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U.S. Department of Education
Office of Elementary and Secondary Education
Washington, DC 20202-6100

ATTACHMENT 1
OMB No. 1810-0060
Expiration Date:

ANNUAL REPORT OF CHILDREN IN INSTITUTIONS FOR NEGLECTED
OR DELINQUENT CHILDREN, ADULT CORRECTIONAL INSTITUTIONS, AND
COMMUNITY DAY PROGRAMS FOR NEGLECTED OR
DELINQUENT CHILDREN

FORM APPROVED:
OMB NO. 1810-0060
EXPIRATION DATE:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a currently valid OMB
control number. The valid OMB control number for this collection is 1810-0060. Public reporting burden for this collection of information is estimated to average 42 hours 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. The obligation to respond to this collection is required to obtain or retain a benefit under Title I, Part A and Title I, Part D, Subparts 1 and 2 of the Elementary and
Secondary Education Act of 1965, as amended. If you have comments or concerns regarding the status of your individual submission of this form, please contact the program
office address, Office of School Support and Accountability, U.S. Department of Education, 400 Maryland Avenue, SW (Room 3C156, LBJ), Washington, DC 20202-6100,
[email protected].

PURPOSE:

The purpose of this annual report is to provide the U.S. Department of Education with data required by Title I, Parts
A and D, of the Elementary and Secondary Education Act (ESEA), for use in the computation of grants to local
educational agencies (LEAs) and State agencies responsible for providing free public education for children in
institutions or community day programs for neglected or delinquent children.

REQUIREMENTS:

This report is required annually for all State educational agencies. No sampling or estimating is to be used in
preparing this report. Since these data will generate Federal funds, they are subject to audit and must be supportable
from documented records.
INSTRUCTIONS

SECTION A - FORMULA DATA AND REPORTING FORMAT SHEETREPORTING FORMULA DATA
Refer to the “Instructions” worksheet of the provided workbook for information on how to report (a) the number of neglected or delinquent
children in local institutions and adult correctional institutions by local educational agency and (b) the number of children enrolled in a regular
program of instruction in State-operated institutions for neglected or delinquent children, community day programs for neglected or delinquent
children, or adult correctional institutions. For any questions or issues with the workbook, please email [email protected].
State educational agency - Enter name.

Commented [PR1]: Note for reviewers: This document is the
currently approved information collection. The track changes show
the updates we are proposing. All of the information deleted from
here has been added to the Excel file, which is where the SEA
provides the information. No substantive changes are proposed for
this information collection.

PART I INSTRUCTIONS (LOCAL INSTITUTIONS): REPORTING THE NUMBER OF NEGLECTED OR DELINQUENT
CHILDREN IN LOCAL INSTITUTIONS AND ADULT CORRECTIONAL INSTITUTIONS BY LOCAL EDUCATIONAL
AGENCY (LEA)
1. State and LEA codes - Identify the State code and LEA code. This information is required for data processing purposes. A spreadsheet
that lists the State code and LEA codes is attached.

Formatted: Indent: Left: 0", First line: 0"

2. October 2023 caseload data - Enter separately the number of children, ages 5-17, inclusive, who live in (1) local institutions for neglected
children and (2) local institutions for delinquent children, including children in local adult correctional institutions, for at least one day during
a 30 consecutive day period, at least one day of which falls within the month of October 2023.

Formatted: Indent: Left: 0", First line: 0"

Formatted: Indent: Left: 0"

Please furnish a total for each LEA only and provide a grand total for the State. It is not necessary to furnish data for each individual
institution.
PART II INSTRUCTIONS (STATE-OPERATED OR STATE SUPPORTED INSTITUTIONS): REPORTING THE ENROLLMENT
OF CHILDREN IN A REGULAR PROGRAM OF INSTRUCTION IN STATE-OPERATED INSTITUTIONS FOR NEGLECTED
OR DELINQUENT CHILDREN, COMMUNITY DAY PROGRAMS FOR NEGLECTED OR DELINQUENT CHILDREN, OR
ADULT CORRECTIONAL INSTITUTIONS
1. State Agency - Furnish the name of the State agency eligible to receive a Title I, Part D, Subpart 1 (Title I, Part D) subgrant. "State
agency" means an agency of State government responsible for the free public education of children in institutions for neglected or delinquent
children, attending community day programs for neglected or delinquent children, or in adult correctional institutions.

Formatted: Indent: Left: 0", First line: 0"

2. Enrollment - Report the number of children enrolled in the educational programs of State-operated or supported institutions for neglected
or delinquent children, community day programs for neglected or delinquent children, or adult correctional institutions on a date during
calendar year 2023 selected by the State agency.

Formatted: Indent: Left: 0", First line: 0"

ED FORM 4376

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U.S. Department of Education
Office of Elementary and Secondary Education
Washington, DC 20202-6100

ATTACHMENT 1
OMB No. 1810-0060
Expiration Date:

Provide only a total for each State agency. It is not necessary to furnish data for each institution or community day program or to separate the
data by category of children.

Formatted: Indent: Left: 0"

PART II INSTRUCTIONS (STATE-OPERATED OR STATE SUPPORTED INSTITUTIONS) CONTINUED

Formatted: Left, Tab stops: -1", Left + -0.5", Left + 0",
Left + 0.29", Left + 0.59", Left + 0.88", Left + 1.17", Left
+ 1.5", Left + 2", Left + 2.5", Left + 3", Left + 3.5", Left
+ Not at 3.98"

To be eligible to be counted as enrolled, a child must be:

Formatted: Indent: Left: 0"

(1) Under 21 years of age;

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(2) One for whom a State agency is providing a free public education; and

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(3) Enrolled in a regular program of instruction supported by non-Federal funds for at least:

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 20 hours per week if in an institution for neglected or delinquent children or a community day program for neglected or delinquent
children; or

Formatted: Indent: Left: 0", First line: 0"



Formatted: Indent: Left: 0", First line: 0"

15 hours per week if in an adult correctional institution.

A "regular program of instruction" means an educational program (not beyond grade 12) in an institution or a community day program for
neglected or delinquent children that consists of classroom instruction in basic school subjects such as reading, mathematics, and vocationally
oriented subjects, and that is supported by non-Federal funds. Neither the manufacture of goods within the institution nor activities related to
institutional maintenance are considered classroom instruction.

Formatted: Indent: Left: 0"

Title I, Part D funds generated by eligible children in an institution or community day program for neglected or delinquent children or in an
adult correctional institution must supplement the number of hours of instruction they receive from State resources. If these children
participate in other programs funded from Federal sources, Title I, Part D funds must be accounted for separately but should be coordinated
with other Federal funds to avoid duplication. If an institution operates an institution wide project, however, Title I, Part D funds may be used
to upgrade the entire educational program of the institution.

Formatted: Indent: Left: 0"

3. Adjustment in enrollment to reflect the relative length of the State agency's annual program - For each institution, multiply the
enrollment of children eligible to be counted by the number of days in the year the institution operates an educational program and divide that
number by 180.

Formatted: Indent: Left: 0", First line: 0"

4.

Formatted: No bullets or numbering

State total - Provide a State total for all State agencies.
SECTION B - CERTIFICATION BY STATE EDUCATIONAL AGENCY

Complete the certification portion of the report. This report must be signed by the appropriate official in the State educational agency (SEA) to
certify that the information reported is complete and accurate. The information provided is subject to audit, and the SEA should maintain
documentation.
SUBMITTAL PROCEDURE
Please submit the informationworkbook and , including a signed certification page, by e-mail to: [email protected]. The information
for this survey is due by January 156, 20274.

ED FORM 4376

Page 2 of 4

Formatted: Tab stops: -1", Left + -0.5", Left + 0", Left +
0.29", Left + 0.59", Left + 0.88", Left + 1.17", Left + 1.5",
Left + 2", Left + 2.5", Left + 3", Left + 3.5", Left + Not at
3.98"

U.S. Department of Education
Office of Elementary and Secondary Education
Washington, DC 20202-6100

ATTACHMENT 1
OMB No. 1810-0060
Expiration Date:

Annual Report of Children In Institutions for Neglected or Delinquent Children, Adult Correctional
Institutions, and Community Day Programs for Neglected or Delinquent Children
NOTICE: This report is required by sections 1124, 1402, 1411, and 1412 of the ESEA. The completion of this report is required to
obtain or retain benefits. Failure to submit the report will result in the inability of the U.S. Department of Education to carry out
legislative requirements and the loss of funds to State and local educational agencies to provide compensatory education services for
children in institutions and community day programs for neglected or delinquent children.

SECTION A - FORMULA DATA AND REPORTING FORMAT SHEET
Children in Locally Operated Institutions for Neglected or Delinquent Children and Adult Correctional Institutions,
Children in State-Operated Institutions for Neglected or Delinquent Children, and Community Day Programs for Neglected or Delinquent
Children, and Adult Correctional Institutions

State educational agency ____________________
(Name)
PART I -- Number of neglected or delinquent children, ages 5 - 17, inclusive, in local institutions by LEA

State
Code

LEA
Code

Name of Local
Educational Agency (LEA)

Neglected Caseload
Count for
October 2023*

Delinquent Caseload
Count for
October 2023**

Total

Total for the State
*
**

Count children residing in institutions for neglected children in this column.
Count children residing in institutions for delinquent children and adult correctional institutions in this column.

ED FORM 4376

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U.S. Department of Education
Office of Elementary and Secondary Education
Washington, DC 20202-6100

ATTACHMENT 1
OMB No. 1810-0060
Expiration Date:

PART II -- Number of children under 21 years enrolled in a regular program of instruction in State-operated or supported institutions for
neglected or delinquent children, community day programs for neglected or delinquent children, or adult correctional institutions. Enrollments
must be adjusted to reflect the relative length of the State agency's annual program.
2023
Enrollment
In A Regular Program of Instruction
(Adjusted to Reflect the Relative
Length of the State Agency's
Annual Educational Program)

Name of State Agency

Total for the State

SECTION B - CERTIFICATION BY STATE EDUCATIONAL AGENCY

I certify that the State educational agency has implemented a system of internal controls and taken the steps necessary to ensure that the
data provided in Parts I and II meet the requirements of Title I of the ESEA and are, to the best of my knowledge, valid and reliable. I
understand that any knowingly and willingly submitted false statement provided herein that I have made is subject to fine or imprisonment
pursuant to 18 U.S.C. 1001.

Signature

_______________
Date Signed

_______________________________
Typed name and title

ED FORM 4376

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