Attachments:
Attachment I: WIA Section 166 Reporting Requirements.
Indian and Native American Financial Status Report (ETA 9080). * NOTE: 9080 Only in PDF format currently
Indian and Native American Comprehensive Services Program Report (ETA 9084) and instructions.
Indian and Native American Supplemental Youth Services Report (ETA 9085) and instructions.

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Attachment I

* Grantees will continue to submit quarterly reports beyond the end of the program year until the appropriation (i.e. subaccount) for the funding year is fully expended. A Final Financial Report will be due 90 days after the appropriation (i.e. subaccount) has been fully expended.

* Grantees will continue to submit quarterly reports beyond the end of the program year until the appropriation (i.e. subaccount) for the funding year is fully expended. A Final Financial Report will be due 90 days after the appropriation (i.e. subaccount) has been fully expended.

INDIAN AND NATIVE AMERICAN PROGRAMS

WORKFORCE INVESTMENT ACT (WIA)

GRANTEE ACTIVITIES

FINANCIAL STATUS REPORT

INSTRUCTIONS

GENERAL INSTRUCTIONS. The Financial Status Report (FSR) entitled "INDIAN AND NATIVE AMERICAN PROGRAMS WORKFORCE INVESTMENT ACT (WIA) - GRANTEE ACTIVITIES" is the required mechanism for grantees to report administrative and program outlays (expenditures) for allowable activities funded through grants, contracts, or cooperative agreements to carry out workforce investment activities. Reported outlays (expenditures) and program income (addition method) must be reported on an accrual basis and cumulative by each funding year. Reports must also include any costs incurred (such as stand-in costs) that are otherwise allowable except for funding limitations.

Grantees will be provided with software containing the required data elements (as identified on attached hard copy prototype format) for ease in reporting electronically via the Internet. Each grantee will be requested to provide an E-mail address which will be the point of Internet communication between the grantee and DOL. On-line reporting instructions and passwords will be issued to the E-mail address provided. A Personal Identification Number (PIN) will also be issued to a grantee-identified person who will be responsible for certifying that the data submitted is complete and accurate. When the PIN is entered by the specified grantee-level person, the data will become automatically accessible to DOL. Each grantee will be notified of the Regional Office individual(s) who will be responsible for reviewing the data. This individual(s) should be the point of contact for general reporting-related communications.

Financial reports are due no later than 45 days after the end of each quarter. A final financial report is required 90 days after the expiration of a funding period or after all funds for the grant period have been expended.

NOTE: INA grantees receiving designation under Pub. L. 102-477 will be required to submit a single overall report, encompassing all funding, to the Bureau of Indian Affairs.

LINE ITEM INSTRUCTIONS.

Item 1. This entry should be "DOL/ETA" plus the Regional Office and Organizational Unit responsible for review of data submitted for this grant.

Item 2. This entry should be the grant number assigned by DOL, as it appears on the grant agreement.

Item 3. This entry should contain the complete name and address of the recipient organization.

Item 4. This entry should be the Employer Identification Number assigned by the U.S. Internal Revenue Service.

Item 5. This entry is for recipient use. It may be used for recipient sub- account/identification number.

Item 6. Check yes only if this is the final report for the grant.

Item 7. Accrual box should be checked as program outlays (expenditures) and program income are required to be reported on an accrual basis.

Item 8. The "funding year" represents the year from which expenditures are being reported. Each year of funding for Indian and Native American Programs WIA grant activities will require a separate FSR to be submitted.

Item 9. Enter beginning and ending dates of period covered by this FSR.

(Beginning of the funding year through last day of reporting quarter.)

Item 10. Transactions:

a. TOTAL FEDERAL OUTLAYS (accrued) is the sum of actual cash disbursements for direct charges for goods and services, plus:
- amount of indirect expense incurred
- net increase or decrease in the amounts owed by the recipient for goods and other property received; for services performed by employees, contractors, subgrantees, and other payees and other amounts becoming owed for which no current services or performance is required, i.e., annuities, insurance claims, and other benefit payments.

NOTE: Total outlays are the sum of line items' c., d., e., and f.

b. REFUNDS, REBATES or any receipt that is treated as a reduction of expenditures rather than as income, unless already netted out of outlay amount shown on line 10a.

c. TOTAL ADMINISTRATIVE OUTLAYS are that portion of Item a. which are allowable administrative outlays (expenditures), net of applicable refunds, rebates, etc.

d. TOTAL EMPLOYMENT SERVICES OUTLAYS are the portion of Item a. that are accrued expenditures for employment services provided to program participants, i.e., job development and employment outreach activities.

e. TOTAL TRAINING SERVICES OUTLAYS are the portion of Item a. that are accrued expenditures for training services provided to program participants, i.e., occupational skill training, OJT, adult basic education, GED attainment, etc.

f. OTHER PROGRAM SERVICES OUTLAYS are the portion of Item a. that are accrued expenditures for all other allowable program services provided to participants.

g. NET FEDERAL OUTLAYS are Line a. minus Line b.

h. RECIPIENT OUTLAYS FOR ALLOWABLE PROGRAM ACTIVITIES refers to non-federal funds expended for allowable program activities of the grant. Any funds received and expended by the recipient that are from a non-federal source are referred to as non-federal funds. Costs incurred, such as stand-in costs, that are otherwise allowable except for funding limitations are reported in line item h.

I. FEDERAL NET OUTLAYS is the identical amount to Line g. Line i. should equal line g.

j. FEDERAL UNLIQUIDATED OBLIGATIONS are obligations incurred, but for which an outlay (expenditure) has not yet been recorded in the grantee's books of account. This amount should include unliquidated obligations to subgrantees and contractors. On the final FSR, Line j. must be zero. (Grantee has 90 days after all funds have been expended or the period of availability has expired to liquidate accrued expenditures accrued during the period of performance.)

k. TOTAL FEDERAL OBLIGATIONS are the sum of the total Federal net outlays (Line i.) and the Federal unliquidated obligations (Line j.)

l. TOTAL FEDERAL FUNDS AUTHORIZED FOR THIS FUNDING PERIOD refers to the total funds authorized for this grant, including any modifications.

m. UNOBLIGATED BALANCE OF FEDERAL FUNDS is the difference between total Federal funds authorized (Line l.) and total Federal obligations (Line k.)

n. DISBURSED PROGRAM INCOME USING ADDITION METHOD is required to be reported on this line item.

o. UNDISBURSED PROGRAM INCOME is program income earned but not expended.

p. TOTAL PROGRAM INCOME REALIZED is the sum of Lines n. and o.

Item 11. INDIRECT EXPENSE

a. Check type of indirect cost rate applied. This should be contained in grant agreement or otherwise negotiated.

b. Enter actual approved rate in effect during reporting period (as identified in item 8).

c. Enter base accrued expenditure dollar amount against which rate is applied.

d. Multiply rate times base and enter total indirect amount.

e. Federal share is the indirect cost minus any portion paid out of recipient funds. This entry should equal d., if there is no non-Federal share.

Item 12. Remarks

Provide any additional comments deemed necessary to further explain data reported. Also explain any changes to previously submitted data.

Item 13. Certification

Page 3 of 6 ETA 9084 (November 2000)

Training Measures

Employment Measures

Page 4 of 6 ETA 9084 (November 2000)

d. Signature and Title: __________________________________ e. Date Signed: _______________ f. Telephone Number: (_____)_____-__________

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents obligation to reply to these reporting requirements are required to obtain or retain benefits (20 CFR 668.610). Public reporting burden for this collection of information is estimated to average 9.67 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of National Programs, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210 (Paperwork Reduction Project Number: 1205-0422).

The Workforce Investment Act Title I-D, Section 166

Indian and Native American

Comprehensive Services Report

1. Purpose. The Comprehensive Services report provides cumulative data on participation, termination, performance measures outcomes, and the socio-economic characteristics of all terminees on a semi-annual and annual basis. The information is used to determine the levels of program service and program accomplishments for the program year.

2. General Instructions. The report is required under the Workforce Investment Act (WIA), Title I-D, Section 166 grant that covers the period July 1 through June 30. The report is a compilation of data from the beginning of the program year through the end of the reporting period. Grantees are required to submit a semi-annual and annual report to DINAP.

The semi-annual report is to be postmarked and sent to DOL no later than 45 days after the end of the reporting period. The annual report must be sent 90 days after the end of the program year. Three copies of the report must be submitted to:

U.S. Department of Labor
Employment and Training Administration
Attention: MIS, Room N-4641
200 Constitution Avenue, N.W.
Washington, D.C. 20210

3. Report Form. The report form is ETA 9084. See next page.

4. Instructions for Completing the Report.

a. Grantee Name and Mailing Address - Enter the grantee name and mailing address as it appears on the appropriate Notice of Obligation (NOO) or equivalent.

b. Grant Number - Enter the grant number as it appears on the appropriate NOO or equivalent.

c. Report Period - Enter the beginning date of the designated Program Year (PY) and the ending date of each reporting cycle of the designated program year.

d. Signature and Title - An authorized signature and title must be entered on the Semi-annual and Annual Comprehensive Services Report.

e. Date Signed - Enter the date the report was signed by the authorized official.

f. Telephone Number - Enter the area code and telephone number of the authorized official.

5. General Information. Unless otherwise indicated, data reported on characteristics of terminee should be based on information collected at the time of eligibility determination. Information on individual's characteristics at time of eligibility determination should not be updated when the individual terminates from the program.

6. Section I and II - Participation and Termination Summary. Section I & II collects summary information on program participants and terminees for the program year. Information includes the total number of participants in the program, concurrent program participation, total terminations, and employment and/or training types of terminations. All terminee totals must be updated throughout the program year to maintain accurate data at the end of the program year.

7. Section III - Average Hourly Wage Summary. Section III collects summary data on the Pre- and Post- Average Hourly Wage outcomes of participants enrolled in employment and training activities for the program year. The Department will use these outcomes to determine any increases in hourly wages due to participation in the program.

8. Section IV - Characteristics of Terminees. Section IV collects information on specific characteristics of terminees for the program year. Characteristic data should be based on information collected at time of eligibility determination.

9. Section V - Participation in Program Activities. Section V collects participant data of those individuals enrolled in Sec. 166 program activities. Participants who are enrolled in one or more program activity may be counted for each activity in this section.

10. Section VI - Performance Measures Summary. Section VI describes the program's performance outcomes for grantees that chose the option of selecting three (3) performance measures from the menu of measures for the program year. Grantees who chose the option of developing Grantee-determined measure(s) should leave this section blank.

In Section VI, each measure the grantee selects has a minimum performance level associated with it. Grantees must meet the minimum performance requirement for at least two of the three measures selected. In most cases, the standard for successful completion is the percentage of terminees which attain a specific outcome. This number is the numerator in calculating the percentage. The base (denominator) for the measure is usually the total number of terminees to be considered under the measure. At least one measure must be from either the Training or Employment category.

Further, at least one measure must have a "base" which includes no less than 25% of the grantee's total terminations for that program year. In addition, each of the other measures selected must represent at least 10% of the grantee's total terminations for that program year. These restrictions will ensure that each grantee is accountable for a significant portion of the total number of those served under its program.

Grantees have until the mid-year report period to modify or change the measures they have selected. The Menu of Measures are listed below.

11. Section VII - Grantee Determined Performance Measures Narrative. Section VII collects outcome data for programs that chose to develop their own specific measure(s). The measure(s) should illustrate the types of activities that are relevant to the program. Grantees who choose this option may not use measures from the Menu of measures options.

12. Section VIII - Grantee Narrative. Section VIII provides DINAP with information not captured in Sections I-VII of the Comprehensive Services Report, that show other innovative program accomplishments. For example, participant "success stories" can be described in this section; or program accomplishments; or how the community benefitted.

The Workforce Investment Act Title I - Section 166

Indian and Native American Program, Comprehensive Services Program

Appendix

All Other Terminations - the total number of participants who terminated for reasons other than those listed in lines 2-4 on the report form.

Alternative School - a specialized, structured curriculum offered inside or outside of the public school system which may provide work/study and/or GED preparation.

Assessment Services - a service designed to initially determine each participant's employability, aptitude, abilities and interests, through interviews, testing and counseling to achieve the applicant's employment related goals.

Attained Basic or Occupational Skill Proficiency - as one of the components of employability enhancements, includes participants who, at termination, had demonstrated proficiency, as defined by the grantee, in one or more of the following two skills areas in which the terminee was deficient at enrollment: basic education skills or occupation skills. Skill gain must be achieved through active program participation and must be the result of a prior employability development planning process which identifies the participant's skill deficiencies and the level of proficiency needed for attainment of the basic/occupational skills.

Attained Employment Enhancement ONLY - the total number of terminees who were not placed in a job; but attained at least one of the following employability enhancements: 1) Entered Non-Section 166 Training or Training Provided by Another Section 166 Grantee, 2) Returned to Full-time School, 3) Completed Major Level of Education, 4) Completed a Worksite Training Objective, and 5) Attained Basic or Occupational Skills Proficiency.

Attended Post High School - an individual who received a high school diploma or a GED certificate and had attended but is not currently attending a post-secondary level vocational, technical, or academic program (one normally requiring a high school diploma or GED for entry)

Average Hourly Wage Preprogram - represents the average hourly wage 52 weeks preprogram for those terminees who entered unsubsidized employment at termination. Use the hourly wage from last job held during the immediate 52 weeks prior to eligibility determination. Terminees who entered unsubsidized employment and had not been employed within the 52 weeks prior should be counted as having $0.00 hourly wage. To calculate, add the pre-program hourly wage for all terminees who entered unsubsidized employment, then divide the result by the number of terminees who entered unsubsidized employment. Example: Three (3) participants obtained employment. Participant X was earning $5.00 an hour prior to entering the program; Participant Y was unemployed longer than 52 weeks prior to entering the program, therefore his or her pre-program wage was $0; and participant Z was earning $6.00 an hour prior to entering the program. The total pre-program wages for terminees X, Y, and Z is $11.00. The Average Wage (pre-program) would be $3.67 ($5+ $0 + $11 divided by 3 participants equals $3.67).

Average Hourly Wage at Termination - represents the average hourly wage of those terminees who entered full or part-time unsubsidized employment. Calculate by adding the hourly wage for all terminees who entered unsubsidized employment, then divide the result by the total number of terminees who entered unsubsidized employment. Include any bonuses, tips, gratuities and commissions earned. Example: Three (3) participants obtained employment. Participant X received an hourly wage at termination of $10.00; Participant Y received $7; and participant Z received $6.50. The total hourly wages for terminees X, Y, and Z is $23.50. Therefore, the Average Hourly Wage at termination would be $7.83 ($23.50 divided by 3 participants equals $7.83).

Base for Measure - each of the measures the grantee selects has a minimum performance level associated with it. The base for the measure is usually the total number of terminees to be considered under the measure or the denominator used to calculate final performance outcome.

Basic Education Skills - training that includes remedial reading, writing, communication, mathematics GED and/or English for non-English speakers.

Basic Literacy Skills Deficient - is a determination that an individual: (1) computes or solves problems, reads, writes, or speaks English at or below the 8^th grade level; or (2) is unable to compute or solve problems, read, write, or speak English at a level necessary to function on the job, in the individual's family or in society.

Basic Skills/GED Attainment Rate (performance measure) - as a rate, those terminees who increased their reading or math skills by at least two grade levels or the equivalent, attained their high school diploma or equivalent, or were out-of-school youth who return to school, as a percentage of all terminees who are enrolled in adult basic education or GED programs.

Classroom Training: Basic Education - means participation in basic education classroom activities designed to enhance the employability of the participant by upgrading basic skills (e.g. remedial education or training in English Language Proficiency, GED classes, etc.)

Classroom Training: Job Skills - means training ordinarily conducted in an institutional setting and designed to provide individuals with technical skills and ability required to perform a specific job or group of jobs (e.g. community college, vocational technical school, etc.)

Completed Major Level of Education - participants who, at termination, had completed a level of educational achievement which had not been reached at entry. Levels of educational achievement are secondary and post-secondary. Completion standards shall include a high school diploma, GED Certificate or equivalent at the secondary level, and require a degree or other written certification of completion at the post-secondary level.

Completion of Work-site Training Objective - participants who, at termination, had attained a level of work readiness, through work-site training which did not exist at entry. This includes the completion of work experience, on-the-job training with job placement, and/or completion of an occupational skills, pre-apprenticeship, or job upgrading program.

DINAP - means the Division of Indian and Native American Programs within the Employment and Training Administration of the Department of Labor.

Displaced Homemaker - an individual who has been providing unpaid services to family members in the home and who (1) has been dependent on the income of another family member but is no longer supported by that income; and (2) is unemployed or underemployed and is experiencing difficulty in obtaining or upgrading employment; or is receiving public assistance and is within 2 years of exhausting lifetime eligibility under part A of title IV of the Social Security Act (42 U.S.C. 601 et seq.).

Eligibility Determination Criteria (Section 166 program) - a person is eligible to receive services under the INA program if that person is: (1) An Indian, as determined by a policy of the Native American grantee, (2) an Alaska native, as defined in Section 3(b) of the Alaska Native Claims Settlement Act (ANCSA), 43 U.S.C. 1602(b); or (3) Native Hawaiian, as defined in WIA section 166(b)(3). The person must also be one of the following: (a) Unemployed; or (b) underemployed as defined in 668.150; or (c) a low income individual, as defined in WIA section 101(25); or (d) the recipient of a bona fide layoff notice which has taken effect in the last six months or will take effect in the following six month period, who is unlikely to return to a previous industry or occupation, and who is in need of retraining for either employment with another employer or for job retention with the current employer; or (e) an individual who is employed, but is determined by the grantee to be in need of employment and training services to obtain or retain employment that allows for self-sufficiency. Also, if applicable, male applicants must also register or be registered for the Selective Services.

Entered Employment with Enhancement - the total number of terminees who entered full or part-time unsubsidized employment after receiving one of the following employability enhancements:1) Entered Non-Section 166 Training or Training Provided by Another Section 166 Grantee; 2) Returned to Full-time School; 3) Completed Major Level of Education; 4) Completion of Work-site Training Objective, and 5) Attained Basic or Occupational Skills Proficiency.

Entered Employment without an Enhancement - the total number of terminees who entered full or part-time unsubsidized employment but did not receive an employability enhancement.

Entered Employment Rate (performance measure) - denotes whether the individual entered unsubsidized employment at termination. As a rate, denotes the number of terminees who entered unsubsidized employment at termination; divided by all terminees.

Entered Non-Section 166 Training or Training Provided by Another Section 166 Grantee - participants who, at termination, entered an occupational skills training program or post-secondary education program funded by another Section 166 grantee; or not funded under Section 166 (for youth including funds other than those from the INA Supplemental Youth Services Program), which builds upon and does not duplicate training received under Section 166.

Entered Unsubsidized Employment (including entering the military) - individuals who, upon termination, entered non-WIA funded employment, including entry into the Armed Forces or self-employment.Also included are individuals who are regularly employed on the staff of a WIA program.

Employability Enhancement (performance measure) - an outcome for participants which is recognized as enhancing long-term employability and contributing to the potential for a long-term increase in earnings and employment. Outcomes which meet this requirement shall be restricted to the following: 1) Entered Non-Section 166 Training or Training Provided by Another Section 166 Grantee; 2) Returned to Full-time School; 3) Completed Major Level of Education; 4) Completion of Worksite Training Objective, and 5) Attained Basic or Occupational Skills Proficiency. Enter the total number of participants who attained any of the following enhancement outcomes. A terminee can only be counted once in this section regardless of how many enhancements the individual attained.

Employed - A person who, during the 7 consecutive days prior to determination of that person's employment status, did any work at all as a paid employee, in his or her own business, profession or farm, worked 15 hours or more as an unpaid worker in an enterprise operated by a member of the family, or was one who was not working, but has a job or business from which he or she was temporarily absent because of illness, bad weather, vacation, labor-management dispute or personal reasons, whether or not paid by the employer for time-off, and whether or not seeking another job.

Grantee-determined Barrier - any circumstance identified by the grantee that will impede employment opportunities for an individual which is not listed under multiple barriers 1-11.

Grantee-determined Measure - grantees have the option to develop their own specific measure(s) which are relevant to the special circumstances surrounding the program. Grantees who choose this option may not use measures from the menu of options . Each measure determined should be unique and relevant to the client population being served. If a grantee decides to develop one measures for the program year, that measure should reflect benchmarks/goals for a two year period. Grantees must describe fully in the CSP; a) the proposed measure(s) and rationale for choosing the measure(s), b) How successful performance outcomes will be measured, c) the number of participants enrolled in the program year, and d) how the program plans to track outcomes and report its performance.

High School Graduate or Equivalent Only (no post high school) - an individual who has received a high school diploma or a GED certificate, but who has not attended any post-secondary level vocational, technical, or academic program (one normally requiring a high school diploma or GED for entry).

Homeless and/or a Runaway Youth - an individual who lacks a fixed, regular adequate night-time residence that is a public or private operated shelter for temporary accommodation; an institution providing temporary residence for individuals intended to be institutionalized; or a public or private place not designated for or ordinarily used as a regular sleeping accommodation for human beings. Also includes a runaway youth. The term does not include a person imprisoned or detained pursuant to an Act of Congress or State law.

INA Grantee - means an entity which is formally designated under subpart B of this part to operate an INA program and which has a grant agreement pursuant to 20 CFR 668.292.

Individuals with a Disability - any individual who has a physical (motion, vision, hearing) or mental (learning or developmental) impairment which substantially limits one or more of such person's major life activities and has a record of such an impairment, or is regarded as having such an impairment.

Intake Services - the screening for eligibility; and 1) a determination of whether the program can benefit the individual; 2) an identification of the employment and training activities and services which would be appropriate for that individual; 3) a determination of the availability of an appropriate employment and training activity; 4) a decision on selection for participation; and 5) the dissemination of information on the program.

Job Creation Rate (performance measure) - as a rate, new jobs created in Native American-owned businesses as a result of the grantee's services (including micro-enterprises and self employment), as a percentage of all terminees.

Job Placement for Long-term Jobless Rate (performance measure) - as a rate, those who enter unsubsidized employment at termination, as a percentage of all terminees who have been unemployed or out of the labor force for 15 of the 26 weeks prior to enrollment.

Job Retention Rate (performance measure) - as a rate, those who are employed for at least 20 hours per week for 12 out of the 13 weeks following termination, as a percentage of terminees placed in jobs at termination who were enrolled in occupational skills classroom training or OJT.

Job Skills Training - training that includes vocational education which is designed to provide individuals with the technical skills and information required to perform a specific job or group of jobs.

Leverage Non-Sec.166 Resources Rate (performance measure) - as a rate, the dollar value of non-166 financial or in-kind contributions to the 166 program and/or non-166 funded services provided to participants, including the following: 1) non-166 contracts or grants or grants that are not formula funded, 2) donated services or services provided by other agencies or individuals not paid for from the Section 166 grant, 3) donated equipment, 4) slots provided by other WIA Title I programs, 5) tuition waivers, 6) support services provided by others. Computed as a percentage of the grantee's allocation of Comprehensive Services program funds under Section 166 for the Program Year covered by this report.

Limited English Language Proficiency - the inability of an individual, whose native language is not English to communicate in English, resulting in a barrier to employment.

Long-term TANF/GA Recipient - an adult or youth listed on the welfare grant who had received cash payment under TANF or GA for any 24 or more of the 30 months prior to eligibility determination and who was a welfare recipient at the time of such determination.

Menu of Measures - grantees have an option to select three (3) measures from a menu of options that are categorized by Employment, Training, and Community. Grantees who choose this option must select at least one measure from either the Employment or Training category. The three measures selected for the program year must be submitted in the grantees plan at the beginning of the program year and may not be changed after the mid-year reporting period.

Multiple Barriers to Employment - participants who have two or more of the following impediments to employment: (1) School dropout, (2) Limited English Language Proficiency, (3) Individual with a Disability, (4) Offender, (5) Basic Skills Deficient, (6) Long-term TANF/GA Recipient, (7) Homeless, (8) Substance Abuse, (9) Displaced Homemaker, (10) Pregnant or Parenting Youth, (11) Single Head of Household with Dependents Under Age 18, or (12) Grantee-determined Barrier.

NEW (Native Employment Works Program) - a tribal work program authorized under section 412(a)(2) of the Social Security Act, as amended by the Personal Responsibility and Work Opportunity Reconciliation Act (P.L. 104-193). Formerly known as Job Opportunities and Basic Skills (JOBS) program.

Occupational Skills Training and Post-Secondary Education Rate (performance measure) - as a rate, those terminees with documented completion of occupational skills classroom training or post-secondary education, resulting in a degree, certificate, or apprenticeship, as a percentage of all terminees enrolled in occupational skills classroom training or post-secondary education.

Offender - an adult or juvenile: (a) who is or has been subject to any stage of the criminal justice process, for whom services under WIA may be beneficial; or (b) who requires assistance in overcoming artificial barriers to employment resulting from a record of arrest or conviction.

On-the-job Training (OJT) - training provided by an employer that is provided to a paid participant while engaged in productive work in a job that (a) provides knowledge or skills essential to the full and adequate performance of the job, and (b) provides reimbursement to the employer of up to 50% of the wage rate of the participant, for the supervision related to the training, and (c) is limited in duration appropriate to the occupation for which the participant is being trained, taking into account the content of the training, the prior work experience of the participant, and the service strategy of the participant, as appropriate.

Other Employment and Training Programs - this includes but is not limited to the following; WIA Title I-B (Adult, Youth, & Dislocated Worker participants), Job Corps, Bureau of Indian Affairs (BIA), Tribal work experience programs (TWEP), Adult Vocational Trainingprograms (AVT), Direct Employment programs (DE), Health and Human Services (HHS), Native Employment Works (NEW), Welfare-to-Work, Indian Education, Housing and Urban Development (HUD), Vocational Education, Vocational Rehabilitation, tribal funding, etc. or similar programs available at the community level which are not funded through the grantee's Section 166 program.

Outreach Services - the collection, publication and dissemination of information on program services directed toward economically disadvantaged and other individuals eligible to receive WIA Section 166 training and supportive services.

Participant - an individual who has been determined eligible upon intake to participate in and who is receiving services (other than follow-up services authorized under this title) under a program authorized by this title. This does not include individuals who receive only outreach and/or intake and initial assessment. Participation begins on the first day, following determination of eligibility, when the individual began receiving subsidized employment, training, or other services provided under this title.

Part-time Employed - an individual who is regularly scheduled for work less than 30 hours per week.

Performance Measures - used to determine the level of performance a grantee achieves for the program years. Grantees selecting the menu of measures option are required to meet or exceed the minimum performance levels for two of three measures selected for the program year. Grantees can change the measures selected and submitted in their plan before the mid year reporting period begins.

Positive Termination Rate (performance measure) - as a rate, those who either entered unsubsidized employment at termination or attain an employability enhancement, divided by all terminees enrolled in the program year.

Pregnant and/or Parenting Youth - a female who is under 22 years of age and who is pregnant/parenting, or a male under 22 years of age who is providing custodial care for one or more dependents under age 18.

Public Assistance Recipient - an individual who at time of eligibility determination, was listed on the welfare grant and was receiving cash payments from a means-tested, income transfer program, or receiving Food Stamps or commodities. The income transfer programs include TANF (SSA Title IV), [General Assistance (Tribal, BIA, State or local government)], Refugee Assistance (PL 96-212), and SSI (SSA Title XVI).

Remained in School - participants who are enrolled for the program year, who were at-risk of dropping out of school but, who were retained in school as a result of continuing active participation in the Section 166 program.

Returned to Full-time School - participants enrolled for the program year who, at intake, were not attending school (exclusive of summer), and had not obtained a high school diploma or equivalent and returned to full-time secondary school (e.g., junior high school, middle school, and high school) including alternative school as a result of participating in the Section 166 program.

School Dropout - as defined by the legislation, an individualwho is no longer attending any school and who has not received a secondary school diploma or its recognized equivalent.

Single Head of Household - a single, abandoned, separated, divorced, or widowed individual who has responsibility for one or more dependent children under age 18.

Student - individuals who are attending any school (including elementary, intermediate, junior high school, secondary or post-secondary, or alternative school program), whether full or part-time, or are between school terms and intends to return to school.

Subsidized Employment - WIA funded employment. {e.g. work experience}

Substance Abuse - an individual who requires substance abuse treatment for employment. An individual who has an alcohol and/or other drug problem which for such an individual constitutes or results in a substantial barrier to employment. Grantees are responsible for developing criteria for identifying those individuals considered to be a substance abuserin their programs.

Success Factor - each of the measures the grantee selects has a minimum performance level associated with it. In most cases, the standard for successful completion is defined by the number of terminees which attain a certain objective. This number is the numerator in calculating the percentage for the actual performance outcome.

Supportive Services - includes but is not limited to: 1) Health care; 2) meals and other nutritional assistance; 3) residential support (including temporary shelter); 4) legal financial and personal counseling; 5) child care; 6) relocation assistance; 7) transportation and commuting assistance; 8) emergency assistance.

Termination - the separation of a participant from a given title of the Act who is no longer receiving employment, training, or services (except post-termination services) funded under the title.

Terminee Satisfaction (performance measure) - as a rate, those terminees who rate their satisfaction of services provided by the grantee as "satisfied"or "very satisfied" for the program year, as a percentage of all those who responded to the survey . A 75% response rate is required, however, there are no explicit requirements with respect to survey method used (e.g. telephone, mail, in-person), or number of questions asked on the survey , or timing of survey administration. The survey questions may be similar to the example provided in the Planning instructions - see Recommended Survey Questions.

Total - is the final accumulation of participants, terminees, terminee characteristics, program outcomes, etc., for the program year.

Total Concurrent Participants funded by Non-Section 166 Programs - the total number of Section 166 participants who are also receiving services provided by other Non-Section 166 employment or training programs. [See Appendix - Other Employment & Training Programs]

Total Participants - the total number of participants enrolled in the Section 166 program for the Program Year.

Training Assistance to Applicants - include: 1) Outreach, 2) intake, 3) screening for eligibility determination.

Training Assistance to Participants - includes, but is not limited to: 1) Orientation to the world of work; 2) testing and counseling; 3) employability assessment other than that involved during intake); 4) job development; 5) job search assistance; 6) job referral and placement; 7) vocational exploration program (VEP); 8) case management.

Underemployed - means an individual who is working part time but desires full time employment, or who is working in employment not commensurate with the individual's demonstrated level of educational attainment.

Unsubsidized Employment - non-WIA funded Employment which includes entry into the Armed Forces, entry into employment in a registered apprenticeship program, or self employment. Also included are individuals who are regularly employed on the staff of a WIA program.

Veteran - an individual who served in the active military, naval, or air services, and who was discharged or released from such service under conditions other than dishonorable.

Vocational Education - provides individuals with the technical skills and information required to perform a specific job or group of jobs.

Wage Growth at Job Placement (performance measure) - as a rate, those terminees whose wage at termination exceeds their preprogram wage (wage of the last job held in the 12 months before enrollment) by at least 10%, as a percentage of all terminees who enter employment at termination and who had a job in the 12 months before enrollment.

Welfare-to-Work Rate (performance measure) - as a rate, those who enter unsubsidized employment at termination, as a percentage of all terminees who are public assistance recipients.

Work Experience - a short-term, long-term or part-time work assignment with an employing agency that can provide positions in the private as well as the public and non-profit sectors. This includes Tribal enterprises which are owned by Indian Tribes provided the profits from such enterprises are used exclusively for functions normally performed by the governing body of such entities. It is otherwise prohibited in the private-for-profit sector.

Youth Progress Rate (performance measure) - for youth enrolled in the Section 166 program, those who at termination show progress and improved skills by completing at least two of the following activities listed during their enrollment: 1) completed job readiness or VEP, 2) complete career assessment, 3) secure unsubsidized employment or enlist, 4) participate in youth services that result in youth; a) returning to school, b) remaining in school, or c) enrolling in Job Corps, 5) improve basic skills by at least two grade levels, or 6) complete occupational skills training.

25-10-10 Rule - at least one of the three measures selected from the menu of measures options must represent 25% of the program's terminees for that program year. In addition, each of the other measures selected must represent at least 10% of the total terminees in the program for that program year. This ensures that each of the measures cover a significant number of terminees in the grantee's entire program

Page 3 of 3 ETA 9085 (November 2000)

d. Signature and Title: __________________________________ e. Date Signed: _______________ f. Telephone Number: (_____)_____-__________

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents obligation to reply to these reporting requirements are required to obtain or retain benefits (20 CFR 668.610). Public reporting burden for this collection of information is estimated to average 9.67 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of National Programs, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington, D.C. 20210 (Paperwork Reduction Project Number: 1205-0422).

The Workforce Investment Act, Section 166

Indian and Native American Supplemental Youth Services Program

Report

1. Purpose. The Supplemental Youth Services report provides cumulative data on participation, termination, performance outcomes, and socio-economic characteristics of participants. Grantees are required to submit a semi-annual and annual report to DINAP. The information is used to determine the levels of program service and program accomplishments for the report year.

2. General Instructions. The Supplemental Youth Services report covers the period beginning April 1 through March 31. The annual report contains cumulative data from the beginning of the reporting year.

Semi-annual reports are to be postmarked and sent to DOL no later than 45 days after the end of the first six months of the cycle and Annual reports must be sent no later than 90 days after the end of the report year (June 30). Three copies of the report must be submitted to:

U.S. Department of Labor
Employment and Training Administration
Attention: MIS, Room N-4641
200 Constitution Avenue, N.W.
Washington, D.C. 20210

3. Report Form. The report form is ETA 9085. See next page.

4. Instructions for Completing the Supplemental Youth Services Report.
a.Grantee Name and Mailing Address - Enter the grantee name and mailing address as it appears on the appropriate Notice of Obligation (NOO) or equivalent.

b.Grant Number - Enter the grant number as it appears on the appropriate NOO for the Supplemental Youth Services (SYS) program or equivalent.
c.Report Period - Enter the beginning date of the designated Report Year and the ending date of each reporting cycle.
d.Signature and Title - An authorized signature and title must be entered on the report.
e.Date Signed - Enter the date the report was signed by the authorized official.
f.Telephone Number - Enter the area code and telephone number of the authorized official.

5. General Information. Terms are defined in the attached Appendix.

6. Section I - Participation and Termination Summary. Section I collects information on the number of participants (including new and carried-over participants) and information on those individuals who enrolled in the program and terminated during the course of the reporting period.

7. Section II - Participant Characteristics. Section II collects characteristic information of participants, including those currently enrolled in the program, at the end of the reporting period and those who terminated at anytime during the report year. Data reported in this section should be based on information collected at the time of eligibility determination. Information on individual characteristics should not be updated when the individual terminates from the program.

8. Section III - Participant Goals and/or Attainments. Section III collects performance outcome information and other goal attainments achieved by participants during the report period, including participants still enrolled in the program at the end of the reporting period and those who terminated at anytime during the report year. Participants may be counted in as many goals attained during the course of the reporting period.

9. Section IV - Performance Goal Attainment. Section IV collects information that projects whether the grantee has met it's minimum performance requirement for the report year. This section captures performance outcomes attained by participants during the program year, including those still enrolled in the program at the end of the reporting period and those who terminated at during the report year. The minimum requirement is that 60% of Native American (INA) youth enrolled in the Supplemental Youth Services Program reported must attain at least two goals under Section III.

The Workforce Investment Act Title I

Indian and Native American Supplemental Youth Services Program

Appendix

Alternative School - a specialized, structured curriculum offered inside or outside of the public school system which may provide work/study and/or GED preparation.

Assessment Services - a service designed to initially determine each participant's employability, aptitude, abilities and interests, through interviews, testing and counseling to achieve the applicant's employment related goals.

Attained GED (Goal/Outcome) - youth who attained a GED recognized by the State as a result of program participation.

Attained High School Diploma (Goal/Outcome) - at-risk youth who attained a high school diploma recognized by the State during enrollment.

Attended Post High School - an individual who has received a high school diploma or a GED certificate and has attended but is not currently attending a post-secondary level vocational, technical, or academic program (one normally requiring a high school diploma or GED for entry)

Basic Education Skills - training that includes remedial reading, writing, communication, mathematics GED and/or English for non-English speakers.

Basic Skills Deficient - is a determination that an individual: (1) computes or solves problems, reads, writes, or speaks English at or below the 8^th grade level; or (2) is unable to compute or solve problems, read, write, or speak English at a level necessary to function on the job, in the individual's family or in society.

Completed Career Assessment (Goal/Outcome) - individuals who have completed, during the course of their program participation, a formal career assessment of occupational interests, values, skills, or aptitudes, leading to an identification of careers for which the participant may be suited.

Completed Internship or Vocational Exploration Program (Goal/Outcome) - individuals who have completed, during the course of their program participation, a work internship or a vocational exploration program designed to provide exposure to alternative career areas.

Completed Job Readiness/Orientation to the World of Work Training (Goal/Outcome) - individuals who have completed, during the course of their program participation, a course of instruction relating to job readiness or world of work skills, including training to develop positive work habits, attitudes and behavior, such as punctuality, regular attendance, presenting a neat appearance, getting along and working well with others, exhibiting good conduct, following instructions and completing tasks, accepting constructive criticism from supervisors and co-workers, showing initiative and reliability, and assuming the responsibilities involved in maintaining a job. This category also entails developing an awareness of the labor market and occupational information, and job search techniques, including preparing resumes and applications and improving interviewing techniques.

Completed Leadership Skills Training (Goal/Outcome) - individuals who have attained, during the course of their program participation, training intended to impart leadership skills.This category includes providing exposure to post-secondary educational opportunities; community and service learning projects; peer-centered activities (including peer mentoring and tutoring); organizational and team work training (including team leadership training); training in decision-making (including determining priorities); citizenship training (including life skills training such as parenting and budgeting of resources); positive social behaviors; any organized group counseling program; or "youth camp".

Completed Occupational Skills Training (Goal/Outcome) - individuals who at termination had completed occupational skills training as a result of program participation. Note: occupational skills training includes (1) vocational education which is designed to provide individuals with the technical skills and information required to perform a specific job or group of jobs, and (2) on-the-job training, which is training provided by an employer that is provided to a paid participant while engaged in productive work in a job that (a) provides knowledge or skills essential to the full and adequate performance of the job, and (b) provides reimbursement to the employer of up to 50% of the wage rate of the participant, for the supervision related to the training, and (c) is limited in duration appropriate to the occupation for which the participant is being trained, taking into account the content of the training, the prior work experience of the participant, and the service strategy of the participant, as appropriate.

DINAP - means the Division of Indian and Native American Programs within the Employment and Training Administration of the Department of Labor.

Eligibility Determination Criteria - a person is eligible to receive services under the INA Supplemental Youth Services program if that person is: (1) An Indian, as determined by a policy of the Native American grantee, (2) an Alaska native, as defined in Section 3(b) of the Alaska Native Claims Settlement Act (ANCSA), 43 U.S.C. 1602(b); or (3) Native Hawaiian, as defined in WIA section 166(b)(3). The person must also meet the definition of Eligible Youth, as defined in WIA section 101(13). As such, youth participants must be not less than age 14 or more than age 21 and must be deficient in basic literacy skills, a school dropout, homeless or a runaway or foster child, pregnant or a parent, an offender, or an individual who requires additional assistance to complete an educational program or to secure and hold employment. Additionally, participants must be low-income individuals, except that not more than five percent who do not meet this minimum income criterion may be considered eligible youth if they are school dropouts; are basic skills deficient; have an educational attainment that is 1 or more grade levels below the grade level appropriate to their age; are pregnant or parenting; are individuals with disabilities, including learning disabilities; are homeless or runaway youth; are offenders; or are other eligible youth who face serious barriers to employment.

Enrolled in Job Corps (Goal/Outcome) - individuals who enrolled in Job Corps who may or may not still be receiving Supplemental Youth services.

Entered Other (Non-Supplemental Youth) Training Program (Goal/Outcome) - an individual who, at termination, enters other training, including occupational skills training or postsecondary education, using funds other than those from the INA SupplementalYouth ServicesProgram. This excludes those enrolled in Job Corps.

Entered Unsubsidized Employment (including entering the military) [Goal/Outcome)] - individuals who, upon termination, entered non-WIA funded employment, including entry into the Armed Forces or self-employment.Also included are individuals who are regularly employed on the staff of a Sec. 166 (or other)WIA program.

High School Graduate or Equivalent (no post high school) - an individual who, at enrollment, had received a high school diploma only, but who had not attended any post-secondary level vocational, technical, or academic program (one normally requiring a high school diploma or GED for entry).

Improved Basic Skills Levels by At least Two Grades (Goal/Outcome) - individuals who advanced at least two grade levels in either reading or math skills. Skill gain must be achieved through active program participation and must be documented through standardized testing.

INA Grantee - means an entity which is formally designated under subpart B of this part to operate an INA program and which has a grant agreement pursuant to 20 CFR 668.292.

Intake Services - the screening for eligibility; and 1) a determination of whether the program can benefit the individual; 2) an identification of the employment and training activities and services which would be appropriate for that individual; 3) a determination of the availability of an appropriate employment and training activity; 4) a decision on selection for participation; and 5) the dissemination of information on the program.

Offender - youth who (a) are or have been subject to any stage of the criminal justice process, for whom services under WIA may be beneficial; or (b) require assistance in overcoming artificial barriers to employment resulting from a record of arrest or conviction.

Participant - an individual who has been determined eligible upon intake to participate in and who is receiving services (other than follow-up services authorized under this title) under a program authorized by this title. This does not include individuals who receive only outreach and/or intake and initial assessment. Participation begins on the first day, following determination of eligibility, when the individual began receiving subsidized employment, training, or other services provided under this title.

Performance Goal Attainment - used to determine the level of performance a grantee achieves for the program years. Grantees must meet at a minimum a 60% goal attainment rate for the program year. At least 60 % of youth participants enrolled in the Grantee's Supplemental Youth Services Program must attain at least two of the twelve goals listed in Section IV.

Pregnant and/or Parenting Youth - a female who is under 22 years of age and who is pregnant/parenting, or a male under 22 years of age who is providing custodial care for one or more dependents under age 18.

Public Assistance Recipient - an individual who at time of eligibility determination, was listed on the welfare grant and was receiving cash payments from a means-tested, income transfer program, or was receiving Food Stamps or commodities. The income transfer programs include TANF (SSA Title IV), [General Assistance (Tribal, BIA, State or local government)], Refugee Assistance (PL 96-212), and SSI (SSA Title XVI).

Remained in School (Goal/Outcome)] - youth participants who were at-risk of dropping out of school but, who were retained in school as a result of continuing active participation in the Supplemental Youth Services program.

Returned to Full-time School (Goal/Outcome) - youth participants who, at intake, were not attending school (exclusive of summer), and had not obtained a high school diploma or equivalent and returned to full-time secondary school (e.g., junior high school, middle school, and high school) including alternative school as a result of participating in the Supplemental Youth Services Program.

School Dropout - as defined by the legislation, an individualwho, at enrollment, is no longer attending any school and who has not received a secondary school diploma or its recognized equivalent.

Student - individuals who, at time of enrollment, are attending any school (including elementary, intermediate, junior high school, secondary or post-secondary, or alternative school program), whether full or part-time, or are between school terms and intends to return to school.

Subsidized Employment - WIA funded employment (e.g. work experience).

Termination - the separation of a participant from a given title of the Act who is no longer receiving employment, training, or services (except post-termination services) funded under the title.

Total Current Participants - the total number of participants who are currently still enrolled in the program (as of close of business on the last day of the program year) and who will continue to receive services into the next program year.

Unsubsidized Employment - non-WIA funded employment which includes entry into the Armed Forces, entry into employment in a registered apprenticeship program, or self employment. Also included are individuals who are regularly employed on the staff of a Sec. 166 (or other)WIA program.

Vocational Education - provides individuals with the technical skills and information required to perform a specific job or group of jobs.

Work Experience - a short-term, long-term or part-time work assignment with an employing agency that can provide positions in the private as well as the public and non-profit sectors. This includes Tribal enterprises which are owned by Indian Tribes provided the profits from such enterprises are used exclusively for functions normally performed by the governing body of such entities.