ࡱ>  bjbjEE  'bc'bcR %%%4YYYhuYXk`Qf *!d%"4jjjjjjj$mnpjjE%Y"u " Y"Y"jk&&&Y"R8%j&Y"j&&b h@f"Rd8j(k0Xkdp"pphhp%hY"Y"&Y"Y"Y"Y"Y"jj$Y"Y"Y"XkY"Y"Y"Y"pY"Y"Y"Y"Y"Y"Y"Y"Y" : LWDA #  FORMTEXT       Local Workforce Development Area Name  FORMTEXT       Date of Request  FORMTEXT       Amount Requested: $  FORMTEXT        FORMCHECKBOX  Zero Dollar Modification5. Type of FundsRapid Response Funds Options. [ Please ensure to complete the Line Item Budget accompanied with this form.  Other Funds. (Select only one of the funding types listed below, and enter the project name) FORMCHECKBOX  Target Population  FORMCHECKBOX  WIOA Statewide Activities Project Name:  FORMCHECKBOX  General Dislocated Worker Population FORMCHECKBOX  Trade/WIOA Co-Enrollment  FORMCHECKBOX  Other Federal Funds (Specify) Project Name:  FORMCHECKBOX  Layoff Aversion/Incumbent Worker Strategies FORMCHECKBOX  Incumbent Worker Training FORMCHECKBOX  Statewide/Regional Projects  FORMCHECKBOX  Other State Funds (Specify) Project Name:   FOR BUREAU USE ONLY  Amount of Funds Approved: $  FORMTEXT      Date Received:  FORMTEXT      C Contract Number:  FORMTEXT       NOO:  FORMTEXT      Program:  FORMTEXT       Admin  FORMTEXT       Contract/NOO Start Date of Funds:  FORMTEXT       Contract/NOO End Date of Funds:  FORMTEXT        Authorized Signature Date LINE ITEM BUDGETGrant Project Name: Fund Source (e.g. Statewide Rapid Response funds): LWDA: Preparer's Name: WIOA EXPENSE ITEMCOST / EXPENSEADMINISTRATION - Cost Category=AdminStaff Salaries & Fringe BenefitsTravel - Within Project AreaCommunicationsFacilities - RentFacilities - UtilitiesFacilities - MaintenanceOffice SuppliesTesting & Instructional MaterialsEquipment - PurchaseEquipment - LeaseOther Admin Operational ExpensesAdmin Indirect CostsSUBTOTAL $ - CAREER & SUPPORTIVE SERVICES - Cost Category=ProgramProgram Staff Salaries & Fringe BenefitsOperational ExpensesOther Program ExpensesIncentive PaymentsNeeds Related PaymentsSupportive Service FundsTravel - Within Project AreaCommunicationsFacilities - RentFacilities - UtilitiesFacilities - MaintenanceOffice SuppliesTesting & Instructional MaterialsEquipment - PurchaseEquipment - LeaseProgram Indirect CostsSUBTOTAL $ - TRAINING SERVICES - Cost Category=ProgramTuition Payments / ITA'sOJT ReimbursementsSkill Upgrade and Retraining Customized TrainingAdult Education & Literacy TrainingApprenticeship TrainingIncumbent Worker TrainingTransitional Jobs ExpendituresRelocation AssistanceOut-of-Area Job Search AssistanceOther Training ExpensesSUBTOTAL $ - YOUTH - Cost Category=ISY & OSYOSY - Work Experience (Participating Costs)OSY - Work Experience (Staffing Costs)OSY - Other Training Expenses (List below)OSY - Other Staff & Operational ExpensesOSY - Incentive Payments (participant costs)OSY - Pay-for-Performance Contract ExpendOSY - Indirect CostsISY - Work Experience (Participating Costs)ISY - Work Experience (Staffing Costs)ISY - Other Training Expenses (List below)ISY - Other Staff & Operational ExpensesISY - Incentive Payments (participant costs)ISY - Pay-for-Performance Contract ExpendISY - Indirect CostsSUBTOTAL $ - OTHER - CC=ProgramResource Sharing AgreementRegional PlanningOther Program Costs (specify)SUBTOTAL $ -  Add categories as necessary.PROJECT TOTAL $ -  INSTRUCTIONS BACKGROUND Local Areas that determine additional funds are needed in a particular funding stream may request additional funds from the Bureau of Workforce Development Administration (BWDA) by utilizing the Request for Funds (RFF) form. REQUEST FOR FUNDS (RFF) FORM Please complete the Request for Funds Form, providing the required information. Use a separate sheet if the space provided is insufficient. Note: RFF forms with more than a single funding type will not be processed. For each type of funding requested, complete a separate RFF form. Local Workforce Development Area #: Enter the LWDA number, ex. SW005. Local Workforce Development Area Name: Enter the name of the Local Workforce Development Area. Date of Request: Enter the date of the request. Amount Requested: Provide the amount of funds being requested. Note: If no new funds are being requested, insert a zero, mark the "Zero Dollar Modification" box, and outline the change requested. Type of Funds: Place an X in the box for the type of funding requested through this RFF. Note the following clarifications for funding types on the RFF form: RAPID RESPONSE OPTIONS Place an X in the box Target Population General Dislocated Worker Population Trade/WIOA Co-Enrollment Layoff Aversion/Incumbent Worker Strategies Incumbent Worker Training Statewide/Regional Projects OTHER FUNDS - Place an X in only one box WIOA Statewide Activities Funds used for activities that may include special projects, youth initiatives, etc. Enter the name of the Local Area project to be funded. Other Federal Funds Requested federal funds that do not fit in any other category. Specify the type of federal funds requested. Enter the name of the Local Area project to be funded. Other State Funds Requested state funds, ex. Industry Partnership Funds. Specify the type of funds requested. Enter the name of the Local Area project to be funded. 6. Analysis of Need: For both participant and non-participant programs: Describe the need for these funds. At a minimum, describe: (1) The economic conditions in the geographic area; (2) What the LWDA plans to do with these funds; and (3) The activities or services that will be provided if the funds are awarded. 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If funds will be used to provide services to workers from specific plants or industries that have closed or have laid off employees, indicate the occupations or companies affected. Acceptable methods of submission include regular mail and e-mail to: PA Department of Labor & Industry Bureau of Workforce Development Administration Grants and Fiscal Services Division, Room 1200 651 Boas Street, Harrisburg, PA 17121  HYPERLINK "mailto:LI-BWDA-Grants-Fiscal@pa.gov" LI-BWDA-Grants-Fiscal@pa.gov The Department will review each request and notify the local areas of approval or disapproval.     REQUEST FOR FUNDS FORM RFF revised 12.28.2016 PAGE 3 6. 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