Completed and signed SF 424 - Application for Federal Assistance. This form is the required application for Federal funds. Under the electronic system, the authorized signatory of the applicant will be issued a unique Personal Identification Number (PIN). The entry of this PIN on the SF 424 constitutes the authorized signature.

Project Synopsis Form (ETA 9106). This form summarizes key aspects of the proposed project such as project type, type of eligible event, key contact information, planned number of participants, performance goals, and historical and planned cost per participant levels.

Employer Data Form (ETA 9105). This form provides employer and dislocation site-specific information needed to validate the eligibility of the dislocation event(s) and the target group of workers for NEG assistance. Information includes name and location of employer, date and type of worker notification, date(s) of layoff and number of workers affected, date(s) and types of Rapid Response activities, and number of planned participants.

Project Operator Data Form (ETA 9107). This form includes key contact and project scope information (e.g., number of participants, total budget, service area) for each project operator. This form must be completed and submitted only to the degree that Project Operators have been identified at the time of application. This information should be submitted as Project Operators are identified and agreements executed. Except in disaster emergency situations, it is expected that Project Operators will have been identified at the time the application is submitted, and the contact information on the form should be completed.

Planning Form (ETA 9103). This form provides cumulative quarterly estimates on project scope (e.g., number of participants, exits), design (e.g., mix of enrollments in activities), and use of funds (e.g., planned expenditures by type of program activity, administration).

Narrative. This section facilitates the applicant being able to provide any explanations/justifications needed for entries in the above forms.

Funds Usage. This information will not be required where the State in which the applicant is located expended a satisfactory level (see Part III. K) of the available formula funds in the most recent completed Program Year and is on target to expend a satisfactory level of the available formula funds for the current Program Year, based on quarterly expenditure reports submitted to USDOL/ETA (i.e., the ETA 9076 B and F).

INITIAL REQUEST: Temporary Disaster Jobs

SF 424 - Application for Federal Assistance

Project Synopsis Form (ETA 9106)

Project Operator Data Form (ETA 9105)

Planning Form (ETA 9103)

Narrative

MODIFICATION OR ADDITIONAL REQUEST: Workforce Investment Employment-Related Services for Disaster Project Participants

Where a significant number of permanently dislocated and/or long-term unemployed individuals have been temporarily employed in clean-up, restoration and humanitarian assistance activities, and there are not sufficient formula funds to provide needed assistance to transition them into permanent employment, the Department will consider a request to use approved but unneeded project funds, and/or a request for additional NEG funds, to provide reemployment assistance. This request should generally be submitted four to six months following the grant award for the temporary job creation.

The submission requirements are:

SF 424-Application for Federal Assistance.

Project Synopsis Form (ETA 9106).

Project Operator Data Form (ETA 9105).

Planning Form (ETA 9103).

Narrative.

Funds Usage.
This information will not be required where the State in which the applicant is located expended a satisfactory level (see Part III. J) of the available dislocated worker formula funds--and if the target group includes long-term unemployed, available adult formula funds--in the most recent completed Program Year and is on target to expend a satisfactory level of the available formula funds for the current Program Year, based on quarterly expenditure reports submitted to USDOL/ETA (i.e., the ETA 9076 B, E and F).

To pay for 65 percent of the advance costs of health insurance premiums for eligible individuals in a "bridge" program in coordination with the Internal Revenue Service's Health Coverage Tax Credit (HCTC) program, as provided for in Section 173(g) of the Workforce Investment Act, as amended by the Trade Adjustment Assistance Reform Act of 2002.

To pay for health insurance infrastructure as needed by States to implement the system.