Exhibit_A_Participation_Activity_Spreadsheet.xlsx

XLSX spreadsheet 391 KB Posted Sep 4, 2025

Attached to: AZ|CTR078330
Contract number: CTR078330
Issued by: Arizona

About this file

Written by GovTribe AI · Oct 9, 2025

This document is a Participant Activity Spreadsheet (PAS) from the Arizona Department of Economic Security (DES) for the Supplemental Nutrition Assistance Program (SNAP) Employment and Training (E&T) program. The spreadsheet is a comprehensive data collection tool used by SNAP E&T Partner Providers to report participant activity, demographic information, and outcomes for federal reporting and reimbursement purposes. The document outlines detailed instructions for submitting participant data, including requirements for tracking demographics, intake information, assigned activities, support services, and employment outcomes.

The spreadsheet serves as a critical mechanism for tracking participant progress through various employment and training components, such as vocational training, English as a Second Language (ESL), Job Readiness, and General Equivalency Diploma (GED) preparation. It includes provisions for support services like transportation, background checks, books, clothing, and other assistance that can be provided to participants. The document specifies a detailed reimbursement process where providers submit the completed spreadsheet within 15 days of the end of each service month, after which DES staff review, verify eligibility, update case management systems, and process invoices for payment. The spreadsheet also captures extensive employment outcome data, including verification of employment, job details, wages, and termination information.

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Other files

File	Type	Posted
CI22016_CI_Determination.pdf	PDF	Sep 4, 2025
CTR078330_Debarment_Check.pdf	PDF	Sep 4, 2025
CTR078330_Attachment_7_ISB.pdf	PDF	Sep 4, 2025
CTR078330_Contract_Documents.pdf	PDF	Sep 4, 2025
CTR078330_Pre-Contracts_Documents.pdf	PDF	Sep 4, 2025
Exhibit_B_Contractor_Invoice_for_Reimbursement.xlsx	XLSX spreadsheet	Sep 4, 2025

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Instructions

SNAP CAN

Participant Activity Spreadsheet (PAS)

Who uses this form?

All SNAP E&T Partner Providers requesting reimbursement.

Why?

DES primarily utilizes the information to accomplish:

Conducting data match to verify eligible participants for reimbursement

Collecting data for Federal Reporting requirements and/or outcome performance

Updating case management system of record (JAS/AJC) with participant activity

When?

Contractor must submit a complete and accurate Participant Activity Spreadsheet (PAS) to DES no later than 15 calendar days after the end of each calendar month.

Only participants that have signed the voluntary participation agreement should be included on the PAS.

Send To: easnaetreports@azdes.gov

Data Element	Purpose	Notes
Demographics (Required)
First Name	Data Match
Last Name	Data Match
SSN (last 5 digits)	Data Match
Date of Birth	Data Match	MM/DD/YYYY format
AZTECS/SNAP Case Number (If Known)	Data Match
English as Second Language	Federal Reporting	Select Yes or No	** drop down list
ABAWD Status	Federal Reporting	Select Yes, No, or Unknown	** drop down list
Intake (Required)
Date of Intake Assessment	Federal Reporting
Highest Grade Completed at Intake	Federal Reporting	Select from Drop Down.	** drop down list
Highest Degree Completed at Intake	Federal Reporting	Select from Drop Down	** drop down list
Assigned Activities/Components (Required)
Component Assigned	Federal Reporting	Use multiple lines if more than 1	** drop down list
Start Date	Federal Reporting	Start date must be in the same service month of the PAS report
Projected End Date	Federal Reporting	Projected end date must be in the same service month of the PAS report
Participation Hours Scheduled Per Month	Federal Reporting
Number of Hours Verified (Actual Participation)	Federal Reporting	Enter Number of Verified Participation hours in the service month of the PAS report.
Support Services (if applicable)
Type of Support Service	Payment	Select from Drop Down. Review Definitions Tab for requirements.	** drop down list
Support Service Amount	Payment	Sum total of amount
Support Service Issue Date	Payment	Start date must be in the same service month of the PAS report
Support Service End Date	Payment	End date must be in the same service month of the PAS report
Closing/Exit (if applicable)
Education/Training Component	Outcome Performance	Select from Drop Down	** drop down list
Component Closure/ Exit Reason	Federal Reporting/Outcome Performance	Select one (1); Completed Satisfactorily, Entered Employment, Incomplete

Garcia, Angelica, C.: Completed Satisfactorily: participant completed the activity successfully, but did not receive employment

Entered Employment: participant exited the activity due to employment

Incomplete: participant did not complete the activity by the scheduled end date

** drop down list
Component Closure/Exit Date	Outcome Performance	MM/DD/YYYY format. End date must be in the same service month of the PAS report
Highest Grade Completed at Exit	Outcome Performance	Select from Drop Down	** drop down list
Highest Degree Completed at Exit	Outcome Performance	Select from Drop Down	** drop down list
Closure/Exit Notes	Outcome Performance
Employment Outcomes (if applicable)
Verified Employment Information (Y/N)	Outcome Performance	Select Yes or No	** drop down list
Public Sector	Outcome Performance	Select Yes or No	** drop down list
Hire Date	Outcome Performance	MM/DD/YYYY format
Employer Name	Outcome Performance
Employer Address	Outcome Performance
City	Outcome Performance
State	Outcome Performance	Select from Drop Down	** drop down list
Zip	Outcome Performance
Type of Employment	Outcome Performance	Pre-Selected. If adding additional lines, type "SC"	** drop down list
Hours Per Week	Outcome Performance
Hourly Wage	Outcome Performance	Numerical to the hundredth decminal (11.11, not $11.111)
Medical Benefits	Outcome Performance	Select from Drop Down	** drop down list
Termination Reason Code	Outcome Performance	Select from Drop Down	** drop down list
Termination Date	Outcome Performance	MM/DD/YYYY format
O Net code	Outcome Performance	Select from Drop Down	** drop down list
Emp Source	Outcome Performance	Pre-Selected. If adding additional lines, type "6"	** drop down list
Employer Type	Outcome Performance	Pre-Selected. If adding additional lines, type "89"	** drop down list
DES Only
Eligible?	Eligibility/Billing	Select Y or N	** drop down list
Reason	Eligibility/Billing	Reason why participant is not eligible

To ensure all required data and additional outcome measures are collected and reported timely, late or incorrect PAS will not be returned after the 15th of the calendar month and may result in a delay in payment.

PAS

SNAP E&T Participant Activity Spreadsheet

Program Provider:

Service Month and Year:

DES Only

Demographics

Intake

Assigned Activities/Components

Support Service

Closing/Exit

Employment Outcomes

Eligible?

Reason

First Name

Last Name

SSN (last 5-digits only)

Date of Birth

AZTECS/SNAP Case Number

(If Known)

English as Second Language?

(Y/N)

Voluntary Participation Agreement on File?

Date of Intake Assessment

Highest Grade Completed at Intake

Highest Degree Completed at Intake

Component

(use multiple lines if more than one)

Start Date

Projected End Date

Participation Hours Scheduled Per Month

# of Verified Hours

	Type of Support Service
(if applicable)	Support Service Amount	Support Services Date Issued	Support Services End Date	Education/Training Component	Component Closure/Exit Reason	Component Closure/Exit Date	Highest Grade Completed at Exit	Highest Degree Completed at Exit	Closure/Exit Notes	Verified Employment Information (Y/N)	Public Sector	Hire Date	Employer Name	Employer Street Address	City	State	Zip	Type of Employment	Hours Per Week	Hourly Wage	Medical Benefits	Termination Reason Code	Termination Date	O Net code	Emp Source	Employer Type
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This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Oct 9, 2025.