FSMIP Interim Performance Report

OMB No. 0581-0240

FSMIP Interim Performance Report

Report Number/Period: (for example: #1 Sept 29, 201x – Mar 31, 201x)

Date: Today’s Date

Recipient Contact: Name/Telephone/E-mail

Recipient Name: Organization Name

Project Title: As it appears on the Grant Agreement

Grant Number: 1X-FSMIP-State-Grant Number

Total Awarded Budget: $ Amount

Total Match: $ Amount

Although a subrecipient or another third party may prepare performance reports, it is nonetheless the recipient’s responsibility to review and approve them before forwarding them to FSMIP.

1. MAJOR ACTIVITIES COMPLETED - Summarize activities performed and milestones achieved for each objective or sub-element of the narrative. Also discuss:

   • Are goals being accomplished as anticipated in the proposed timeline?

   • Have there been any project changes (personnel, administrative, stakeholder involvement, etc.) that may be impacting the pace and success of the project? If yes, explain.

2. UNEXPECTED DELAYS - Note unexpected delays or impediments as well as favorable or unusual developments. Explain what the organization did to resolve or address these issues.

3. NEXT STEPS - Outline work to be performed during the next 6-month period; and

4. FINANCIAL SUMMARY- Comment on the level of grant funds and matching contributions expended to date on the project. Note the reasons for budget revisions, if made, and when FSMIP approval was granted. Report any program income generated, if any, and how it was utilized.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0240. The time required to complete this information collection is estimated to average 4 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.

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