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Public Law 102 -477 Annual Report Public Law 102 -477 Annual Report

Public Law 102 -477 Statistical Report Pub. L. 102 -477 Statistical Report Tribal Nation Public Law 102 -477 Statistical Report Pub. L. 102 -477 Statistical Report Tribal Nation Report Period From: To: 1. Enter the name of the Tribal Nation or Consortium 2. Enter your report period.

Participant Requirements To be considered a participant they: • Must complete an application. • Participant Requirements To be considered a participant they: • Must complete an application. • Submit supporting documentation. • Eligible to receive services.

 • Participant is 22 years or older at program entry. • If the • Participant is 22 years or older at program entry. • If the participant receives cash assistance at any time, DO NOT report him/her in the Adult column, report as cash assistance recipient.

 • Participant is a Youth if 21 years or younger at program entry. • Participant is a Youth if 21 years or younger at program entry. • If the participant receives cash assistance at any time, DO NOT report him/her in the Youth column, report as cash assistance recipient.

Criteria for Reporting Cash Assistance Recipients • No age requirement. • Participant must be Criteria for Reporting Cash Assistance Recipients • No age requirement. • Participant must be deemed eligible to receive or is receiving cash assistance, such as General Assistance funds (BIA) or Temporary Assistance for Needy Families (DHHS). • If the participant received cash assistance at any time during enrollment, or 60 days prior to enrollment, they should be reported in the Cash Assistance Recipient column.

Criteria for Reporting Cash Assistance Recipients • Dependents of participants receiving cash assistance should Criteria for Reporting Cash Assistance Recipients • Dependents of participants receiving cash assistance should not be reported as receiving cash assistance. Only report the individual receiving the service through your program. • You can report participants as cash assistance recipients even if you do not have GA or TANF in your 477 program. We want to show a clearer picture of the individuals you serve through your program.

Participants Served I. Participants Served Adults A. Total Participants 125 Youth Cash Assistance Recipients Participants Served I. Participants Served Adults A. Total Participants 125 Youth Cash Assistance Recipients 55 23 B. Total Terminees C. Total Current Participants • I. A. Total Participants – Report the total number of participants served in the 477 program (include current and terminated individuals) during your program year.

Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 55 23 B. Total Terminees 58 26 15 C. Total Current Participants • I. B. Total Terminees – Report the total number of participants that have either successfully or unsuccessfully ceased enrollment in your 477 program during your program year.

Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 55 23 B. Total Terminees 58 26 15 C. Total Current Participants • I. B. Total Terminees – If a terminee is 22 years & older count him/her in the Adult column, unless at the time of enrollment the person was considered a youth – For example, If the participant enrolled at age 20 and terminated at 23, that participant is reported as a youth at termination.

Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 55 23 B. Total Terminees 58 26 15 C. Total Current Participants • I. B. Total Terminees – If a terminee is 21 years and younger they should be counted in the Youth column. – If the participant was a cash assistance recipient at any time during enrollment, or 60 days prior to enrollment, he/she should be reported in the Cash Assistance Recipient column, regardless of age.

Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 Participants Served I. Participants Served Adults Youth Cash Assistance Recipients A. Total Participants 125 55 23 B. Total Terminees 58 26 15 C. Total Current Participants 67 29 8 • I. C. Total Current Participants – The total number of participants considered to have been served at any time during the reporting period, but have not yet completed & terminated from the program as of the last day of the report period. – Simply put---those remaining in your program that have not been terminated.

Terminee Outcomes • Only report participants that have terminated at any time during the Terminee Outcomes • Only report participants that have terminated at any time during the reporting period, whether or not they have been successful in meeting their stated short or long range goals. These are the individuals reported in I. B. Total Terminees. • Participant information can be recorded at any time within 90 days following the completion or termination from the program. • Do Not include characteristics of all participants.

Terminee Outcomes • Terminees may be counted once in each of the positive termination Terminee Outcomes • Terminees may be counted once in each of the positive termination categories (i. e. employment objective, education/training objective, miscellaneous objective achieved). • Terminees reported as “Other (nonpositive) may not be counted in any of the three positive termination categories.

Terminee Outcomes II. Terminee Outcomes Adult Cash Assistance Recipients 33 A. Total with Employment Terminee Outcomes II. Terminee Outcomes Adult Cash Assistance Recipients 33 A. Total with Employment Objective Youth 20 12 1. Entered Unsubsidized Employment 2. Other Employment Outcomes 3. Employment Objective Not Achieved 4. Earnings Gain $ $ $ • II. A. Total with Employment Objective – Count all terminees who have been terminated with an employment objective in their individualized service plan. Note: The Total with Employment Objective cannot exceed the actual number of terminees reported for Adult, Youth, and Cash Assistance Recipient columns (section I. B).

 • If you have 58 Total Adult Terminees reported, then the number of • If you have 58 Total Adult Terminees reported, then the number of adults reported in II. A. Total with Employment Objective, and II. B. Total with Educational/Training Objective, cannot be more than 58. However they can be counted with both employment and educational objectives, because all terminees could have had both an employment and educational objective. Adult I. B. Total Terminees 58 II. A. Total with Employment Obj. 62 II. B. Total with Educ. /Training Obj. 58 Ok Ok II. B. Total with Educ. /Training Obj. Not Ok 59 Not Ok

Terminee Outcomes II. Terminee Outcomes Adult 20 12 8 1. Entered Unsubsidized Employment Cash Terminee Outcomes II. Terminee Outcomes Adult 20 12 8 1. Entered Unsubsidized Employment Cash Assistance Recipients 33 A. Total with Employment Objective Youth 2 3 2. Other Employment Outcomes 3. Employment Objective Not Achieved 4. Earnings Gain $ $ $ • II. A. 1. Entered Unsubsidized Employment Report the number of terminees that have entered employment, whom do not receive any subsidy. Include self-employment.

Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 33 20 12 1. Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 33 20 12 1. Entered Unsubsidized Employment 8 2 3 2. Other Employment Outcomes 25 18 7 A. Total with Employment Objective 3. Employment Objective Not Achieved 4. Earnings Gain $ $ $ • II. A. 2. Other Employment Outcomes Terminees whom have an employment objective and met that goal. This includes terminees who have been successfully assisted in retaining an existing job with supportive services or successfully completes an OJT assignment but were not retained in employment.

Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 33 20 12 1. Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 33 20 12 1. Entered Unsubsidized Employment 8 2 3 2. Other Employment Outcomes 25 18 7 3. Employment Objective Not Achieved 1 0 2 A. Total with Employment Objective 4. Earnings Gain $ $ $ • II. A. 3. Employment Objective Not Achieved Report terminees that had an employment objective but did not meet any of their employment goals.

Earnings Gain! • If you report terminees as entering unsubsidized employment • you must Earnings Gain! • If you report terminees as entering unsubsidized employment • you must report II. A. 4. Earnings Gain. • Unsubsidized Employment and Earnings Gain are directly related!

Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 33 20 12 1. Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 33 20 12 1. Entered Unsubsidized Employment 8 2 3 2. Other Employment Outcomes 25 18 7 3. Employment Objective Not Achieved 1 0 2 A. Total with Employment Objective 4. Earnings Gain $2. 68 $ $5. 15 • II. A. 4. Earnings Gain For those terminees entering unsubsidized employment, calculate the hourly wage of the last job held within the last six (6) months prior to program enrollment and compare that rate with the rate at the time of termination from the program.

Example of Earnings Gain • If a terminee earned $5. 15/hour at a job Example of Earnings Gain • If a terminee earned $5. 15/hour at a job held six months prior to enrollment in the program and terminated the program gaining unsubsidized employment earning $6. 25/hour, the earnings gain for the individual is $1. 10. • Not all earning gains are positive.

Example of Earnings Gain • If the terminee was unemployed for six months prior Example of Earnings Gain • If the terminee was unemployed for six months prior to entering the program, their hourly rate at entry is $0. • If that terminee gains unsubsidized employment earning $6. 50/hour, the gain would be $6. 50/hour.

Calculating the Average Gain • Add all gains (+) and any losses (-). • Calculating the Average Gain • Add all gains (+) and any losses (-). • Divide the total of gains/losses by the number of terminees entering unsubsidized employment. • The result is the average gain. • Report the average gain dollar amount in II. A. 4.

Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients B. Total with Educational/Training Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients B. Total with Educational/Training Obj. 30 7 5 1. Degree/Certificate Attempted/Attained / / / 2. Other Education Outcome 3. Education Objective Not Achieved 4. Literacy Gain – # of participants attempted/attained / 5. Numeracy Gain– # of participants attempted/attained / • II. B. Total with Educational/Training Objective Report the number of terminees who have terminated from the program and had an educational/training objective. Include terminees gaining knowledge such as completing a semester or more of classes or long/short term classroom training measurement.

Terminee Outcomes II. Terminee Outcomes B. Total with Educational/Training Obj. 1. Degree/Certificate Attempted/Attained Adult Terminee Outcomes II. Terminee Outcomes B. Total with Educational/Training Obj. 1. Degree/Certificate Attempted/Attained Adult Youth Cash Assistance Recipients 30 7 5 / / / 2. Other Education Outcome 3. Education Objective Not Achieved 4. Literacy Gain – # of participants attempted/attained / 5. Numeracy Gain– # of participants attempted/attained / • II. B. 1. Degree/Certificate Attempted/Attained The first number is the total number of terminees that attempted a degree/certificate, whether or not they attained the degree/certificate. The second number is the total number of terminees that attained a degree/certificate.

Terminee Outcomes II. Terminee Outcomes B. Total with Educational/Training Obj. 1. Degree/Certificate Attempted/Attained 2. Terminee Outcomes II. Terminee Outcomes B. Total with Educational/Training Obj. 1. Degree/Certificate Attempted/Attained 2. Other Education Outcome Adult Youth Cash Assistance Recipients 30 7 5 29 / 5 6/0 5/1 24 7 4 3. Education Objective Not Achieved 4. Literacy Gain – # of participants attempted/attained / 5. Numeracy Gain– # of participants attempted/attained / • II. B. 2. Other Education Outcome Report terminees that had an educational goal, were terminated from the program, and met a goal other than attainment of a certificate or degree.

Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 30 7 5 29 Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients 30 7 5 29 / 5 6/0 5/1 2. Other Education Outcome 24 7 4 3. Education Objective Not Achieved 1 0 1 B. Total with Educational/Training Obj. 1. Degree/Certificate Attempted/Attained 4. Literacy Gain – # of participants attempted/attained / 5. Numeracy Gain– # of participants attempted/attained / • II. B. 3. Education Objective Not Achieved Report terminees who had educational goals and terminated from the program without meeting any of their goals.

Terminee Outcomes II. Terminee Outcomes C. Misc. Objective Achieved Adult Youth Cash Assistance Recipients Terminee Outcomes II. Terminee Outcomes C. Misc. Objective Achieved Adult Youth Cash Assistance Recipients 0 0 1 D. Other (Non-Positive) • II. C. Miscellaneous Objective Achieved Report all terminees that met one or more of their short or long-term goals. For example, a terminee may have acquired a driver’s license, or may have had applying for other supportive services as a goal, e. g. LIHEAP. The miscellaneous objective cannot be reported elsewhere on the report.

Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients C. Misc. Objective Achieved Terminee Outcomes II. Terminee Outcomes Adult Youth Cash Assistance Recipients C. Misc. Objective Achieved 0 0 1 D. Other (Non-Positive) 2 0 3 • Report only the terminees that failed to meet their short and long-term goals as stated in their development plan. • If a terminee met one or more of their goals but not their final goal, they should be counted in sections II. A. , II. B. , or II. C.

Terminee Characteristics III. Terminee Characteristics Adult Youth Cash Assistance Recipients A. Female B. Male Terminee Characteristics III. Terminee Characteristics Adult Youth Cash Assistance Recipients A. Female B. Male C. Education Level: 1. Dropout 2. Student 3. High School Diploma/GED 4. Post High School D. Veteran • III. Terminee Characteristics – Report only those terminees who have their cases closed and were included in I. B. Total Terminees. – Do Not include characteristics of all participants, only terminees.

Terminee Characteristics III. Terminee Characteristics Adult Youth Cash Assistance Recipients A. Female B. Male Terminee Characteristics III. Terminee Characteristics Adult Youth Cash Assistance Recipients A. Female B. Male C. Education Level: 1. Dropout 2. Student 3. High School Diploma/GED 4. Post High School D. Veteran • III. A. /B. Female/Male – Report the number of females/males reported in section I. B. Total Terminees. – The total of females + males should equal the total number of terminees reported in section I. B.

Terminee Characteristics III. Terminee Characteristics C. Education Level: Adult Youth Cash Assistance Recipients 1. Terminee Characteristics III. Terminee Characteristics C. Education Level: Adult Youth Cash Assistance Recipients 1. Dropout 2. Student 3. High School Diploma/GED 4. Post High School D. Veteran • III. C. Education Level Report the education level of the terminees reported in section I. B. Total Terminees at time of enrollment into the program. The total sum of education level (1 -4) should equal the total number of terminees reported in section I. B.

Example III. Terminee Characteristics Youth 10 3 5 2. Student 5 16 0 3. Example III. Terminee Characteristics Youth 10 3 5 2. Student 5 16 0 3. High School 30 3 9 4. Post High School C. Education Level: Adult 13 4 1 1. Dropout Cash Assistance Recipients Diploma/GED D. Veteran • III. C. Education Level If you reported 58 total terminees in section I. B. , then the total of education levels should equal 58. The same is true for the Youth and Cash Assistance Recipients columns.

Terminee Characteristics III. Terminee Characteristics C. Education Level: Adult Youth Cash Assistance Recipients 1. Terminee Characteristics III. Terminee Characteristics C. Education Level: Adult Youth Cash Assistance Recipients 1. Dropout 2. Student 3. High School Diploma/GED 4. Post High School D. Veteran 2 1 • III. D. Veteran –Report all terminees that have served in the military and are considered veterans.

Participant Activities • Report ALL participants (current or terminated). • Report the type of Participant Activities • Report ALL participants (current or terminated). • Report the type of activities, goals, and objectives established for participants through their development plan. • If a participant was involved in more than 1 activity, goal, or objective, count the participant once in each category of activity that applies. • The total number of participants reported in this section may be greater than the total number of participants reported in section I. A. Total Participants.

Participant Activities IV. Participant Activities Adult A. Employment 65 Youth Cash Assistance Recipients 26 Participant Activities IV. Participant Activities Adult A. Employment 65 Youth Cash Assistance Recipients 26 20 B. Education/Training C. Misc. Objective/Supportive Services D. Other/Service Referral • IV. A. Employment Report participants engaged in employment activities, such as, job referrals, Work Experience, job interviewing, supportive work services, and job related goals.

Participant Activities IV. Participant Activities Adult Youth Cash Assistance Recipients A. Employment 65 26 Participant Activities IV. Participant Activities Adult Youth Cash Assistance Recipients A. Employment 65 26 20 B. Education/Training 85 38 19 C. Misc. Objective/Supportive Services D. Other/Service Referral • IV. B. Education/Training Report participants engaged in any educational or training activity, including OJT, Adult Basic Education, GED prep, and related services.

Participant Activities IV. Participant Activities Adult Youth Cash Assistance Recipients A. Employment 65 26 Participant Activities IV. Participant Activities Adult Youth Cash Assistance Recipients A. Employment 65 26 20 B. Education/Training 85 38 19 C. Misc. Objective/Supportive Services 10 2 12 D. Other/Service Referral • IV. C. Miscellaneous Objective /Supportive Services Report participation in non-employment and noneducation activities. Examples of this activity are transportation assistance, housing assistance, assistance in obtaining a driver’s license, childcare when furnished to adults as supportive services, and similar assistance.

Participant Activities IV. Participant Activities Adult Youth Cash Assistance Recipients A. Employment 65 26 Participant Activities IV. Participant Activities Adult Youth Cash Assistance Recipients A. Employment 65 26 20 B. Education/Training 85 38 19 C. Misc. Objective/Supportive Services 10 2 12 D. Other/Service Referral 2 1 1 • IV. D. Other/Service Referral Report any other services or referrals provided to participants. Examples are

Child Care Development Activities V. Child Care Development Activities A. Families Receiving Child Care Child Care Development Activities V. Child Care Development Activities A. Families Receiving Child Care Adult Youth Cash Assistance Recipients 22 B. Children Receiving Child Care 1. Ages 0 to 3 years 2. Ages 4 to 5 years 3. Ages 6 and above • V. A. Families Receiving Child Care Report the number of family units provided with child care services that are funded through the 477 budget.

Child Care Development Activities V. Child Care Development Activities A. Families Receiving Child Care Child Care Development Activities V. Child Care Development Activities A. Families Receiving Child Care B. Children Receiving Child Care Adult Youth Cash Assistance Recipients 22 26 1. Ages 0 to 3 years 6 2. Ages 4 to 5 years 10 3. Ages 6 and above 10 • V. B. 1 -3. Children Receiving Child Care Report the number of children served. The total of the three age categories should add up to the total number of children reported receiving child care. Report services provided through the program whether or not the 477 budget includes funds from formal child care programs, such as CCDF.

Child Care Development Activities V. Child Care Development Activities Adult Youth Cash Assistance Recipients Child Care Development Activities V. Child Care Development Activities Adult Youth Cash Assistance Recipients C. Care Received – Type of Provider 1. Tribal Center Based 15 2. Other Center Based 5 3. Group Home 0 4. Other Care 6 • V. C. 1 -4. Care Received Report the type of childcare provider used most often by each child. The types of providers should add up to the total number of children receiving child care.

Jobs Creation/Economic Development VI. Jobs Creation/Economic Development Jobs Created Indians/Alaska Natives Employed Businesses Assisted Jobs Creation/Economic Development VI. Jobs Creation/Economic Development Jobs Created Indians/Alaska Natives Employed Businesses Assisted A. Number • VI. A. Jobs Creation/Economic Development Report the number of new jobs (not participants) created as a result of you 477 program. Report the number of Indians/Alaska Natives employed as a result of the new jobs created. Report the number of businesses assisted by your 477 program. This may include supportive services such as, counseling services for existing employees, training for employees, OJT placements, recruitment and advertisement of positions, and related support.

Who completed this report? Report Prepared By: Stephanie Juanico Printed Name & Signature Phone Who completed this report? Report Prepared By: Stephanie Juanico Printed Name & Signature Phone Number Date 202 -208 -5819 OMB Control No. 1076 -0135 Expiration Date: 09/30/10 • The individual completing the report should include their name (printed & signed), phone number, and date the report was completed, so we have contact information in the event of a discrepancy.

Suggestions • Keep a binder of activities your program offers for reference to assist Suggestions • Keep a binder of activities your program offers for reference to assist with writing the narrative report. • Keep a log of all participants as they terminate the program within the program year. • If you report statistical data manually, code participant files to identify adults, youth, and cash assistance recipients, for easy reference.

Public Law 102 -477 - Tribal Work Group - Executive Committee Address Phone Fax Public Law 102 -477 - Tribal Work Group - Executive Committee Address Phone Fax Co-Chair Rae. Belle Whitcomb Bristol Bay Native Association P. O. Box 310 Dillingham, AK 99576 (907) 842 -2262, Xt 410 (907) 842 -3498 Co-Chair Margaret Zientek Citizen Potawatomi 1601 S. Gordon Cooper Drive Shawnee, OK 74801 (405) 598 -0797 (405) 598 -0833 Secretary Kim Carroll Cherokee Nation 17675 S. Muskogee Ave. Tahlequah, OK 74465 (918) 207 -3842 (918) 458 -7694 At-Large Rep Brenda Schwantes Sun’aq Tribe of Kodiak 312 W. Marine Way Kodiak, AK 99615 (907) 486 -4449 (907) 486 -3361 At-Large Rep Kay Kidder Nez Perce Tribe 116 Veterans Drive Lapwai, ID 83540 (208) 621 -4604 (208) 843 -7380