2021-22 Work Colleges Expenditure Report_CLEAN to OMB

OMB No: 1845-0152

Expires: 04/30/2024

2021–22 Work Colleges Program Expenditure Report

Award Year July 1, 2021 through June 30, 2022

Submission Deadline: The deadline for submitting the 2021–22 Work Colleges Program Expenditure Report is September 30, 2022. Electronic submission of the report must occur before 12:00 midnight (ET).

Signature: This form must include a wet signature, see instructions.

Mailing Instructions: The printed and signed copy of the expenditure report must be postmarked by September 30, 2022 and mailed to:

U.S. Department of Education
P.O. Box 9003
Niagara Falls, NY 14302

For overnight delivery, mail to:

U.S. Department of Education
2429 Military Road, Suite 200
Niagara Falls, NY 14304

Paperwork 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 1845-0152. Public reporting burden for this collection of information is estimated to average 2 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. The obligation to respond to this collection is mandatory in accordance with the 1998 Amendments to the Higher Education Act of 1965 (Pub. L. 105-244 Sec. 424) and the Higher Education Opportunity Act of 2008 (Pub. L. 110-315). If you have comments or concerns regarding the status of your individual submission of this form, please contact the Common Origination and Disbursement (COD) School Relations Center directly at 1-800-848-0978 or email [email protected].

2021–22 Work Colleges Program Expenditure Report

Award Year July 1, 2021 through June 30, 2022

Name of Institution: [prefilled by COD] State: [prefilled by COD] OPEID: [prefilled by COD]

1. Final Adjusted 2021–22 Work Colleges authorization $
   
   

2. Total federal funds available for the 2021–22 Work Colleges Program
   (Lines 1 + 2a + 2b + 2c + 2d) minus (Lines 2e + 2f + 2g) $ [Calculated]
   
   

   1. Total amount of 2021–22 Federal Work-Study (FWS)
      funds transferred to and spent in the Work Colleges Program $
      
      

   2. 2022–23 Work Colleges funds carried back and spent in
      2021–22 $
      
      

   3. Additional 2022–23 Work Colleges funds carried back and
      spent for 2022 summer employment $
      
      

   4. 2020–21 Work Colleges funds carried forward to be spent in
      2021–22 $
      
      

   5. 2021–22 Work Colleges funds carried forward to be spent in
      2022–23 $
      
      

   6. 2021–22 Work Colleges funds carried back and spent in
      2020–21 $
      
      

   7. Additional 2021–22 Work Colleges funds carried back and
      spent for 2021 summer employment $
      
      

3. Total federal funds spent for Work Colleges earned compensation

(Lines 3a + 3c) $ [Calculated]

1. Total federal funds spent for Work Colleges
   Community Service earned compensation $___________
   
   

2. Total non-federal funds spent for Work Colleges
   Community Service earned compensation $___________

3. Total federal funds spent for Work Colleges

non-Community Service earned compensation $___________

4. Total non-federal funds spent for Work Colleges

non-Community Service earned compensation $___________

4. Total funds spent for Work Colleges earned compensation
   (Lines 4a + 4b) $ [Calculated]
   
   

   1. Total funds spent for Work Colleges Community Service

earned compensation (Lines 3a + 3b) $[Calculated]

2. Total funds spent for Work Colleges non-Community Service

earned compensation (Lines 3c + 3d) $[Calculated]

5. Total funds spent for Work Colleges Job Location and Development (JLD) activities
   (Lines 5a + 5b) $ [Calculated]
   
   

   1. Total federal funds spent for Work Colleges
      JLD Activities $
      
      

   2. Total non-federal funds spent for Work Colleges
      JLD Activities $___________
      
      

6. Total funds spent for administrative cost allowance (ACA) and other Work
   Colleges Program allowable expenses, including staff salaries, related travel,
   printing, and mailing costs
   (Lines 6a + 6b) $ [Calculated]
   
   

   1. Total federal funds spent for ACA and other Work Colleges
      expenses $
      
      

   2. Total non-federal funds spent for ACA and other Work
      Colleges expenses $
      
      

7. Total federal funds spent for the 2021–22 Work Colleges Program
   (Lines 3 + 5a + 6a) $ [Calculated]
   
   

8. Total non-federal funds spent for the 2021–22 Work Colleges Program
   (Lines 3b + 3d + 5b + 6b) $ [Calculated]
   
   

9. Expended 2021–22 Work Colleges authorization
   (Lines 2e + 2f + 2g + 7) minus (Lines 2a + 2b + 2c + 2d) $ [Calculated]
   
   

10. Unexpended 2021–22 Work Colleges authorization
    (Line 1 – Line 9) $ [Calculated]
    
    

I understand that by signing my name below I am certifying that the information above is true and accurate and that it is subject to review by the U.S. Department of Education.

Signature Date Signed

Title: [prefilled by COD] Typed Name: [prefilled by COD]

Telephone No.: [prefilled by COD]

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