INSTRUCTIONS FOR PROGRAM SUMMARY

This form is to be completed by each Program Agent applying for financial assistance under the Emergency Employment Act of 1971.

1.

Check the type of application submitted. If this is an application for full funding, the information submitted should include all funds and jobs for the total program, including those which were contained in the initial funding.

5.

Enter the name, title, address and telephone number of the highest elected or appointed official of the govemment unit applying for funds,

6.

Enter the Federal Social Security Number used by the applicant on its Employer's Quarterly Federal Tax Return, U. S. Treasury Department Form 941.

8.

9.

10.

Enter the name of the organization within the applicant unit of government that will have overall responsibility for the conduct and management of the program.

Enter the name, title, address and telephone number of the official to be contacted on all matters relating to the application and grant funds issued as the result of the application.

Enter the final two digits of the fiscal year in which the program is to be conducted; the total program cost for that year, the Federal allocation; and the local share.

11. Enter the total cost of the initial funding of the program, the amount of Federal funds requested for initial funding and the local share. The Federal funds requested can be no more than 20 percent of the total Federal allocation for the year (Block 10).

12.

13.

14.

15,

Enter the amount of advance funds requested against the Federal share of the initial funding.

List the Program Agent and all other units or sub-units (other than those of the Program Agent) of govemment who will be granted funds by the Program Agent for the employment of participants, (If additional space is needed, use MA Form 6-47A, "Program Summary" continuation sheet.)

Indicate the type of unit (State, County, City, etc.) listed.

Indicate the geographic area to be served by the listed unit or sub-unit (e.g., county, city, etc.). If the Program Agent is the State, the area served may be indicated as the "balance of the state" and each county or city need not be listed.

17.

18.

19.

20.

Enter the total amount of Federal funds to be used by the Program Agent or the amount of funds to be granted to each unit or sub-unit,

The total funds should equal that indicated in Block 11a for initial funding or Block 10a for full funding.

Indicate the period covered in the Program Summary and the total average number of participants to be employed each month of the program. The Program Summary for initial funding should cover approximately a 6-month period, Enter the total estimated costs for each cost category and indicate the amounts to be provided as the local share of the program and the amount to be provided from Federal funds. Funds for training and employment services are not included in the amounts for initial funding and should not be included in Program Summaries covering Initial Funding. IMPORTANT NOTES

The Emergency Employment Act of 1971 requires that the Goverment shall not approve an application under this Act where the request for Federal costs exceeds 90 percent of the total cost of the program, unless otherwise waived, Grantee's contribution may be in cash or in kind, fairly evaluated, including but not limited to salaries and benefits for program staff (other than eligible participants), plant, equipment or services. In the event that the Program Agent proposes a contribution in an area not covered by this form, he shall attach a page explaining his proposed contribution. In completing this cost breakdown, the applicant also should recognize that not less than 85 percent of the Federal funds for initial funding of the program must be expended for wages and fringe benefits for participants,

INSTRUCTIONS FOR OCCUPATIONAL SUMMARY

An individual Occupational Summary will be completed for the Program Agent and for each sub-agent listed on the Program Summary (MA 6-47), The Occupational Summary for the Program Agent will cover only those jobs under his immediate jurisdiction.

1.

Check the appropriate boxes. If this is an application for full funding, the
information submitted should include all funds and jobs for the total program,
including those which were contained in the initial funding.

4.

Enter the name, title, address and telephone number (including area code)
of the official to be contacted on all matters dealing with the program to
be conducted by the Program Agent or sub-agent.

5.

If the form covers a sub-agent, enter the name of the Program Agent from whom the sub-agent's funds are to be obtained.

6.

Enter the date of the Program Agent's application for funds or modification.

7.

Enter the estimated average number of participants to be employed during each month of the program.

13.

8.

Enter the total estimated costs for each cost category and indicate the
amount to be provided as the local share of the program and the amount to
be provided from Federal funds. Funds for Training and Employment Ser
vices are not included in Initial Funding grants and the Occupational
Summary for Initial Funding should not include expenditures for these cost
categories.

9.

This table shows the kinds and numbers of jobs which will be provided by
the Program Agent or sub-agent, the rates of pay for each job, and the
man-months of employment.

10.

Insert the Dictionary of Occupational Titles (DOT) Code for each Occu
pational title, to six digits. If the full DOT Code is not available for
an occupational title, show at least the DOT Code to three digits, if
possible,

Enter the number (shown below) of the public service area in which the
job is to be established. The public service area should be determined
by the primary function of the employing agency or the specific unit of
the employing agency if that agency covers more than one public service
area. The public service area should not be determined by the Occupa-
tional Title.

List descriptive titles of occupations to be created under this program. These titles are to be listed by Employing Agency, i. e., the organizational unit within the Program Agent or sub-agent on whose payroll the participant filling the job will be listed, such as the Police Department, Health Agency, etc. If the employing agency is a State department or division, the occupations should be listed by the city or county in which the jobs are located,

Enter the number of jobs in each occupation to be created under the
funding requested, Separate professional jobs (as defined in the
regulations) from all others,

Enter the monthly wage rate for each occupation,

Enter the estimated number of man-months of employment to be pro-
vided by the number of jobs established for the occupation. This is
determined by totaling the number of months each job will be filled,

Enter the total amount of wages that are to be paid participants in this
occupation. This total is obtained by multiplying Column 14 by Col-
umn 15.

Indicate the total number of jobs, man-months of employment and wages.

GPO 916-606

APPLICATION FOR FULL FUNDING

ALLOCATED UNDER SECTION 9(a) (1)

OF

THE EMERGENCY EMPLOYMENT ACT OF 1971

Application is hereby made for the balance of funds allocated under Section 9(a) (1) of the Emergency Employment Act of 1971, Public Law 92-54, to the area for which the Applicant has been previously designated Program Agent under Grant Agreement Number

The Program Agent agrees that the funds requested here in will be used to conduct a program within the area covered by this application in order to provide unemployed and underemployed persons with transitional employment in jobs providing needed public services and, wherever feasible, related training and employment services, to enable such persons to move into employment and training not supported under this Act.

The Program Agent agrees to:

1.

2.

3.

4.

5.

Utilize the plans and administrative arrangements previously funded to provide continuity of employment for participants employed under initial funding and to provide a smooth transition to the fully-funded program requested in this application;

Plan and conduct its program in accordance with the regulations promulgated by the Secretary of Labor
(29 CFR 55) for the Emergency Employment programs under PL 92-54. In particular, the applicant hereby
warrants that the program described in the attached document will be conducted as required by section
55.6 of the regulations;

Allot funds among the areas located within the geographic area covered by this application in an equitable manner, in accordance with the regulations of the Secretary of Labor (29 CFR 55);

Administer or supervise, and assume full responsibility for all activities and services provided under this grant;

Use no less than ninety (90) percent of the funds granted for wages and fringe benefits for unemployed and underemployed participants and no more than 3,2 percent for the administration of the program.

The Program Agent certifies:

1.

2.

3.

He has authority to receive, expend, distribute and grant funds for the purposes contained in the attached program summary.

He has the authority by statute, or will have authority by agreement, to require the sub-agents and employing agencies receiving funds, to adhere to conditions and requirements established for the use of the funds granted under PL 92-54.

Funds requested here in do not exceed ninety (90) percent of the cost of carrying out the program proposed in this application, and the remaining ten (10) percent will be provided in accordance with section 55, 16 of the regulations.

Signature of Authorized Official

Title

Date

MA 6-49

Aug. 1971

INSTRUCTIONS FOR

APPLICATION FOR FULL FUNDING
(MA 6-49)

1.

Forward six (6) copies of the Application to the appropriate Regional Manpower Administrator.

2.

3.

4.

The Application must be signed by the official authorized to enter into agreements on behalf of the Program Agent.

The Application for Balance of Funds should include information covering the total program, The funds and jobs provided under Initial Funding must be included in the data presented in the Application for Full Funding.