Form ETA-9104 Quarterly Performance Report

U.S. Department of Labor OMB Control No. 1205-0439

Employment and Training Administration Expiration Date: 06/30/2010

Quarterly Performance Report Form, ETA 9104

National Emergency Grant Electronic Application System

Grantee:

Grant #:

Project Type:

Project

Grant Quarter:

Performance Period Covered by this Report:

Receiving Intensive Services
Enrolled In NEG-Funded Training
Receiving NEG-Funded Supportive Services
Receiving NEG-Funded Supportive Services
Exists
Entering Employment At Exit
Total Participants
Supportive Services
Program Management & Oversight
Administration, excl. NRP/Premium Payment Processing
Other
Total—Program Management and Oversight
Indirect
Other
Total Expenditures: Grantee Level
Core and Intensive Services
NEG-Funded Training
NEG-Funded Supportive Services
Program Management & Oversight
Other
Total—Program Management & Oversight
Other
Total Expenditures: Project Operator Level
Total Expenditures: Grantee and Project Operator

Public Burden Statement:

Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control number. Respondents’ obligation to complete this form is required to obtain or retain benefits ( PL: 107-210). Public reporting burden for this collection of information is estimated to average 30 minutes 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. This is public information and there is no expectation of confidentiality. Send comments regarding this burden estimate to the U.S. Department of Labor, Office of National Response, Room C-5311, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0439).

ETA Form 9104 (March 2004)

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