Attachment B - Request for Payment DETA-19245-1-E -.xlsx
XLSX spreadsheet 29 KB Posted
- Solicitation number
- ILA0030-A
- Issued by
- Wisconsin
About this file
This is a Request for Payment form (Attachment B) for the Wisconsin Department of Workforce Development's Youth Apprenticeship (YA) Consortium Bridging Outcomes initiative, which supports YA consortia that bridge completers into Wisconsin Registered Apprenticeships (RA). The form serves as the payment request submission document that YA consortia must complete and send to DETYASAE2020@dwd.wisconsin.gov to claim payments for apprentices who have successfully transitioned from YA programs into active RA contracts. The payment request accommodates up to five apprentices per submission, with provisions for additional forms when claiming more than five apprentices. Required information includes consortium supplier details (name, remittance address, contact information, and UEI), invoice information formatted as [Supplier ID #] - [Invoice #], and comprehensive apprentice data including RA contract numbers, RA occupations, RA employer/sponsor names, YA student numbers, YA program names, high school class years (2020-2023), and names as noted in YODA records.
Compensation is structured at $1,000 per apprentice successfully bridged into an active RA contract, with the invoice amount calculated by multiplying the number of apprentices claimed by $1,000. The initiative is funded entirely through the Department of Labor's SAE 2020 Grant (AP-35130-20-60-A-55, ILA0030A) with a total federal allocation of $9 million representing 100 percent of the project budget. Supplier information must match the approved YA consortium's signed contract and state vendor records, and suppliers must maintain active, non-excluded status on www.sam.gov. The form requires submission in Excel format with attestation documentation (Attachment C) and operates under internal state accounting codes: Fund 10000, Appropriation 14100, Department ID 4450055500, Account 7740000, and Activity ET156. The document version referenced is DETA-19245-1-E (N. 08/2022).
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Other files
| File | Type | Posted |
|---|---|---|
| YA Request for Applications DETA-19514-P.docx | DOCX document | |
| Attachment C - Attestation DETA-19513-P.docx | DOCX document | |
| Attachment A - Blanket Agreement Application DETA-19515-P.docx | DOCX document |
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Text version
Req for Payment YA Consortium
| ILA:0030A - SAE 2020 - Attachment B |
| REQUEST FOR PAYMENT - MULTIPLE APPRENTICES |
| Department of Workforce Development | State of Wisconsin | Instructions for Use: |
| The submission of this payment request by the YA consortium ("Supplier") certifies that the YA consortium provided direct services that resulted in the listed YA completer bridging into a Wisconsin Registered Apprenticeship with an active contract in accordance with the funding program requirements as described in the blanket agreement and other ILA0030A documents, of which this request is a part. | 1. Send your completed Attachment B: Request for Payment and accompanying Attachment C: Attestation Form to |
DETYASAE2020@dwd.wisconsin.gov
| YOUTH APPRENTICESHIP CONSORTIUM INFORMATION | **NOTE: If more than 5 apprentices are being claimed, additional Requests for Payment and Attestation docs will be needed. | ||
| *Supplier name and remittance address | *Supplier contact name, phone number, and email | * Supplier UEI (previously known as DUNS) | 2. Use only the most recent document version, available on the RFA page. |
| 3. The items that have asterisks must be filled in by the consortium/supplier. Supplier is the Fiscal Agent where the payment will be sent. | |||
| 4. Supplier information must match the approved YA consortium's signed contract | |||
| * Ref # (For Internal Use Only) | *Supplier ID | *Supplier location | a) Supplier name and address must match consortium name on Attachment A and the State of Wisconsin records for the consortium as a vendor) (See the RFA Description Section 4 if you are in the process of changing Supplier Location code.) |
b) The supplier ID and supplier location must match the State of Wisconsin's vendor records
c) Supplier contact name, phone number, and email should be a person knowledgeable about the request.
d) Supplier's UEI (previously known as DUNS) must be active on www.sam.gov and show no exclusions.
Internal Use Only: Fund 10000; Appropriation 14100; Dept ID 4450055500; Account 7740000; 44500ET05066 21 (SAE2020 tier 2); Activity ET156
| INVOICE DETAILS | For Internal Use Only | ||
| Invoice number | *[Supplier ID #] - [Invoice #] | 5. Invoice number should use the following format: Supplier ID # - Invoice # (e.g. 0000012345-1). Each subsequent Attachment B: Request for Payment (when claiming > 5 apprentices) that is submitted, should increase by increments of 1 for the invoice number (e.g. 2nd Request for Payment would be: 0000012345-2). | |
| Invoice date | 8/30/22 | ||
| *Invoice amount | $ - 0 | 6. Invoice date will automatically default to the current date. | |
| 7. Invoice amount should be entereed as (# of apprentices x $1000). | |||
| #1 APPRENTICE DETAILS | For Internal Use Only | ||
| *Apprentice Name | 8. Lines 19-67 are for up to 5 Apprentices to be claimed in one invoice. Use additional Attachment B if claiming > 5 apprentices. | ||
| Apprentice RA contract number | BAS will fill in | 9. The first 4 lines apply to the Registered Apprentice's RA information. | |
| *RA occupation | 10. The next 4 lines apply to the YA student, program and experience. | ||
| *RA employer/sponsor name | 11. Submit the request for payment in Excel format. | ||
| *Apprentice's YA student number | |||
| *Apprentice's YA program name | |||
| *Apprentice's HS class (choose: 2020, 2021, 2022, 2023) | |||
| *Name during the YA program as noted in YODA | |||
| This project is funded in whole by the Department of Labor, SAE 2020 Grant, AP-35130-20-60-A-55 (ILA0030A), receiving Federal funding at $9 million which reflects 100% of the project’s total budget. | |||
| This work is licensed under a | Creative Commons Attribution 4.0 International License. |
| #2 APPRENTICE DETAILS | For Internal Use Only | |
| *Apprentice Name | ||
| Apprentice RA contract number | BAS will fill in | |
| *RA occupation | ||
| *RA employer/sponsor name | ||
| *Apprentice's YA student number | ||
| *Apprentice's YA program name | ||
| *Apprentice's HS class (choose: 2020, 2021, 2022, 2023) | ||
| *Name during the YA program as noted in YODA |
| #3 APPRENTICE DETAILS | For Internal Use Only | |
| *Apprentice Name | ||
| Apprentice RA contract number | BAS will fill in | |
| *RA occupation | ||
| *RA employer/sponsor name | ||
| *Apprentice's YA student number | ||
| *Apprentice's YA program name | ||
| *Apprentice's HS class (choose: 2020, 2021, 2022, 2023) | ||
| *Name during the YA program as noted in YODA |
| #4 APPRENTICE DETAILS | For Internal Use Only | |
| *Apprentice Name | ||
| Apprentice RA contract number | BAS will fill in | |
| *RA occupation | ||
| *RA employer/sponsor name | ||
| *Apprentice's YA student number | ||
| *Apprentice's YA program name | ||
| *Apprentice's HS class (choose: 2020, 2021, 2022, 2023) | ||
| *Name during the YA program as noted in YODA |
| #5 APPRENTICE DETAILS | For Internal Use Only | |
| *Apprentice Name | ||
| Apprentice RA contract number | BAS will fill in | |
| *RA occupation | ||
| *RA employer/sponsor name | ||
| *Apprentice's YA student number | ||
| *Apprentice's YA program name | ||
| *Apprentice's HS class (choose: 2020, 2021, 2022, 2023) | ||
| *Name during the YA program as noted in YODA | ||
| This project is funded in whole by the Department of Labor, SAE 2020 Grant, AP-35130-20-60-A-55 (ILA0030A), receiving Federal funding at $9 million which reflects 100% of the project’s total budget. | ||
| This work is licensed under a | Creative Commons Attribution 4.0 International License. | |
| DETA-19245-1-E (N. 08/2022) |
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