Form ETA 9103-1 ETA 9103-1 PLANNING FORM 1- Regular Projects

PLANNING FORM* 1- Regular Projects OMB Approval No. 1205-0439

All quarterly entries are CUMULATIVE over all previous quarters Expiration Date: 01/31/07

Performance Factor

program year quarter

Admin

Program

Qtr 1

Qtr 2

Qtr 3

Qtr 4

Qtr 5

Qtr 6

Qtr 7

Qtr 8

Qtr 9

Qtr 10

Qtr 11

Qtr 12

Implementation Schedule

Total Planned Participants

Receiving Intensive Services

Enrolled in Training

Receiving Supportive Services

Receiving Needs Related Payments

Exits

Entering Employment at Exit

Total Expenditures: Grantee Level

Supportive Services

Program Management and Oversight

Admin Excluding NRP Processing*

NRP Processing

Other *

Indirect

Other*

Total Expenditures: Project Operator Level

Core and Intensive Services

Training

Supportive Services

NRPs

Other*

Program Management and Oversight

Admin Excluding NRP Processing*

NRP Processing

Other *

Total Expenditures: Grantee and Project Operator Level

*This form must be accompanied by an appropriate budget narrative which lists, for each *ed line item, components of the costs, e.g. staff salaries, fringe benefits, equipment, travel, facilities, and the estimated cost amounts for each.

ETA 9103