ETA 9103-3 PLANNING FORM 3 Trade-WIA Dual Enrollment

E. PLANNING FORM* 3 – Trade-WIA Dual Enrollment 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 (NEG-funded only)

Receiving Supportive Services (NEG-funded only)

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 (NEG-funded only)

Supportive Services (NEG-funded only)

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

The reporting requirements are approved by OMB according to the Paperwork Reduction Act of 1995 under OMB approval No. 1205-0439. NOTE: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondent’s obligation to reply to these reporting requirements are mandatory (PL: 107-210). Public reporting burden for this collection of information is estimated at 15 minutes. Send comments regarding the burden estimate or any other aspect of this collection, including suggestions for reducing this burden to the U.S. Department of Labor, Office of National Response, Room N-5422, Washington D.C. 20210. (Paperwork Reduction Project 1205-0439).