salaries and Benefits
Provide the total expenditures of ESSER I, ESSER II and ARP ESSER on staff salaries and benefits from March 13, 2020 – close of this reporting period (September 30, 2021).
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ESSER I (CARES) |
ESSER II (CRRSAA) |
ARP ESSER |
LEA Name |
DUNS# |
SAM # |
NCES ID# |
Total amount of ESSER I funds expended on staff salaries and
benefits |
Total amount of ESSER II funds expended on staff salaries and benefits
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Total amount of ARP ESSER funds expended on staff salaries and benefits
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3.b10 LEA Hiring and Retention of Specific Positions with ESSER I, ESSER II, and/or ARP ESSER Funds
(Note: this question is optional for this annual performance report; this question will be required in Year 2 of annual performance reporting for ARP ESSER.)
LEA Name |
DUNS# |
SAM # |
NCES ID# |
Total Amount Expended for These Staff (cumulative across all ESSER funds) |
Indicate the total number of these specific positions supported with any of the ESSER funds for the following positions from March 13, 2020 through the close of the reporting period (September 30, 2021). This includes SY 2020-21 & SY 2021-22. Support indicates salaries and/or benefits were paid with ESSER funds. |
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___Special educators and related service personnel and paraprofessionals ___Bilingual or English as a second language educators ___School counselors, school psychologists and/or social workers ___Nurses ___Short term contractors ___Classroom educators, not covered by previous categories ___Support personnel, not covered by previous categories ___Administrative staff, not covered by previous categories |
3.c Provide the per pupil allocation of ESSER funds to high-poverty schools and non-high poverty schools. Please note that while there is no requirement that LEAs allocate ESSER funds to individual schools, the purpose of this question is for the public to understand how ESSER funds are supporting the needs of schools that serve higher shares of students from low-income backgrounds. For example, an LEA may have spent some ESSER funds at the LEA level on behalf of the entire district, and the remainder of ESSER funds supporting programs and services in individual schools. If the LEA did not allocate ESSER I/ESSER II/ARP ESSER funds to individual schools, please enter “$0” in rows b through e, pertaining to Title I participating schools and non-Title I eligible schools for that ESSER fund. To calculate the average per pupil expenditure information requested below, please use the official 2020 enrollment count as reported to EdFacts as of October 1, 2020.
LEA Name |
DUNS # |
SAM # |
NCES ID# |
Expenditure Categories |
ESSER I (CARES) |
ESSER II (CRSSAA) |
ARP ESSER |
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3.d Which activities or interventions did the LEA implement to satisfy the LEA’s mandatory 20% set-aside requirements of ARP ESSER funds, which respond to students’ academic, social, and emotional needs and address the disproportionate impact of COVID-19 on underserved student groups, including each major racial and ethnic group, children from low-income families, children with disabilities, English learners, migratory students, students experiencing homelessness, youth in foster care, and other groups disproportionately impacted by the pandemic that have been identified by the SEA (mark all that apply):
Evidence-based summer learning or summer enrichment
Evidence-based afterschool programs
Extended instructional time (school day, school week, or school year)
Evidence-based high dosage tutoring
Full-Service Community Schools
Mental health services and supports
Adoption or integration of social emotional learning into the curriculum/school day
Other (Please specify):_(1,500 character limit)______________
Other (Please specify): _(1,500 character limit)____________________________
Other (Please specify): _(1,500 character limit)____________________________
3.d1: Did the LEA expend more than 20% of its total allocation on the above activities? Y/N
3.d2 If yes, what percentage? ____%
3.d3 Please describe how the selected activities or interventions respond to students’ academic, social, and emotional needs.
(3,000 character limit) |
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3.d4 Please describe how the selected activities or interventions address the disproportionate impact of COVID-19 on each listed underserved student groups, including each major racial and ethnic group, children from low-income families, children with disabilities, English learners, migratory students, students experiencing homelessness, youth in foster care, and other groups disproportionately impacted by the pandemic that have been identified by the SEA.
(3,000 character limit) |
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3.e1 The
Department acknowledges a set of expenditures may support multiple,
complementary priorities. Please tell us what proportion of ESSER I,
ESSER II and ARP ESSER expenditures at this LEA supported the
following priorities. (Note: these
percentages do not need to add to 100% and will likely
exceed 100%.)
Priority |
Percentage of ESSER I Expenditures Supporting |
Percentage of ESSER II Expenditures Supporting |
Percentage of ARP ESSER Expenditures Supporting |
a. Extended instructional time to promote learning acceleration/learning loss recovery |
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3.e2 What percentage of expenditures at the LEA provided targeted supports to students disproportionately impacted by the COVID-19 pandemic? If the LEA did not target supports to schools or students/staff, please enter “100%” in row b.
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ESSER I |
ESSER II |
ARP ESSER |
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Total |
100% |
100% |
100% |
Section 4- Equitable Support for Learning Recovery and/or Acceleration
(SEA must provide responses for all ESSER I, ESSER II and ARP ESSER Subaward Recipients)
4.a1 Describe the methods used by the LEA to identify which students were most impacted by the COVID-19 pandemic and how that information was used to allocate funds to schools.
LEA |
DUNS# |
SAM # |
NCES ID# |
How did the LEA identify which students were most impacted by the COVID-19 pandemic? (Mark Y/N for each)
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How did the LEA allocate funds to students most impacted by the COVID-19 pandemic? (Please describe the formula or decision-making rubric to allocate funds across schools) |
<Populated from previous question responses> |
<Populated from previous responses> |
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<Populated from previous responses> |
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(3,000 character limit)
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4.b2 How did this LEA use ESSER (ESSER I, ESSER II or ARP ESSER) funds to support learning recovery or acceleration for subpopulations who were disproportionately impacted by the COVID-19 pandemic? (If this LEA provided an activity or support to all students and additional or supplemental services/activities targeted to subpopulations, please answer yes to the activity “for all students” and select the subpopulation for whom additional support/access was provided.)
(Note: this question is optional for this annual performance report; this question will be required in Year 2 of annual performance reporting for ARP ESSER.)
LEA |
DUNS# |
SAM # |
NCES ID# |
Methods/Intervention |
(If Yes, then) Capacity and Participation |
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<Populated from previous question responses> |
<Populated from previous responses> |
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<Populated from previous responses> |
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Is this program available to all students? Y/N Indicate the number of students this program serves at full capacity: __________ Total unique headcount of students
that participated in this activity: __________
Eligible refers to students within the subgroup who meet eligibility criteria for participation, such as to belonging to the appropriate grade for the activity.
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Student Profile
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# Enrolled eligible Students at LEA in subgroup |
# Eligible students in subgroup participating |
Not Applicable – this student population is not present at the LEA |
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Is this program available to all students? Y/N Indicate the number of students this program serves at full capacity: __________ Total unique headcount of students
that participated in this activity: __________
Eligible refers to students within the subgroup who meet eligibility criteria for participation, such as to belonging to the appropriate grade for the activity.
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Student Profile
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# Enrolled eligible Students at LEA in subgroup |
# Eligible students in subgroup participating |
Not Applicable – this student population is not present at the LEA |
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Is this program available to all students? Y/N Indicate the number of students this program serves at full capacity: __________ Total unique headcount of students
that participated in this activity: __________
Eligible refers to students within the subgroup who meet eligibility criteria for participation, such as to belonging to the appropriate grade for the activity.
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Student Profile
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# Enrolled eligible Students at LEA in subgroup |
# Eligible students in subgroup participating |
Not Applicable – this student population is not present at the LEA |
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Is this program available to all students? Y/N Indicate the number of students this program serves at full capacity: __________ Total unique headcount of students
that participated in this activity: __________
Eligible refers to students within the subgroup who meet eligibility criteria for participation, such as to belonging to the appropriate grade for the activity.
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Student Profile
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# Enrolled eligible Students at LEA in subgroup |
# Eligible students in subgroup participating |
Not Applicable – this student population is not present at the LEA |
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Is this program available to all students? Y/N Indicate the number of students this program serves at full capacity: __________ Total unique headcount of students
that participated in this activity: __________
Eligible refers to students within the subgroup who meet eligibility criteria for participation, such as to belonging to the appropriate grade for the activity.
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Student Profile
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# Enrolled eligible Students at LEA in subgroup |
# Eligible students in subgroup participating |
Not Applicable – this student population is not present at the LEA |
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How many full-service community schools are in operation in this LEA? _____ What is the total enrollment in full-service community schools within this LEA? ____
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Was educational technology purchased for all students? Y/N If no, indicate the number of
students for whom educational technology was purchased ________ Indicate the number of eligible students within each of the following subgroups, and the number of eligible students from that subgroup that received or were directly supported by the educational technology: (If the LEA serves no students in a group, please indicate by marking “N/A”).
Eligible refers to students within the subgroup who meet eligibility criteria for the educational technology, such as to belonging to the appropriate grade and/or having a specific need for the educational technology.
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Student Profile
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# Enrolled eligible Students at LEA in subgroup |
# Eligible students in subgroup participating |
Not Applicable – this student population is not present at the LEA |
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4.c1 Please provide the count of FTE staff assigned to serve each school in this LEA, regardless of funding source, as of October 1, 2020. For example, if one full-time nurse is shared equally by five schools within an LEA, allocate 0.2 FTE to each school served. These data will be merged with school membership data to calculate staff-to-student ratios for the 2020-21 school year.
(Note: this question is optional for this annual performance report; this question will be required in Year 2 of annual performance reporting for ARP ESSER.)
LEA NAME |
DUNS # |
SAM # |
NCES ID# |
School Name (within LEA) |
Count FTE by Staff Type (to the nearest tenth) |
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<Populated from previous question responses> |
<Populated from previous responses> |
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<Populated from previous responses> |
Pre-populated |
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[Note to reviewers: these questions will be appended to the LEA and non-LEA entities tables above in the online data collection tool.]
5.a 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# |
SAM # |
NCES ID# |
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 |
Full-time equivalent (FTE) positions on September 30, 2021 |
<Pre-populate LEA and non-LEA Entity from data provided in previous tables> |
<Pre-populate from data provided in previous tables> |
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<Populated from previous responses>
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<Pre-populate from data provided in prior year reporting if applicable> |
<Pre-populate from data provided in prior year reporting if applicable> |
<Pre-populate from data provided in prior year reporting if applicable> |
<Pre-populate from data provided in prior year reporting if applicable> |
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As a condition of receiving funds under ARP ESSER, each SEA and LEA that receives ARP ESSER funds must comply with the applicable maintenance of equity requirements. For more information on these requirements, please refer to ED guidance (link to Maintenance of Equity FAQ). Please provide the following information to meet the current FY 2022 annual reporting requirement. SEAs will be required to provide additional information in subsequent reporting years on how the State maintained equity. Data reported in this section will be used to inform the extent to which each State has maintained equity.
SEA Maintenance of Equity
The statewide per-pupil amount of State funds allocated or appropriated to all LEAs in the State in FY 2021: $________
The statewide per-pupil amount of State funds allocated or appropriated to all LEAs in the State in FY 2022: $________
Per-pupil reduction of overall State funds for FY 2022 (Note: If the per-pupil amount for FY 2022 is less than FY 2021, the difference is the amount by which the SEA has reduced its per-pupil amount of State funds to LEAs in FY 2022. If an SEA increases or maintains per-pupil funding to all LEAs in FY 2022, then for the purposes of determining whether the SEA has maintained fiscal equity for its high-need LEAs, the reduction is zero.): ______ (Auto-calculated)
Provide the per-pupil amount of State funding appropriated or allocated by fiscal year for each high-need LEA as identified by the SEA. SEAs are expected to provide the following data for the same high-need LEAs that it reported baseline and initial Maintenance of Equity data to Department in 2021. To the extent that the State has updated data or information, a State may update that information below.
Name of High-Need LEA |
DUNS # |
SAM # |
NCES ID |
Per-pupil amount of State funding FY 2021 |
Per-pupil amount of State funding FY 2022 |
High-need LEA per-pupil reduction in State funds |
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(Auto-calculated) |
Provide the per-pupil amount of State funding appropriated or allocated by fiscal year for each highest-poverty LEA as identified by the SEA. SEAs are expected to provide the following data for the same highest-poverty LEAs that it reported baseline and initial Maintenance of Equity data to the Department in 2021. To the extent that the State has updated data or information, a State may update that information below.
Name of Highest-Poverty LEA |
DUNS # |
SAM # |
NCES ID |
Per-pupil amount of State funding in FY 2019 |
Per-pupil amount of State funding FY 2022 |
Highest-poverty LEA per-pupil reduction in State funds |
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(Auto-calculated) |
Student Outcomes
The U.S. Department of Education will append the most recent and certified submission of LEA and SEA data (with disaggregation by subpopulation) from existing collections as detailed below:
Metric Category |
Specific Metric(s) |
Engagement and Participation |
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Student Learning and Progression |
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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 140 hours per SEA response and 140 hours per LEA 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.
1 Row a should reflect the total award under the respective Act (CARES, CRRSAA or ARP), inclusive of any changes to the total award that may have occurred within or outside of the current reporting period. For example, if an SEA received $1M in total ESSER I /CARES funds in the first reporting period, and no changes were made to the total allocation to the SEA through the end of the current reporting period, the SEA should report $1M in row a, ESSER I column. If the total allocation to the state was reduced by $200K, and regardless of whether that reduction occurred in reporting period 1 or period 2, the SEA should report $800K in row a, ESSER I column.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Alexandra |
| File Modified | 0000-00-00 |
| File Created | 2021-10-31 |