Form 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 ____________________________ Fax ______________________________

Email (not optional) ___________________________________________________________________

Investment Program Public Works ____ Economic Adjustment ____ Revolving Loan Fund ____

Project Number ___________________________________________________________________

Award Date ____________________________ Close-out Date______________________

(if applicable)

Investment awarded during federal fiscal year: FY 19_____ FY 20____

Data in this report:

___ 3 years after investment award ____ 6 years after investment award ___ 9 years after investment award

CONSTRUCTION OR LOAN FUNDING
Total Investment	EDA Investment	Applicant Investment 1	Private Investment 2	Other Federal Investment
$	$	$	$	$

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

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 Approved ED-915

OMB Control Number 0610-0098

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