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Practical Nursing Student Instructional Hours

Instructions for PDE 4104, Practical Nursing Student Instructional Hours, July 1, 2020 through June 30, 2021

General Instructions

This form is used to collect data on student instructional (classroom and clinical) hours that will determine the full-time equivalent (FTE) students of Practical Nursing (PN) programs. Quarterly payments will be made based on actual quarterly FTE enrollments. Reconciliation will be made based on the final report submitted by July 15 and any adjustments will be made in the September payment.

The PDE 4104 form should be completed for each due date indicating the data for that quarter along with the prior quarters. The form should be emailed to or mailed to Terri Porter in the Bureau of Career and Technical Education, 11th Floor, 333 Market Street, Harrisburg, PA 17126-0333. The final submission (due date of July 15, 2021) requires data for all four quarters as well as summary data and the signature of the Director or Superintendent.

Who To Report

Students enrolled in PN programs for which reimbursement is requested. These programs must be in compliance with the Rules and Regulations of the State Board of Nursing for Practical Nurses. Only students meeting the required classroom and clinical instruction should be included. Do not include out-of-state students. No extra study time or remedial time should be considered. All students should be included regardless of funding source. Do not exclude hours of students for sick leave or personal reasons for absence other than withdrawal.


One FTE is equivalent to 1200 hours of classroom and clinical hours. Payment is based on $1800 per FTE subject to funding availability. If the state appropriation is not sufficient to pay total statewide FTEs, PDE will apply a reduction factor. For each quarter, calculate the payment using the actual hours divided by 1200 multiplied by $1800. Actual hours should be rounded to whole or half hours only. Do not round other figures. The final reconciliation will be made using the July 15, 2021 data. Actual hours for the year should agree with your attendance data.


The Total Actual Hours for Year is the total of the actual hours of the four quarters. Total Actual Hours divided by 1200 times $1800 will give you Reimbursement Earned in Fiscal Year 2020-21. Actual Received as of June 30, 2021 is the Initial Payment plus the December Quarterly Payment, March Quarterly Payment, and June Quarterly Payment. Your Final Payment will be the difference between Reimbursement Earned and Actual Received less any reduction factor necessary.

Signature Block

The signature of the Director or Superintendent is only necessary with the final submission, which is due on July 15, 2021. Photocopies of the PDE 4104 form may be sent for each submission.