Form 6200-04 Job Training Reporting Form

United States
ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460

Form Approved
OMB No. 2050-0192
Expires: xx-xx-xxxx

JOB TRAINING REPORTING FORM
Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions,
searching data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate—o r any other aspect of this collection of information, including suggestions for reducing this burden—to the
Environmental Protection Agency, Office of Environmental Information, Code 2822T, Washington, DC 20460 and to the Paperwork Reduction Project,
Office of Management and Budget, Washington, DC 20503. DO NOT RETURN your form to either of these addresses. Send your completed form to the
address provided by the issuing office.

PART I - COOPERATIVE AGREEMEMENT RECIPIENT INFORMATION
1. Cooperative Agreement Recipient Name:

2. Cooperative Agreement Number:

PART II - PERFORMANCE MEASURES INFORMATION
This Federal
Fiscal
QUARTER

CUMULATIVE

3. Number of Participants Entering Training
3a. Number of Veterans Entering Training
4. Number of Participants Completing Training
5a. Number of Participants Obtaining Employment
5b. Number of Individuals that did not Obtain Employment but are
Pursuing Education (e.g., GED, college courses, etc.)
6. Average Hourly Wage of Participants Obtaining Employment
7. Funds Leveraged (total)
7-1. Funding Source Name:
7-2. Activity Funded:
7-1. Funding Source Name:
7-2. Activity Funded:
7-1. Funding Source Name:
7-2. Activity Funded:
8. Supplemental Performance Measures Information (optional):

PART III - APPROVALS
9. Cooperative Agreement Recipient Project Manager:
Name (please print)

Signature:

Date:

Signature:

Date

10. U.S. EPA Regional Representative:
Name (please print)

EPA Form 6200-04

INSTRUCTIONS FOR COMPLETING
JOB TRAINING REPORTING FORM
GENERAL INSTRUCTIONS
Overview:
As specified in your cooperative agreement terms and conditions, all Job Training cooperative agreement
recipients must report to EPA on a regular basis. This OMB and EPA approved reporting form (OMB No.
2050-0192, EPA Form 6200-04) supplements your Quarterly Reports with information about specific
activities and accomplishments that EPA deems necessary to adequately monitor and evaluate progress
toward goals defined in cooperative agreements. Please contact your EPA Regional representative if you
have any questions when completing this form. Please note that, in most instances, all reported information
is accessible by the public under the Freedom of Information Act (FOIA) and may be distributed by EPA to
the public unless an FOIA exclusion is applicable.
Compared to the Quarterly Reports, the Job Training Reporting Form (JT Reporting Form or JT Form)
contains quantitative information on four specific measures of recipient performance. Reporting on these
specific activities and accomplishments must be provided in the attached JT Reporting Form rather than in
the Quarterly Reports. Additional voluntary and/or narrative information may be provided in Part II of this
form or in the Quarterly Report.
When to Submit:
Original JT Reporting Forms. Cooperative agreement recipients must develop the first JT Reporting Form
when the first specified accomplishment has occurred (e.g., when the first class of trainees “graduates” from
the training program provided under the cooperative agreement, or when leveraged funding is committed to
supplement the cooperative agreement activities).
Updated JT Reporting Forms. JT Reporting Forms should be updated and delivered as additional
accomplishments occur. In addition, an updated form should be provided when the cooperative agreement is
being closed out. Cooperative agreement recipients should provide ample time to report job placement
activities prior to the closeout of the project period. If you have data to report after the closeout of the
cooperative agreement, please contact the ACRES Help desk at [email protected].
To Whom to Submit:
Cooperative agreement recipients must submit JT Reporting Forms to their EPA Regional Representative
identified in the terms and conditions of the cooperative agreement. If data is entered online it will
automatically be delivered to the EPA Regional Representative.
How to Submit:
The Assessment, Cleanup, and Redevelopment Exchange System (ACRES) is available online and is the
preferred method for Job Training cooperative agreement recipients to enter and submit the JT Reporting
Form. Electronic reporting is optional. The JT Reporting Form may also be submitted in hard copy with the
next required Quarterly Report or via e-mail to the EPA Regional Representative.

EPA Form 6200-04

DETAILED INSTRUCTIONS FOR COMPLETING EACH ITEM ON FORM
PART I – COOPERATIVE AGREEMENT RECIPIENT INFORMATION
1. Cooperative Agreement Recipient Name. Enter the cooperative agreement recipient name. Use the
official name provided in the cooperative agreement, unless otherwise directed by the EPA Regional
Representative.
2. Cooperative Agreement Number. Enter the cooperative agreement number. Use the number as provided
in the cooperative agreement.
PART II - PERFORMANCE MEASURES INFORMATION
This section contains two parts—one mandatory, for performance measures information; the other optional,
for narrative information to supplement the quantitative information provided (Field 8).
Mandatory Performance Measures.
Provide all quantitative information relating to each of the mandatory performance measures. For each
measure, enter amounts in column (a) — This Federal Fiscal Quarter — to reflect the incremental
accomplishments attained during the current federal fiscal reporting quarter and column (b) — Cumulative
— to reflect the total accomplishments attained to date during the term of the cooperative agreement. Note:
quantitative information relating to these performance measures should only be provided in the JT Form (i.e.,
not in narrative reporting contained in the Quarterly Report).
3. Number of Participants Entering Training. Enter the number of participants who entered a cooperative
agreement funded training program.
3a. Number of Veterans Entering Training. Enter the number of participants who entered a cooperative
agreement funded training program that are Veterans.
4. Number of Participants Completing Training. Enter the number of participants taking the cooperative
agreement funded training who have completed the training program.
5a. Number of Participants Obtaining Employment. Enter the number of graduates from the cooperative
agreement funded training program who have obtained employment of any kind. Self-employed graduates
should be included in this count. The cumulative total number inserted in column (b) should only increase
during the term of the cooperative agreement; the recipients’ reporting of the cumulative total should not
reflect any decreases for graduates who had obtained employment but later reported losing their jobs. If
desired, provide a brief narrative description in section 8 for any reported job losses.
5b. Number of Individuals that did not Obtain Employment but are Pursuing Education (e.g., GED,
college courses, etc.). Enter the number of graduates from the cooperative agreement funded training
program who have not obtained employment but are pursuing an education. Education can include GED
classes, college courses, vocational training, etc.
6. Average Hourly Wage. Enter the average hourly wage of job training graduates in their initial posttraining employment. Provide the hourly wage for the first job that each employed graduate secures after
completing the job training program. Anecdotal information about subsequent jobs and wages may also be
narratively provided.

EPA Form 6200-04

7. Funds Leveraged. Enter the total amount of funding leveraged as a result of cooperative agreement
activities. Capture the total number of non-cooperative agreement dollars linked and leveraged to support
additional, related activities of the recipient. To be reportable, there must be a demonstrable link or
connection between the EPA funded activity and the leveraged funding. Funding can occur through direct
financial assistance and/or through in-kind services or supplies. Usually, leveraged funding that was
committed prior to the award of the EPA recipient should not be reported as leveraged. In addition, leveraged
funding should not be reported in this section until the funding has been committed. These leveraged funds
may be used to support activities that cannot be funded by the EPA cooperative agreement (e.g.,
transportation or child care for job training students).
In addition to the total leveraged funds, also describe the source(s) and amount of funding leveraged, and the
types of activities it funded. For each funding source (7-1), also list the type of activity funded (7-2) and the
amount of funding leveraged per source in columns (a) and (b). As necessary, add additional lines for 7-1
and 7-2.
7-1. Funding Source Name(s). For each funding source, enter the name of the organization
providing the funds and/or in-kind services. Examples of sources of leveraged funding include other
EPA programs; private organizations; state environmental, labor, or economic agencies; tribal
governments; local governments (including community development corporations); and other federal
agencies.
7-2. Activity Funded. For each funding source listed under 7-1, provide the type of activity that was
supported. Examples of leveraged activities include additional curricula development/training (e.g.,
environmental and non-environmental), supplies/equipment, transportation for students, and child
care for students.
8. Supplement Performance Measures Information (Optional). Provide a brief narrative description to
supplement the required performance measures reporting, including, for example: demographic information
(e.g., gender, age, ethnicity, education); description of the training curricula; information on the types of jobs
obtained by the participants entering/completing the training; names of employers; names of brownfield sites
graduates are placed at; availability of photographs/video footage of the training/graduation/post-training
employment; and/or other milestones tracked by the recipient for its own management.
PART III - APPROVALS
9. Cooperative Agreement Recipient Project Manager. Type or print the name of the cooperative
agreement recipient project manager. The project manager should also sign and date the completed JT
Reporting Form before submission.
10. U.S. EPA Regional Representative. Type or print the name of the EPA Regional Representative. The
EPA Representative should also sign and date the reviewed JT Reporting Form.

EPA Form 6200-04