Form VETS-404 - Incentive Award Report

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Overview

VETS-404
VETS-404 Cont'd

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Sheet 1: VETS-404

Accessibility key: Only cells that can be edited may be selected.
Accessibility key: Only cells that can be edited may be selected. A value followed by an asterisk indicates an invalid entry.	U.S. Department of Labor			Jobs for Veterans State Grants						OMB Control Number: 1293-0009
	Veterans' Employment and Training Service			Incentive Award Report						Expiration Date: mm/dd/yyyy
	Section A: General Information
		1. State:				4. Incentive Award Allocation Amount:		VETS-401 Item B.4.i; must match the VETS-402 EDR Item B.4 as of Q4
		2. State Agency Name:			5. Cumulative Incentive Award Outlays & Obligations per VETS-402:
		3. Date Prepared or Updated:						VETS-402 EDR Item C.4.c as of Q4
	Section B: Incentive Award Allocation Usage
	Table 1. Individual Incentive Awards. In the table below, enter the name and title of each employee who was issued an individual cash performance incentive award this fiscal year, and the amount of the award. If more rows are needed, use the VETS-404 Continuation Sheet.					Table 2. Office Incentive Awards. In the table below, enter the name, location, and type of each office that was issued an office cash performance incentive award this fiscal year, and the amount of the award. If more than 20 rows are needed, use the VETS-404 Continuation Sheet.
		Individual's Name	Title	Cash Amount		Office Name	Office Location	Office Type	Cash Amount
			Total from Continuation tab:	$-				Total from Continuation tab:	$-
			Total Individual Cash Awards:	$-				Total Office Cash Awards:	$-
	Section C: Other Incentive Awards					Section D: Deviation from Incentive Award Plan
	Table 3. In the table below, identify recipients of any non-cash incentive awards that were charged to the base allocation, and a description and cost of the award. If more rows are needed, use the VETS-404 Continuation Sheet.					In the narrative field below, explain any deviation from the approved incentive award plan, including the reason for spending less than 100% of the incentive award allocation. Enter "N/A" if not applicable.
		Recipient/Team Name/Title	Award Description	Award Cost
						Section E: Plan Development
						If your state does not have an approved incentive award plan, describe your efforts toward developing an approvable plan in the future in the narrative field below. Otherwise, enter "N/A."
			Total from Continuation tab:	$-
			Total:	$-
	Section F: Incentive Award Report Overview
		Summary				Edit Checks
			State's incentive award allocation (entered in Sec. A.4):	$0.00		1. Do the EDR's reported IA outlays & obligations match IAR Section B total?			Yes
			Incentive award outlays & obligations, per EDR (entered in Sec. A.5):	$0.00		2. Are IAR Section B totals within the state's incentive award allocation amount?			Yes
			Total per Incentive Award Report (individual + office from Sec. B):	$0.00		3. Has the entire incentive award allocation been expended/obligated by Q4?			Yes
			Total incentive awards charged to JVSG base allocation (Sec. C):	$0.00		4. Have all required fields been completed?			No
		Incentive Award Alerts				Incentive Award References
		Up to 4 alerts will appear below based on the entries throughout this form:				For statute and guidance related to JVSG performance incentive awards, see:
		No alerts! It looks like your VETS-404 IAR is ready to submit.				38 U.S. Code § 4102A(c)(2)(A)(iii): Conditions for the receipt of funds
		There is a $0 mismatch between amounts reported on the EDR vs IAR. Compare your entries in Section A with your EDR and ensure all individual and office cash awards have been accurately entered in Section B.				38 U.S. Code § 4112: Performance incentive awards for quality employment, training, and placement services
						VPL 01-24 JVSG State Plan Submission and Modification
		The awards in Section B are greater than the incentive award allocation entered in Section A. Double-check your most recently approved VETS-401 Budget Information Summary and the incentive awards entered in Section B.				-Attachment 5 JVSG Incentive Award Plan Technical Assistance Guide
						VPL 03-23 JVSG Annual Funding Applications, Section V.A
		Your incentive award allocations was not fully obligated by the end of the fourth quarter. Be sure to leave $0 unspent or you will need to return the funds before the grant can be closed out.				VPL 03-22 JVSG Recurring Reports and Forms, Section VII
		Some required fields appear to be blank. Enter 'N/A' for narrative fields that are not applicable, and be sure to complete each field in the tables for any row that has an associated cost. There are currently 7 blank fields that need a response. Tip: check the Continuation tab entries.
	$0						VETS-404 Incentive Award Report
							Revised March 2025
	Public Burden Statement - According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1293-0009. The time required to complete this information collection is nn hours per response, including the time to review instructions, search existing data sources, gather the data needed, and complete and review the information collection. The obligation to respond is required to obtain or retain a benefit (38 U.S.C. 2021 and 2023). If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Labor, Veterans' Employment and Training Service, 200 Constitution Avenue, N.W., Washington, D.C. 20210.
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Sheet 2: VETS-404 Cont'd

Accessibility key: Only cells that can be edited may be selected.
Accessibility key: Only cells that can be edited may be selected. A value followed by an asterisk indicates an invalid entry.				Jobs for Veterans State Grants
				Incentive Award Report Continuation Sheet
		Use this tab only if the number of rows provided in Tables 1, 2, and/or 3 on the VETS-404 were insufficient. Otherwise, leave this tab blank.
	Section B, Continued: Incentive Award Allocation Usage
	Table 1. Individual Incentive Awards, Continued. In the table below, enter the name and title of each employee who was issued an individual cash performance incentive award this fiscal year, and the amount of the award.					Table 2. Office Incentive Awards, Continued. In the table below, enter the name, location, and type of each office that was issued an office cash performance incentive award this fiscal year, and the amount of the award.
		Individual's Name	Title	Cash Amount		Office Name	Office Location	Office Type	Cash Amount
			Total Continuation Sheet Individual Cash Awards:	$-				Total Continuation Sheet Office Cash Awards:	$-
	Section C, Continued: Other Incentive Awards
	Table 3. In the table below, identify recipients of any non-cash incentive awards that were charged to the base allocation, and a description and cost of the award.
		Recipient/Team Name/Title	Award Description	Award Cost
			Total Continuation Sheet Noncash Awards:	$-
End form