ABCDEFGHIJKLMNORSTUVWXYZ
1
Staffing Detail
2
In rows 6 and 7, provide your site’s CAP Code and your organization’s Federal Tax ID (EIN). The information in the EIN cell must be identical to the EIN on your Doing Business Data form. If your site is not yet State-approved and does not have a CAP code, please leave this line blank.
3
4
SITE and VENDOR INFORMATION
5
6
CAP Code:
7
Federal Tax ID (EIN):
8
9
EXISTING STAFF INFORMATION - Information on staff currently working in your contracted special education program
10
In this section, please provide the requested information for all staff whose salaries and wages are currently paid for, in part or in whole, by funds from this site’s 4410/4201 center-based preschool program.
11
LAST NAME - please provide the employee’s surname or family name. Please do not use all caps.
FIRST NAME - please provide the employee’s first name(e.g. Dolores). If the employee goes by or regularly uses a middle name please provide it in this column as well (e.g. Dolores Marie).
STAFF TITLE - enter the job title for the staff member (e.g. Lead Teacher). This should be the title as you would post it on a job board.
UNION AFFILIATION - use the drop down to select the union that the staff member belongs to. If the employee is not a union member select “None”. If you are unsure, please contact your Union representative (e.g. DC1701/37 - Local 205). Please do not leave this blank or copy and paste data from another workbook. Please only use the drop down options.
UNION TITLE and/or CERTIFICATION - Use the drop down options to select the appropriate Union Title for each employee. If you are unsure of the appropriate Union Title please reach out to your Union. If the employee is a certified teacher but is not affiliated with a union, please use the drop down to indicate their level of certification (e.g. “A - Teacher/MA/Certified”)
DOB - enter the employee’s date of birth (e.g. 01/01/1950).
DATE HIRED - enter the date that your organization hired this individual as a full time employee. If they are not a full time employee enter the date they were hired into their current role (e.g. 06/01/1990).
CERTIFICATE # - For Certified Teachers only, please provide the New York State License number for all certified teachers. For all other employees, please leave this column blank. Please make sure that all of your teachers’ certifications are up to date (e.g. 000000).
CURRENT PROGRAM HOURS per week - estimate the average number of hours per week that the staff member spends on activities to support the fulfillment of the existing 4410 or 4201 contract. If this staff member’s role benefits other programs run by your organization (for example they are the Director for the entire site that offers multiple program types operated under multiple contracts) you must use the percent of their salary allocated to your special education budget and multiply that by the number of hours they work per week.
12
Example: An employee works 40 hours a week and spends 30% of her time supporting students enrolled in the 4410 program so 30% of her salary is funded by the 4410 contract. Multiply 40 by .3 = 12. Enter 12 in column J.
13
ANTICIPATED ADDITIONAL HOURS per week - estimate the average number of hours per week that the staff member may need to work in addition to their current schedule to fulfill the requirements of this enhancement contract.
14
Example: A lead teacher currently works 5.5 hours per day (5 hours teaching plus 30 minutes for lunch) which adds up to 27.5 hours per week. Under the enhancement, their teaching day would increase to 6.3 hours (6 hours and 20 minutes) plus 30 minutes for lunch and an additional 10 minute break, totalling 7 hours per day and 35 hours a week. In this column you would enter the difference between the new schedule and the old, 35 minus 27.5 equals 7.5.
15
CURRENT PROGRAM SALARY/ANNUAL WAGES - enter the amount of the staff members salary or annual total wages that is funded by your program’s 4410/4201 program.
16
Example 1: For a full-time lead teacher who only works on the 4410/4201 program, enter the entire annual salary.
Example 2: For a part-time paraprofessional who earns $17 per hour and works an average of 20 hours per week on the 4410/4201 program, multiply the hourly wage by the hours per week and the work weeks per year, then enter the result (e.g. 17 per hour * 20 hours * 43 work weeks = $ 14,620).
Example 3: For a site director whose salary is partially attributed to the 4410/4201 program, enter the amount that appears on the 4410 or 4201 budget.
17
FRINGE RATE - provide the fringe benefit rate for this staff member. You must include FICA and all other applicable payroll taxes (e.g. 12.65%).
CLEARED? - please indicate if this employee has undergone a comprehensive background check and is active and eligible in PETS.
18
19
EMPLOYEE NAME
(Please do not use ALL CAPS)		STAFF TITLEUNION
AFFILIATION		UNION TITLE and/or CERTIFICATION
(Per Union Schedule if applicable)		DATE OF BIRTH
MM/DD/YYYY		DATE HIRED
MM/DD/YYYY		CERTIFICATE #
(Certified Teachers Only)		CURRENT PROGRAM HOURS
per week		ANTICIPATED ADDITIONAL HOURS
per week		CURRENT PROGRAM SALARY/ ANNUAL WAGESFRINGE RATECLEARED? Yes/No
(please use propper case)
20
LAST NAMEFIRST NAME
21
SmithJaneLead TeacherDC1707/37 - Local 2051 - Teacher/MA/Certified 01/01/195006/01/199000000025.0011.00 $ 52,000.00 12.65%Yes
22
<select one>
23
<select one>
24
<select one>
25
<select one>
26
<select one>
27
<select one>
28
<select one>
29
<select one>
30
<select one>
31
<select one>
32
<select one>
33
<select one>
34
<select one>
35
<select one>
36
<select one>
37
<select one>
38
<select one>
39
<select one>
40
<select one>
41
<select one>
42
<select one>
43
<select one>
44
<select one>
45
<select one>
46
<select one>
47
<select one>
48
<select one>
49
<select one>
50
<select one>
51
<select one>
52
<select one>
53
<select one>
54
<select one>
55
<select one>
56
<select one>
57
<select one>
58
<select one>
59
<select one>
60
<select one>
61
<select one>
62
<select one>
63
<select one>
64
<select one>
65
<select one>
66
<select one>
67
<select one>
68
<select one>
69
<select one>
70
<select one>
71
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154