Exhibit_A_Participation_Activity_Spreadsheet.xlsx

XLSX spreadsheet 391 KB Posted

Attached to
AZ|CTR078356
Contract number
CTR078356
Issued by
Arizona

About this file

This document is a Participant Activity Spreadsheet (PAS) for the Arizona Department of Economic Security's (DES) Supplemental Nutrition Assistance Program (SNAP) Employment and Training (E&T) program. The spreadsheet serves as a comprehensive reporting tool for SNAP E&T Partner Providers to document participant activities, demographics, support services, and employment outcomes. The document outlines detailed instructions for completing the spreadsheet, which is used for data matching, federal reporting, and case management system updates.

The spreadsheet captures extensive participant data including demographics, intake information, assigned activities, support services, education and training components, and employment outcomes. Partner providers must submit the completed spreadsheet within 15 calendar days after the end of each month, with only voluntary participants included. Support services can include transportation, background checks, books, licensing fees, child care, clothing, and other assistance to help participants engage in employment and training activities. The document provides exhaustive dropdown menus and codes for various categories such as education levels, employment types, industry sectors, and closure reasons, enabling precise tracking and reporting of SNAP E&T program participants' progress and outcomes.

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Other files

File Type Posted
CTR078356_Contract_Documents.pdf PDF
CTR078356_Debarment_Check.pdf PDF
CTR078356_Attachment_7_ISB.pdf PDF
CI22016_CI_Determination.pdf PDF
CTR078356_Pre-Contracts_Documents.pdf PDF
Exhibit_B_Contractor_Invoice_for_Reimbursement.xlsx XLSX spreadsheet

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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 ElementPurposeNotes
Demographics (Required)
First NameData Match
Last NameData Match
SSN (last 5 digits)Data Match
Date of BirthData MatchMM/DD/YYYY format
AZTECS/SNAP Case Number (If Known)Data Match
English as Second LanguageFederal ReportingSelect Yes or No** drop down list
ABAWD StatusFederal ReportingSelect Yes, No, or Unknown** drop down list
Intake (Required)
Date of Intake AssessmentFederal Reporting
Highest Grade Completed at IntakeFederal ReportingSelect from Drop Down.** drop down list
Highest Degree Completed at IntakeFederal ReportingSelect from Drop Down** drop down list
Assigned Activities/Components (Required)
Component AssignedFederal ReportingUse multiple lines if more than 1** drop down list
Start DateFederal ReportingStart date must be in the same service month of the PAS report
Projected End DateFederal ReportingProjected end date must be in the same service month of the PAS report
Participation Hours Scheduled Per MonthFederal Reporting
Number of Hours Verified (Actual Participation)Federal ReportingEnter Number of Verified Participation hours in the service month of the PAS report.
Support Services (if applicable)
Type of Support ServicePaymentSelect from Drop Down. Review Definitions Tab for requirements.** drop down list
Support Service AmountPaymentSum total of amount
Support Service Issue DatePaymentStart date must be in the same service month of the PAS report
Support Service End DatePaymentEnd date must be in the same service month of the PAS report
Closing/Exit (if applicable)
Education/Training ComponentOutcome PerformanceSelect from Drop Down** drop down list
Component Closure/ Exit ReasonFederal Reporting/Outcome PerformanceSelect 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 DateOutcome PerformanceMM/DD/YYYY format. End date must be in the same service month of the PAS report
Highest Grade Completed at ExitOutcome PerformanceSelect from Drop Down** drop down list
Highest Degree Completed at ExitOutcome PerformanceSelect from Drop Down** drop down list
Closure/Exit NotesOutcome Performance
Employment Outcomes (if applicable)
Verified Employment Information (Y/N)Outcome PerformanceSelect Yes or No** drop down list
Public SectorOutcome PerformanceSelect Yes or No** drop down list
Hire DateOutcome PerformanceMM/DD/YYYY format
Employer NameOutcome Performance
Employer AddressOutcome Performance
CityOutcome Performance
StateOutcome PerformanceSelect from Drop Down** drop down list
ZipOutcome Performance
Type of EmploymentOutcome PerformancePre-Selected. If adding additional lines, type "SC"** drop down list
Hours Per WeekOutcome Performance
Hourly WageOutcome PerformanceNumerical to the hundredth decminal (11.11, not $11.111)
Medical BenefitsOutcome PerformanceSelect from Drop Down** drop down list
Termination Reason CodeOutcome PerformanceSelect from Drop Down** drop down list
Termination DateOutcome PerformanceMM/DD/YYYY format
O Net codeOutcome PerformanceSelect from Drop Down** drop down list
Emp SourceOutcome PerformancePre-Selected. If adding additional lines, type "6"** drop down list
Employer TypeOutcome PerformancePre-Selected. If adding additional lines, type "89"** drop down list
DES Only
Eligible?Eligibility/BillingSelect Y or N** drop down list
ReasonEligibility/BillingReason 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 OnlyDemographicsIntakeAssigned Activities/ComponentsSupport ServiceClosing/ExitEmployment Outcomes
Eligible?ReasonFirst NameLast NameSSN (last 5-digits only)Date of BirthAZTECS/SNAP Case Number
(If Known)English as Second Language?
(Y/N)Voluntary Participation Agreement on File?Date of Intake AssessmentHighest Grade Completed at IntakeHighest Degree Completed at IntakeComponent
(use multiple lines if more than one)Start DateProjected End DateParticipation Hours Scheduled Per Month# of Verified Hours
Type of Support Service
(if applicable)Support Service AmountSupport Services Date IssuedSupport Services End DateEducation/Training ComponentComponent Closure/Exit ReasonComponent Closure/Exit DateHighest Grade Completed at ExitHighest Degree Completed at ExitClosure/Exit NotesVerified Employment Information (Y/N)Public SectorHire DateEmployer NameEmployer Street AddressCityStateZipType of EmploymentHours Per WeekHourly WageMedical BenefitsTermination Reason CodeTermination DateO Net codeEmp SourceEmployer Type
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