U.S. Department of Education ATTACHMENT 1

Office of Elementary and Secondary Education OMB No. 

Washington, DC 20202-6100 Expiration Date: 

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 Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. 

The valid OMB control number for this information collection is 1810-0060. The time required to complete this 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 concerning 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 form, write directly to: Student Achievement and School 

Accountability, U.S. Department of Education, 400 Maryland Avenue, SW (Room 3W230, LBJ), 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.

REQUIREMENTS: 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 records.

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 2014 caseload data - Enter separately the number of children, ages 5-17, inclusive, 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 each 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 community 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 program 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 20202-6100 Expiration Date: 

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 instruction 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 educational 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 that 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 community 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 these children 

participate in other programs funded from Federal sources, 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 by 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 should maintain 

documentation.

SUBMITTAL PROCEDURE

If submitting 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 Achievement 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 mailed separately to the above address. The information for 

this survey is due by January 15, 2015.
U.S. Department of Education ATTACHMENT 1

Office of Elementary and Secondary Education OMB No. 

Washington, DC 20202-6100 Expiration Date: 

ED FORM 4376 Page 3 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 

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 institutions 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 State-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

Name 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 20202-6100 Expiration Date: 

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 children, 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.

Name of State Agency

2014

Enrollment

In A Regular 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

_______________________________ 

Typed name and title