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INTERIM PERFORMANCE REPORT
Please consult attached instructions when filling out this form.
1. Federal agency and organization element to
which report is submitted:
Institute of Museum and
Library Services
2. Federal award or other identifying
number assigned by federal agency:
Page
of
Pages
3a. D‐U‐N‐S® number:
3b. EIN/TIN:
4. Recipient organization (name and complete address, including ZIP+4/postal code):
6a. Award period of performance start
date (mo/day/yr):
6b. Award period of performance end
date (mo/day/yr):
5. Recipient identifying or
account number:
7. Reporting period end date
(mo/day/yr):
9. Report frequency:
annual semi‐
annual
quarterly other
If other, describe:
8. Project URLs, if any:
10. Other attachments? Yes No
Contact the IMLS program office to receive instructions for transmitting additional attachments.
11a. Name and title of Project Director:
11b. Telephone (area code, number, extension):
11c. Email address:
12. Certification: By submitting this report I certify to the best of my knowledge and belief that this information is correct
and complete for performance of activities for the purposes set forth in the award documents.
13a. Signature of Authorized Certifying Official:
13c. Name and title of Authorized Certifying Official:
13b. Date report submitted (mo/day/yr):
13d. Telephone (area code, number,
extension):
13e. Email address:
14. Agency use only
The purpose of the interim performance report is to provide a record of grant‐funded project activities
at annual intervals throughout the grant period. If you have questions concerning the interim
OMB No. XXXX‐XXXX, EXPIRES XX/XX/XXXX
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performance reporting requirements, you may address them to the Program Officer who is assigned to
your grant and whose name and contact information appear in your Official Award Notification. IMLS
may share interim performance reports with grantees, potential grantees, and the general public to
further the mission of the agency and the development of museum and library services. Reports may be
distributed in a number of ways and formats, including online.
15. Recipient Organization:
16. Project Title:
17. Project Summary
18. Activities
Activities Proposed in Your
Application
Activities Completed
during the Reporting Period
Explanation of Any Variance
19. Changes
Type of Change
Description
Date of Approval
(if applicable)
20. Lessons Learned
Burden Estimate and Request for Public Comments: Public reporting burden for this collection of information is estimated to average 3.17
hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information. Send comment regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden, to the Institute of Museum and Library Services, Chief Information
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Officer, 1800 M Street, NW, 9th Floor, Washington, DC 20036‐5802, and to the Office of Management and Budget, Paperwork Reduction
Project 3137‐0029, Washington, DC 20503.
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| File Type | application/pdf |
| File Modified | 2015-05-26 |
| File Created | 2015-05-26 |