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.
• Submit supporting
documentation.
• Eligible to receive services.
• 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.
• 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 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 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
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
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
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
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
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
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 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
A. Total with Employment Objective
Adult
Youth
Cash Assistance Recipients
33
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 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
Adult
I.B. Total Terminees
58
I.B. Total Terminees
58
II.A. Total with
Employment Obj.
58
II.A. Total with
Employment Obj.
62
II.B. Total with
Educ./Training Obj.
Ok
58
Ok
Not Ok
II.B. Total with
Educ./Training Obj.
59
Not Ok
Terminee Outcomes
II. Terminee Outcomes
A. Total with Employment Objective
1. Entered Unsubsidized Employment
Adult
Youth
Cash Assistance Recipients
33
20
12
8
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. 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. 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 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. 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 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 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 (-).
• 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 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
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. 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 / 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
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
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
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
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. 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
C. Education Level:
Adult
Youth
10
3
5
2. Student
5
16
0
3. High School
30
3
9
4. Post High School
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. 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 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
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
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
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
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
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
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
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
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 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 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
Co-Chair
RaeBelle Whitcomb
Bristol Bay Native
Association
P.O. Box 310
Dillingham, AK 99576
(907) 842-2262, Xt410
(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