Agencies are required to submit their tuition assistance data on this form.

Agency _____________________________________________________

Official Preparing Report _______________________________________

Title ________________________________________________________

Address_____________________________________________________

Telephone ______________________________

Fax ___________________________________

1. Results of funds disbursement:

a. Total amount of funds disbursed from March 14-August 1, 2000 $_______________

b. Projected amount of funds that will be disbursed from August 2-September 30, 2000 $_____________________

c. Number of your employees who received tuition assistance_______________ (If both parents work for your agency, count both parents.)

d. Number of children who benefited _____________

e. On the Attachment, list the amount each employee received each week; the total amount of funding received by each employee; the total family income; and the employees grade level.

2. Types of child care used:

Child care centers. Total number of centers where children were enrolled______

Family child care homes. Total number of family child care homes where children were enrolled _________

3. Application:

a. What was the total number of applicants?________________

2. b. How many employees made application but were not eligible?_____________
   
3. c. How many applicants were denied assistance due to lack of
      funds? ____________
4. d. How many applications are in process? _______________

OPM Form 1645

March 2000

1. Did you use any of the models or a variation of a model from OPMs guide?

Yes _____ No _____ If yes, which model(s) did you use?

_____ Model A

_____ Model B

_____ Model C

_____ Model D

_____ Model E

5. What was your agencys definition of "lower income employees"? ______________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

6. Did your agency place any restrictions on the funds?___________ If so, indicate how they were restricted (e.g. restricted for only Federally sponsored centers or restricted for full-time employees only.________________________________

_______________________________________________________________

7. Program Administration:

a. Did your agency administer the program? Yes _____ No _____

2. b. Did your agency contract with another organization to administer the funds?

          Yes _____ No _____

If so, which organization(s) were they?_____________________________________

____________________________________________________________________

____________________________________________________________________

8. Did your agency bargain with the unions? Yes _____ No _____ If yes, which unions?__________________________________________________

_____________________________________________________________

OPM Form 1645

March 2000

9. How helpful were the OPM materials contained in their Guide for Implementing

Child Care Legislation?

_____ Not relevant

_____ Not at all

_____ Somewhat helpful

_____ Helpful

_____ Very helpful

10. How helpful were OPM staff in assisting you or answering your questions about this program?

_____ Not relevant

_____ Not at all

_____ Somewhat helpful

_____ Helpful

_____ Very helpful

Comments:

Signature of Official completing this form: __________________________________

Date:___________________

Mail or fax completed form to:

U.S. Office of Personnel Management
Family-Friendly Workplace Advocacy Office
1900 E St. NW Room 7315
Washington, DC 20415
Fax: (202) 606-2091

THIS FORM MUST BE RECEIVED BY OPM NO LATER THAN AUGUST 1, 2000.

OPM Form 1645

March 2000

Attachment to Report to OPM on Agency Results of Tuition Assistance Program for Lower Income Federal Employees

Agency______________________________________________

For each Federal employee, list the following:
Note: Do not identify employees by name.

OPM Form 1645

March 2000

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