Form ed-916 Economic Devevlopment Districts and Indian Tribes

Economic Development Administration

GPRA Data Collection Form

Economic Development Districts and Indian Tribes

PART I

Date ___________________________________________________________________

Recipient Name ___________________________________________________________________

Full Address ___________________________________________________________________

Authorized Contact ___________________________________________________________________

Telephone ____________________________ Fax ______________________________

Email (not optional) ___________________________________________________________________

EDA Investment Planning Partnership Investments

Investment Number ___________________ Award Period___________ to ________________

Description of Investment: Economic Development District _____ Indian Tribe _____

PART II

Recipients Provide the Following Information

1. Economic Development Districts (EDD) only

a. Number of Sub-state Jurisdictions eligible to participate in the EDD ______________

b. Number of Sub-state Jurisdictions actively participating by attending meetings ______________

or financially contributing to the EDD.

2. Economic Development Districts and Indian Tribes

a. Number of economic development initiatives from the Comprehensive Economic ______________

Development Strategy (CEDS) process implemented during the investment award

period that led to private investment and jobs.

Qty. Qty.

b. Categorize type of project(s): Facility Construction / Rehab. _____ Infrastructure _____

Technical Assistance _____ Planning _____

(total of these five must be equal to 2a) Other _____

c. How many (if any) of the above were: Technology __ Brownfields __ (should be subset of projects identified in 2b)

4. Number of Investments Funded by Any Source: (Total must equal 2a. If EDA-funded investment, include only those awarded by EDA, during this reporting period and have an EDA investment number. Do not count this planning investment.)

EDA Funded (Qty) _____ Funded by Other Source (Qty) _____

e. Attach a list of economic development initiatives reported in 2a. Identify the sources of funding for each initiative, specify EDA, state, local or other federal agency(s).

f. Estimated number of jobs created or retained as a result of projects in 2a ______________

g. Estimated amount of private sector investment generated by projects in 2a ______________

h. Estimated amount of public sector investment generated by projects in 2a ______________

OMB Approved ED-916

OMB Control Number 0610-0098

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