5300-26 Exchange Network Grant Program Progress Reporting Form

Proposed modification to semi-annual reporting form

OMB No. 2025-0006

Expires 04/30/2015

U.S. ENVIRONMENTAL PROTECTION AGENCY Exchange Network Grant Program Progress Reporting Form for Use by Recipients of Assistance Agreements
Please Check: □ Semi-annual report □ Final Report	Instructions: This form is for Exchange Network Grant recipients to report their progress. Recipients should send these to their regional grant project officer for spring reports by April 30 for the period October 1-March 31. Fall reports are due to the regional project officer by October 31 for the period April 1-September 30.
Recipient Information: Agency Name:		EPA Grant Number – Program Code, Number, and Amendment Number (e.g., OS – 12345678 – 0):
		For grants awarded before 2006 Exchange Network Grant Category (i.e., One Stop, Readiness, Implementation, or Challenge):
Project Manager: Name: Phone: Email:		Funding Year: Award Amount: Expenditures during this reporting period: Funds Remaining:
		Reporting Period (starting and ending dates, mm/dd/yyyy):	Date Report Submitted (mm/dd/yyyy):
		EPA Project Officer to Whom Report is Submitted: Name: EPA Region/Program:
Focus:

Progress Report Instructions: In the “Scheduled Completion Date” column enter the dates from the grant work plan In the “Actual Completion Date” column enter the date each output completed as of the period covered by this report
EXAMPLE
Goals	Outputs	Scheduled Completion Date	Actual Completion date
1. Flow ambient air quality data through the Exchange Network.	1. Develop XML schema	. mm/yyyy	mm/yyyy
	2. Initiate first test data flow	mm/yyyy

Goals	Outputs	Scheduled Completion Date	Actual Completion date

Comments

Instructions: If you have had any problems during the current period please report them here. In accordance with 40 C.F.R. §30.51(f) and 40 C.F.R. §31.40(d), a recipient of an EPA assistance agreement must notify EPA of any problems, delays, or adverse conditions that will materially impair the recipient’s ability to achieve the outputs/outcomes specified in the assistance agreement work plan.

Problems during this reporting period:

Describe any actions your organization has taken or plans to take to resolve the problem:

If you need help from EPA you may request it here:

Other comments:

Definitions

• Project/Program Goal: A major objective or endpoint identified in the assistance agreement work plan. A work plan may include one or more project/program goals. Use the goals as described in the assistance agreement work plan.

• Output: A product, service, or implementation target that will be produced or achieved during the project/program. Outputs may be qualitative or quantitative, but they must be measurable during the assistance agreement funding period.

• Outcome: Changes or benefits resulting from the successful achievement of the project/program activities and outputs. Outcomes may be environmental, behavioral, health-related, or programmatic in nature, but they must be quantitative. Outcomes may not necessarily be achievable within the assistance agreement funding period, and they can be described as short-term, intermediate, or long-term:

  1. short-term – changes in learning, knowledge, attitudes, or skills;

  2. intermediate – changes in behavior, practices, or decisions; or

  3. long-term – changes in environmental, human health, or other conditions.

Paperwork Reduction Act (PRA) Burden Statement: The public reporting and recordkeeping burden for this collection of information is estimated to average 45 minutes per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

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EPA Form 5300-26