COVID-19 Disaster Recovery DWG - Suggested Full Application Worksheet_fillable.pdf
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- ETA-TEGL-12-19
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COVID-19 Disaster Recovery DWG – Suggested Full Application Worksheet
COVID-19
DISASTER RECOVERY NATIONAL DISLOCATED WORKER GRANT (DWG)
SUGGESTED FULL APPLICATION WORKSHEET
Grant Recipient Name:
Project Name:
Grant Number:
Are all quarterly reports up to date? ☐ Yes ☐ No
Check applicable requests made in this modification request:
☐ Full Application ☐ Budget Realignment
☐ Statement of Work Change ☐ Response to Outstanding Terms and Conditions
☐ Incorporate Negotiated Indirect Cost Rate Agreement
(NICRA) or Cost Allocation Plan (CAP)
☐ Period of Performance Change Requesting an extension to: (__________)
☐ Change of Address or Authorized Representative
Information ☐ Equipment Purchase
☐ Other: ☐ Request for Additional Funding
Enrollment Summary – Update for Disaster-Relief Employment
For Modifications
Initial
Projection
Enrolled to
Date
Projected
New
Enrollments
Number of Participants in Disaster-Relief Employment Only
Number of Participants in Career and Training Services Only
Number of Participants in Both Disaster-Relief Employment and Career and Training Services
Participant Totals
Eligible Participants – Individuals receiving services through a Disaster Recovery DWG must meet one of the following criteria. Select all that apply:
☐ Temporarily or permanently laid off as a consequence of the disaster
☐ A dislocated worker
☐ A long-term unemployed worker
☐ A self-employed individual who became unemployed or significantly under-employed as a result of the disaster or emergency
Geographic Area to Be Served: List the counties/parishes to be served by this project. Also indicate additions/deletions since the submittal of the initial application, and why the change was made.
Community Needs Assessment:
Summarize the impact of COVID-19 in the proposed service area.
Identify new information determined since submission of the emergency application.
Identify the specific needs to be addressed in the proposed service area.
Describe how these needs were identified and how they will be monitored throughout the grant period.
Explain how the disaster-relief employment will address the specific needs stated above.
Proposed Disaster-Relief Jobs – Table Completion Instructions
Statement of Need Project Activities Requirements to Carry Out
Disaster-Relief Positions Partners
Needs:
Identify each need resulting from the disaster that the project proposes to address.
Areas Where
Need Exists:
Identify where this need exists within the project’s proposed service area.
Disaster-Relief Jobs to Address Need:
Identify the general types of disaster-relief work to address the stated need.
Disaster-relief positions may address cleanup resulting from the impact of the disaster event, along with the humanitarian assistance needs created by the disaster.
Training or Supplies Needed for Disaster-Relief Positions:
Identify the resources required to carry out the disaster-relief positions. Include training needs, supplies, supportive services, etc.
Partners Involved with
Establishing the Disaster-
Relief Positions:
Identify the entities involved with establishing the positions, such as project operators, worksite employers, establishments where disaster-relief employment will take place, etc.
NOTE: It is not necessary to submit a comprehensive list of each and every worksite, along with each and every job title at that worksite. Worksites must be selected as described in Training and Employment Guidance Letter (TEGL) No. 12-19, National Dislocated Worker Grant Program Guidance. Recipients are expected to maintain documentation for each worksite included in the project for both monitoring and auditing purposes. Such documentation should include, at a minimum:
name and location of worksite;
public or private property (if private, provide justification for work as required in TEGL 12-19);
number of participants working on site;
dates of work on a site;
description of work performed at the site; and written determination of how this site was approved, per recipient’s established policies and procedures.
SEE EXAMPLE OF COMPLETED TABLE ON FOLLOWING PAGE
EXAMPLE:
Contact tracing required to halt spread of COVID-19.
All counties Case workers will facilitate contact identification, contact listing, and contact follow-up.
Cell phones, laptops, training in empathetic messaging
Local health departments, hospitals, non-profits in the health industry.
Homebound individuals cannot access needed food and supplies because they cannot go to the grocery store.
Grocery store workers are at risk of getting sick because customers unknowingly continue to shop when infected.
All counties Personal shoppers and delivery drivers to shop, package, and deliver groceries and other supplies to homebound community members, and run errands as needed for homebound individuals.
Some shoppers will be stationed at stores to prepare orders, while others will be mobile and able to shop at multiple locations.
Training in food safety, sanitization, CDL, and COVID-
19 symptoms/prevention.
Sanitation supplies, gloves, face masks, disinfectants, smartphone w/thermometer sensor/app, and
COVID-19 testing kits.
Community-based stores will partner to make goods available online for home shoppers.
Public facilities and small businesses cannot open until buildings are sanitized.
All counties Cleaners to sanitize public facilities and small businesses.
Training in sanitization, infectious diseases, and COVID-
19 symptoms/prevention.
Sanitation supplies, gloves, face masks, disinfectants, foggers, protective gear, smartphone w/thermometer sensor/app, and
COVID-19 testing kits.
Local public health centers
Call centers at mental health clinics are inundated with calls from individuals suffering anxiety or depression as a result of confinement or job loss.
All counties Peer counselors and resource coordinators will be placed remotely to work with call centers, local workforce centers, and community centers to provide peer-to-peer counseling and help connect individuals with proper resources. Peer-to-peer counselors will help callers develop personal plans to support their mental and physical health as well as their critical resource needs.
Training in peer-to-peer counseling, virtual counseling, unemployment insurance, community resources, and planning. These positions are remote.
Local Workforce Development
Boards, mental health clinics, and community centers.
Proposed Disaster-Relief Jobs
(For grant recipient completion)
Disaster-Relief Positions Partners
Needs:
Identify each need resulting from the disaster that the project proposes to address.
Identify where this need exists within the project’s proposed service area.
Disaster-Relief Jobs to Address Need:
Identify the general types of disaster-relief work to address the stated need.
Disaster-relief positions may address cleanup resulting from the impact of the disaster event, along with the humanitarian assistance needs created by the disaster.
Training or Supplies Needed for Disaster-Relief Positions:
Identify the resources required to carry out the disaster-relief positions. Include training needs, supplies, supportive services, etc.
Partners Involved with
Establishing the Disaster-
Relief Positions:
Identify the entities involved with establishing the positions, such as project operators, worksite employers, establishments where disaster-relief employment will take place, etc.
Worksite Management
Describe the plan for identifying, approving, establishing, and managing the disaster-relief worksites, as well as how worksite progress will be tracked.
Monitoring/Oversight Plan for Worksites
Describe internal controls in place for tracking and monitoring project activities, including worksites and worksite employers, to ensure compliance with federal requirements and grant terms.
Proposed Employment and Training Services – Instructions and Example
Employment and Training
Services
Partners/Service Providers
Needs:
Identify career and training needs resulting from the disaster that the project proposes to address.
Identify where this need exists within the project’s proposed service area.
Employment and Training Services to
Address Need:
Identify career and training services to address the stated need. Include credentials and length of time needed to complete training. Training must be completed within the grant period.
Employment and Training
Resources and Supplies:
Identify the resources required to carry out the career and training services, such as support technology, subscriptions, and internet access.
Partners/WIOA Service
Providers/Contracted
Services:
Identify community partners, WIOA service providers, and other contracted services the recipient will use to implement required activities.
EXAMPLE:
Unemployment Claims increased by 20% due to business closures.
All counties Dislocated workers will be trained in in-demand positions currently available including: cybersecurity; food safety;
healthcare; peer-to-peer counselling.
Expanded broadband and cloud subscription service to allow local workforce development staff to work remotely and facilitate group trainings, one-on-one counseling, and expanded trainee access to online classes. Up-to-date cell phones and laptops for individuals requiring access.
ABC Internet Service Provider, XYZ Video Conferencing
Services, Workforce
Development Boards, Community Colleges, etc.
Proposed Employment and Training Services
(For grant recipient completion)
Employment and Training
Services
Partners/Service Providers
Needs:
Identify career and training needs resulting from the disaster that the project proposes to address.
Area Where Need
Exists:
Identify where this need exists within the project’s proposed service area.
Employment and Training Services to
Address Need:
Identify career and training services to address the stated need. Include credentials and length of time needed to complete training. Training must be completed within the grant period.
Employment and Training
Resources and Supplies:
Identify the resources required to carry out the career and training services, such as support technology, subscriptions, and internet access.
Partners/WIOA Service
Providers/Contracted
Services:
Identify community partners, WIOA service providers, and other contracted services the recipient will use to implement required activities.
DWG Performance
DWG performance accountability is outlined in Training and Employment Guidance Letter (TEGL) 14-18, Attachment 6. The DWG program applies performance measures as described in Workforce Innovation and Opportunity Act (WIOA) Section 116. These include the following:
Planned Employment Rate (2nd Quarter after Exit)
Planned Employment Rate (4th Quarter after Exit)
Planned Median Earnings
Planned Credential Rate
Planned Measurable Skill Gains Rate
Are the planned performance goals for this project the same as the applicable negotiated goals for the Dislocated Worker program? Yes or No?
If the above goals are lower than the negotiated goals, please explain why:
Career, Training, and Supportive Services
Briefly explain why existing formula funds are not sufficient to fund proposed career, training and supportive services.
Career, Training, and Supportive Services
Briefly explain why existing formula funds are not sufficient to fund proposed career, training and supportive services.
COMPLETE BLUE COLUMNS ONLY IF REQUESTING
INCREMENTAL OR SUPPLEMENTAL FUNDING
Actual Data as of
Modification Submission
Date
New Projections if
Supplemental/Incremental
Funds Awarded
Participant Breakdown by
Services
Initial
Planned
Enrollment
Numbers
Initial Planned
Expenditures
Actual
Enrollments as of
Modification
Submission
Actual
Expenditures as of
Modification
Submission
New
Projected
Enrollments
New Projected
Expenditures
Participant Disaster-Relief
Employment Wages
Participant Fringe Benefits
Related Disaster-Relief
Training and Supportive
Services
TOTALS:
COMPLETE BLUE COLUMNS ONLY IF REQUESTING
INCREMENTAL OR SUPPLEMENTAL FUNDING
Actual Data as of
Modification Submission
Date
New Projections if
Supplemental/Incremental
Funds Awarded
Participant Breakdown by
Services
Initial
Planned
Enrollment
Numbers
Initial Planned
Expenditures
Actual
Enrollments as of
Modification
Submission
Actual
Expenditures as of
Modification
Submission
New
Projected
Enrollments
New Projected
Expenditures
Career Services
Training Services, excluding
On-the-Job Training (OJT)
OJT Only
Supportive Services
Needs-Related Payments
TOTALS:
Enrollment and Expenditure
Worksheet for Disaster-Relief
Employment
Enrollment and Expenditure
Worksheet for Employment and Training Services
PROJECT NARRATIVE: OVERALL PROJECT MANAGEMENT
Provide an explanation of the procedures you will use to identify funds not being utilized in accordance with the project plan:
Explain your plan for developing and implementing corrective action, where required, to ensure adherence to the project goals:
| Project Name: |
| Grant Number: |
| Initial ProjectionNumber of Participants in DisasterRelief Employment Only: |
| Enrolled to DateNumber of Participants in DisasterRelief Employment Only: |
| Projected New EnrollmentsNumber of Participants in DisasterRelief Employment Only: |
| Initial ProjectionNumber of Participants in Career and Training Services Only: |
| Enrolled to DateNumber of Participants in Career and Training Services Only: |
| Projected New EnrollmentsNumber of Participants in Career and Training Services Only: |
| Initial ProjectionNumber of Participants in Both DisasterRelief Employment and Career and Training Services: |
| Enrolled to DateNumber of Participants in Both DisasterRelief Employment and Career and Training Services: |
| Projected New EnrollmentsNumber of Participants in Both DisasterRelief Employment and Career and Training Services: |
| Initial ProjectionParticipant Totals: |
| Enrolled to DateParticipant Totals: |
| Projected New EnrollmentsParticipant Totals: |
| 1: |
| Community Needs Assessment Summarize the impact of COVID19 in the proposed service area Identify new information determined since submission of the emergency application Identify the specific needs to be addressed in the proposed service area Describe how these needs were identified and how they will be monitored throughout the grant period Explain how the disasterrelief employment will address the specific needs stated aboveRow1: |
| Needs Identify each need resulting from the disaster that the project proposes to addressRow1: |
| Areas Where Need Exists Identify where this need exists within the projects proposed service areaRow1: |
| DisasterRelief Jobs to Address Need Identify the general types of disaster relief work to address the stated need Disasterrelief positions may address cleanup resulting from the impact of the disaster event along with the humanitarian assistance needs created by the disasterRow1: |
| Training or Supplies Needed for DisasterRelief Positions Identify the resources required to carry out the disasterrelief positions Include training needs supplies supportive services etcRow1: |
| Partners Involved with Establishing the Disaster Relief Positions Identify the entities involved with establishing the positions such as project operators worksite employers establishments where disaster relief employment will take place etcRow1: |
| Needs Identify each need resulting from the disaster that the project proposes to addressRow2: |
| Areas Where Need Exists Identify where this need exists within the projects proposed service areaRow2: |
| DisasterRelief Jobs to Address Need Identify the general types of disaster relief work to address the stated need Disasterrelief positions may address cleanup resulting from the impact of the disaster event along with the humanitarian assistance needs created by the disasterRow2: |
| Training or Supplies Needed for DisasterRelief Positions Identify the resources required to carry out the disasterrelief positions Include training needs supplies supportive services etcRow2: |
| Partners Involved with Establishing the Disaster Relief Positions Identify the entities involved with establishing the positions such as project operators worksite employers establishments where disaster relief employment will take place etcRow2: |
| Needs Identify each need resulting from the disaster that the project proposes to addressRow3: |
| Areas Where Need Exists Identify where this need exists within the projects proposed service areaRow3: |
| DisasterRelief Jobs to Address Need Identify the general types of disaster relief work to address the stated need Disasterrelief positions may address cleanup resulting from the impact of the disaster event along with the humanitarian assistance needs created by the disasterRow3: |
| Training or Supplies Needed for DisasterRelief Positions Identify the resources required to carry out the disasterrelief positions Include training needs supplies supportive services etcRow3: |
| Partners Involved with Establishing the Disaster Relief Positions Identify the entities involved with establishing the positions such as project operators worksite employers establishments where disaster relief employment will take place etcRow3: |
| Needs Identify each need resulting from the disaster that the project proposes to addressRow4: |
| Areas Where Need Exists Identify where this need exists within the projects proposed service areaRow4: |
| DisasterRelief Jobs to Address Need Identify the general types of disaster relief work to address the stated need Disasterrelief positions may address cleanup resulting from the impact of the disaster event along with the humanitarian assistance needs created by the disasterRow4: |
| Training or Supplies Needed for DisasterRelief Positions Identify the resources required to carry out the disasterrelief positions Include training needs supplies supportive services etcRow4: |
| Partners Involved with Establishing the Disaster Relief Positions Identify the entities involved with establishing the positions such as project operators worksite employers establishments where disaster relief employment will take place etcRow4: |
| Needs Identify each need resulting from the disaster that the project proposes to addressRow5: |
| Areas Where Need Exists Identify where this need exists within the projects proposed service areaRow5: |
| DisasterRelief Jobs to Address Need Identify the general types of disaster relief work to address the stated need Disasterrelief positions may address cleanup resulting from the impact of the disaster event along with the humanitarian assistance needs created by the disasterRow5: |
| Training or Supplies Needed for DisasterRelief Positions Identify the resources required to carry out the disasterrelief positions Include training needs supplies supportive services etcRow5: |
| Partners Involved with Establishing the Disaster Relief Positions Identify the entities involved with establishing the positions such as project operators worksite employers establishments where disaster relief employment will take place etcRow5: |
| Needs Identify each need resulting from the disaster that the project proposes to addressRow6: |
| Areas Where Need Exists Identify where this need exists within the projects proposed service areaRow6: |
| DisasterRelief Jobs to Address Need Identify the general types of disaster relief work to address the stated need Disasterrelief positions may address cleanup resulting from the impact of the disaster event along with the humanitarian assistance needs created by the disasterRow6: |
| Training or Supplies Needed for DisasterRelief Positions Identify the resources required to carry out the disasterrelief positions Include training needs supplies supportive services etcRow6: |
| Partners Involved with Establishing the Disaster Relief Positions Identify the entities involved with establishing the positions such as project operators worksite employers establishments where disaster relief employment will take place etcRow6: |
| Worksite Management Describe the plan for identifying approving establishing and managing the disasterrelief worksites as well as how worksite progress will be trackedRow1: |
| MonitoringOversight Plan for Worksites Describe internal controls in place for tracking and monitoring project activities including worksites and worksite employers to ensure compliance with federal requirements and grant termsRow1: |
| Needs Identify career and training needs resulting from the disaster that the project proposes to addressRow1: |
| Area Where Need Exists Identify where this need exists within the projects proposed service areaRow1: |
| Employment and Training Services to Address Need Identify career and training services to address the stated need Include credentials and length of time needed to complete training Training must be completed within the grant periodRow1: |
| Employment and Training Resources and Supplies Identify the resources required to carry out the career and training services such as support technology subscriptions and internet accessRow1: |
| PartnersWIOA Service ProvidersContracted Services Identify community partners WIOA service providers and other contracted services the recipient will use to implement required activitiesRow1: |
| Needs Identify career and training needs resulting from the disaster that the project proposes to addressRow2: |
| Area Where Need Exists Identify where this need exists within the projects proposed service areaRow2: |
| Employment and Training Services to Address Need Identify career and training services to address the stated need Include credentials and length of time needed to complete training Training must be completed within the grant periodRow2: |
| Employment and Training Resources and Supplies Identify the resources required to carry out the career and training services such as support technology subscriptions and internet accessRow2: |
| PartnersWIOA Service ProvidersContracted Services Identify community partners WIOA service providers and other contracted services the recipient will use to implement required activitiesRow2: |
| Needs Identify career and training needs resulting from the disaster that the project proposes to addressRow3: |
| Area Where Need Exists Identify where this need exists within the projects proposed service areaRow3: |
| Employment and Training Services to Address Need Identify career and training services to address the stated need Include credentials and length of time needed to complete training Training must be completed within the grant periodRow3: |
| Employment and Training Resources and Supplies Identify the resources required to carry out the career and training services such as support technology subscriptions and internet accessRow3: |
| PartnersWIOA Service ProvidersContracted Services Identify community partners WIOA service providers and other contracted services the recipient will use to implement required activitiesRow3: |
| Needs Identify career and training needs resulting from the disaster that the project proposes to addressRow4: |
| Area Where Need Exists Identify where this need exists within the projects proposed service areaRow4: |
| Employment and Training Services to Address Need Identify career and training services to address the stated need Include credentials and length of time needed to complete training Training must be completed within the grant periodRow4: |
| Employment and Training Resources and Supplies Identify the resources required to carry out the career and training services such as support technology subscriptions and internet accessRow4: |
| PartnersWIOA Service ProvidersContracted Services Identify community partners WIOA service providers and other contracted services the recipient will use to implement required activitiesRow4: |
| Needs Identify career and training needs resulting from the disaster that the project proposes to addressRow5: |
| Area Where Need Exists Identify where this need exists within the projects proposed service areaRow5: |
| Employment and Training Services to Address Need Identify career and training services to address the stated need Include credentials and length of time needed to complete training Training must be completed within the grant periodRow5: |
| Employment and Training Resources and Supplies Identify the resources required to carry out the career and training services such as support technology subscriptions and internet accessRow5: |
| PartnersWIOA Service ProvidersContracted Services Identify community partners WIOA service providers and other contracted services the recipient will use to implement required activitiesRow5: |
| Needs Identify career and training needs resulting from the disaster that the project proposes to addressRow6: |
| Area Where Need Exists Identify where this need exists within the projects proposed service areaRow6: |
| Employment and Training Services to Address Need Identify career and training services to address the stated need Include credentials and length of time needed to complete training Training must be completed within the grant periodRow6: |
| Employment and Training Resources and Supplies Identify the resources required to carry out the career and training services such as support technology subscriptions and internet accessRow6: |
| PartnersWIOA Service ProvidersContracted Services Identify community partners WIOA service providers and other contracted services the recipient will use to implement required activitiesRow6: |
| Career Training and Supportive Services Briefly explain why existing formula funds are not sufficient to fund proposed career training and supportive servicesRow1: |
| Provide an explanation of the procedures you will use to identify funds not being utilized in accordance with the project planRow1: |
| Explain your plan for developing and implementing corrective action where required to ensure adherence to the project goalsRow1: |
| Check Box1: Off |
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| Check Box3: Off |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box8: Off |
| Check Box9: Off |
| Check Box10: Off |
| Check Box11: Off |
| Check Box12: Off |
| Insert date_af_date: |
| Check Box13: Off |
| Check Box14: Off |
| Check Box15: Off |
| Check Box16: Off |
| Initial Planned: |
| Initial Planned2: |
| Initial Planned3: |
| Initial Planned Expenditures1: |
| Initial Planned Expenditures2: |
| Initial Planned Expenditures3: |
| TOTALS1: 0 |
| Actual Enrollments1: |
| Actual Enrollments2: |
| Actual Enrollments3: |
| TOTALS2: 0 |
| Actual Expenditures1: |
| Actual Expenditures2: |
| Actual Expenditures3: |
| TOTALS3: 0 |
| New Projected1: |
| New Projected2: |
| New Projected3: |
| TOTALS4: 0 |
| New Projected Expenditures1: |
| New Projected Expenditures2: |
| New Projected Expenditures3: |
| TOTALS5: 0 |
| Initial5: |
| Initial4: |
| Initial3: |
| Initial2: |
| Initial1: |
| Initial11: |
| Initial22: |
| Initial33: |
| Initial44: |
| Initial55: |
| InitialTOTALS_2: 0 |
| Actual1: |
| Actual2: |
| Actual3: |
| Actual4: |
| Actual5: |
| ActualTOTALS_2: 0 |
| Actual Expenditures as1: |
| Actual Expenditures as2: |
| Actual Expenditures as3: |
| Actual Expenditures as4: |
| Actual Expenditures as5: |
| Actual Expenditures asTOTALS_2: 0 |
| New1: |
| New2: |
| New3: |
| New4: |
| New5: |
| New P1: |
| New P2: |
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| New PTOTALS_2: 0 |
| NewTOTALS_2: 0 |
File details come from the government source that posted it.