U.S. Department of Education ATTACHMENT 1 Office of Elementary and Secondary Education OMB No. Washington, DC 20202
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ED FORM 4376 Page 1 of 4

**ANNUAL REPORT OF CHILDREN IN INSTITUTIONS FOR NEGLECTED OR DELINQUENT CHILDREN, ADULT CORRECTIONAL INSTITUTIONS, AND** 

**COMMUNITY DAY PROGRAMS FOR NEGLECTED OR**

**DELINQUENT CHILDREN** FORM APPROVED: OMB NO. EXPIRATION DATE:
According to the Paperwork Re duction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a vali d OMB control number. The valid OMB control number for this information collection is 1810
- 0060. The time required to complete th is information collection is estimated to average 42 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. **If you have any comments concer**  **ning the accuracy of the time estimate(s) or suggestions for improving this form, please write to** : U.S. Department of Education, Washington, DC 20202
- 4651. **If you have any comments or concerns regarding the status of your individual submission of this for m, write directly to**  : Student Achievement an d School Accountability , U.S. Department of Education, 400 Maryland Avenue , SW (Room 3W230, LB J ), Washington, DC 20202
- 6132. **The Department encourages States to use electronic means to collect and transmit the**  **information requested in this survey in order to reduce burden.** PURPOSE: The purpose of this annual report is to provide the Department with data required by Title I, Parts A and D, of the Elementary and Secondary Education Act, as amended by Public Law 107
- 110, for use in the computation of grants to local educational agencies (LEAs) and State agencies responsible for providing free public education for children in institutions or community day programs for neglected or delinquent children. REQUIREMENT S: This report is required annually for all State educational agencies. No sampling or estimating is to be used in preparing this report. Since these data will generate Federal funds, they are subject to audit and must be supportable from documented rec ords. **INSTRUCTIONS SECTION A**  **- FORMULA DATA AND REPORTING FORMAT SHEET**  State educational agency
- Enter name. **PART I --**  **NUMBER OF NEGLECTED OR DELINQUENT CHILDREN IN LOCAL INSTITUTIONS AND ADULT CORRECTIONAL INSTITUTIONS BY LOCAL EDUCATIONAL AGENCY (**  **LEA)** 1. State and LEA codes
- Identify the State code and LEA code. This information is required for data processing purposes. A list showing these data is attached. 2. October 201 4 caseload data
- Enter separately the number of children, ages 5
- 17, in clusive, who live in (1) local institutions for neglected children and (2) local institutions for delinquent children, including children in local adult correctional institutions, for at least one day during a 30 consecutive day period, at least one day of which falls within the month of October 2014
. Please furnish a total for each LEA only and provide a grand total for the State. It is not necessary to furnish data for ea ch individual institution. **PART II --**  **ENROLLMENT OF CHILDREN IN A REGULAR PROGRAM OF INSTRUCTION IN STATE**  **- OPERATED**  **INSTITUTIONS FOR NEGLECTED OR DELINQUENT CHILDREN, COMMUNITY DAY PROGRAMS FOR NEGLECTED OR DELINQUENT CHILDREN, OR ADULT CORRECTIONAL INSTITUTIONS**  1. State Agency
- Furnish the name of the State agency eligible to receive a Title I subgrant. "State agency" means an agency of State government responsible for the free public education of children in institutions for neglected or delinquent children, in com munity day programs for neglected or delinquent children, or in adult correctional institutions. 2. Enrollment
- Report the number of children enrolled in the educational programs of State
- operated or supported institutions for neglected or delinquent children, community day programs for neglected or delinquent children, or adult correctional institutions on a date during calendar year 2014 selected by the State agency. Provide a total for each State agency only. It is not necessary to furnish data for each institution or community day progra m or to separate the data by category of children.U.S. Department of Education ATTACHMENT 1 Office of Elementary and Secondary Education OMB No. Washington, DC 20202
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ED FORM 4376 Page 2 of 4 **INSTRUCTIONS** (continued) To be eligible to be counted as enrolled, a child must be: (1) Under 21 years of age; (2) One for whom a State agency is providing a free public education; and (3) Enrolled in a regular program of instruc tion supported by non
- Federal funds for at least:  20 hours per week if in an institution for neglected or delinquent children or a community day program for neglected or delinquent children; or  15 hours per week if in an adult correctional institution. A **"regular program of instruction"**  means an edu cational program (not beyond grade 12) in an institution or a community day program for neglected or delinquent children that consists of classroom instruction in basic school subjects such as reading, mathematics, and vocationally oriented subjects, and t hat is supported by non
- Federal funds. Neither the manufacture of goods within the institution nor activities related to institutional maintenance are considered classroom instruction. Title I funds generated by eligible children in an institution or com munity day program for neglected or delinquent children or in an adult correctional institution must supplement the number of hours of instruction they receive from State resources. If thes e children participate in other programs funded from Federal sourc es, Title I funds must be accounted for separately but should be coordinated with other Federal funds to avoid duplication. If an institution operates an institutionwide project, however, Title I funds may be used to upgrade the entire educational program of the institution. 3. Adjustment in enrollment to reflect the relative length of the State agency's annual program
- For each institution, multiply the enrollment of children eligible to be counted by the number of days in the year the institution operates an educational program and divide that number by 180. 4. State total
- Provide a State total for all State agencies. **SECTION B -**  **CERTIFICATION BY STATE EDUCATIONAL AGENCY** Complete the certification portion of the report. This report must be signed b y the appropriate official in the State educational agency (SEA) to certify that the information reported is complete and accurate. The information provided is subject to audit, and the SEA sh ould maintain documentation. **SUBMITTAL PROCEDURE** If submittin g a paper version of this form, send a signed original of the certification page and the other requested information provided in accordance with the above instructions to: Monique M. Chism, Ph.D., Director Student Achiev ement and School Accountability U. S. Department of Education 400 Maryland Avenue, SW (LBJ, Room 3W230) Washington, DC 20202
- 6132 Attention: Todd Stephenson SEAs are encouraged to submit electronically the information requested in the survey to Mr. Todd Stephenson on the staff of Student Achievement and School Accountability. When submitting electronically please send to NorD
- DataFY2015@ed.gov
. If submitting electronically, please provide us with a signed certification page, which can be mai led separately to the above address. **The inform ation for**  **this survey is due by January 1**  **5 ,**  **2015**
.U.S. Department of Education ATTACHMENT 1 Office of Elementary and Secondary Education OMB No. Washington, DC 20202
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ED FORM 4376 Page 3 of 4

**Annual Report of Children In Institutions for Neglected or Delinquent Children, Adult Correctional Institutions, and Com**  **munity Day Program s for Neglected**  **or Delinquent Children NOTICE:**  This report is required by sections 1124, 1402, 1411, and 1412 of the Elementary and Secondary Education Act of 1965, as amended (ESEA). The completion of this report is required to obtain or retain benefits. Failure to submit the report will result in the inability of the U.S. Department of Education to carry out legislative requirements and the loss of funds to State and local educational agencies to provide compensatory education services for children in institution s and community day programs for neglected or delinquent children.

**SECTION A -**  **FORMULA DATA AND REPORTING FORMAT SHEET** Children in Locally Operated Institutions for Neglected or Delinquent Children and Adult Correctional Institutions, Children in Stat e - Operated Institutions for Neglected or Delinquent Children, and Community Day Programs for Neglected or Delinquent Children, and Adult Correctional Institutions

**State educational agency**

____________________ (Name) **PART I**
-- Number of neglected or delinquent children, ages 5
- 17, inclusive, in local institutions by LEA
**State Code**  **LEA**

**Code Nam**  **e of Local**

**Educational Agency (LEA) Neglected Caseload**  **Count for October**  **2014** ***** **Delinquent Caseload Count for**  **October 2014**  ****** **Total**

**Total for the State** * Count children residing in institutions for neglected children in this column. ** Count children residing in institutions for delinquent children and adult correctional institutions in this column.U.S. Department of Education ATTACHMENT 1 Office of Elementary and Secondary Education OMB No. Washington, DC 20202
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ED FORM 4376 Page 4 of 4 **PART II**
-- Number of children under 21 years enrolled in a regular program of instruction in State
- operated or supported institutions for neglected or delinquent chi ldren, community day programs for neglected or delinquent children, or adult correctional institutions. Enrollments must be adjusted to reflect the relative length of the State agency's annual program.

**Nam e of State Agency**  **2014 Enrollm**  **ent In A R**  **egular Program**

**of Instruction (Adjusted to Reflect the Relative**  **Length of the State Agency's Annual Educational Program** **)**

**Total for the State**

**SECTION B -**  **CERTIFICATION BY STATE EDUCATIONAL AGENCY** I certify that the State educational agency has determined that the data provided in Parts I and II meet the requirements of Title I, ESEA. The information provided in this report is, to the best of my knowledge, complete and accurate.

_______________ Signature Date Signed

_______________________________ Ty ped name and title