ED-915 Public Works, Economic Adjustment Infrastructure and Rev

Economic Development Administration
GPRA Data Collection Form
Public Works, Economic Adjustment Infrastructure and Revolving Loan Fund Investments
Date___________________________________________________________________
Recipient Name

___________________________________________________________________

Full Address

___________________________________________________________________

Authorized Contact

___________________________________________________________________

Telephone

____________________________

Email (not optional)

___________________________________________________________________

Investment Program

Public Works ____

Project Number

___________________________________________________________________

Award Date

____________________________

Fax ______________________________

Economic Adjustment ____

Revolving Loan Fund ____

Close-out Date______________________
(if applicable)

Investment awarded during federal fiscal year:
Data in this report:
___ 3 years after investment award

Total Investment

FY 19_____

FY 20____

____ 6 years after investment award ___ 9 years after investment award

CONSTRUCTION OR LOAN FUNDING
EDA Investment
Applicant Investment 1 Private Investment 2

$
$
$
$
(Note: Total Project should be the total of the other values in this section)

Other Federal
Investment
$

GRANT RECIPIENT COMPLETE THIS SECTION
RESULT OF EDA INVESTMENT
3 Years After Award 3

6 Years After Award 3

9 Years After Award 3

Private Investment Generated
Jobs Created
Jobs Retained
Total Jobs Created/Retained
1 (includes Local and State)
2 private investment associated with project construction, e.g. foundation grants
3 at the time of this report (see instructions)
OMB Approved ED-915
OMB Control Number 0610-0098
Expires 06/30/2011

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