Form TAB B TAB B TAB B - TBCP Baseline Report

Tribal Broadband Connectivity Program (TBCP) Reporting Requirements

Tribal Broadband Connectivity Program Report Forms (FINAL).xlsx

TBCP Baseline Report Form - TAB B

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Overview

TBCP Data Report Form Cover
Baseline Report
Performance (Technical) Report
Annual Report
TBCP Reports Addendum A
TBCP Reports Addendum B
TBCP Reports Addendum C


Sheet 1: TBCP Data Report Form Cover


Tribal Broadband Connectivity Program
Data Report Form
This Tribal Broadband Connectivity Program (TBCP) report form will serve as a tool to capture indicators highlighting broadband infrastructure, and adoption and use activities from the award's inception to the award's closeout. The form contains three separate reports: Baseline Report, Performance (Technical) Report and Annual Report.
Baseline Report:
The Baseline Report is submitted once at the beginning of your project and is based on anticipated figures and schedules. You will use the Baseline Report to provide your projected goals and planned activities from award start date to closeout. Some metrics will also ask you to provide data on the current state of your program before expending TBCP grant funds. The Baseline Report is due 45 calendar days after NEPA approval.
Performance (Technical) Report:
The Performance (Technical) Report is submitted semi-annually for periods ending March 31 and September 30, and captures project performance and outcomes. You will use the Performance (Technical) Report to provide your actual completed goals and planned activities from award inception to the current reporting period. You will submit the Performance (Technical) Report twice a year until you expend all TBCP grant funds, as well as upon closeout of the award. The Performance (Technical) Report is due 30 calendar days after the closing period. The final closeout report is due 120 calendar days after the last Performance Technical Report.
Annual Report:
The Annual Report captures narrative data on your project. You will use the Annual Report to provide necessary information on TBCP grant-funded project activities from award inception to the current reporting period. You will submit the annual report once a year until you expend all TBCP grant funds. The Annual Report is due 30 calendar days after the closing period.
Click on the links below to view the report forms. If you expend funds for infrastructure projects only or broadband use and adoption projects only, fill in NA for any indicators for which you do not collect data.
Baseline Report
Performance (Technical) Report
Annual Report

Sheet 2: Baseline Report

OMB Control No. XXX-XXXX Expiration Date: TBD
TRIBAL BROADBAND CONNECTIVITY PROGRAM BASELINE REPORT
GENERAL INFORMATION
GENERAL Recipient Organization:
Award Identification Number:
Recipient Street Address:
City, State, Zip Code:
DUNS/UEI Number:
Award Start Date (MM/DD/YYYY):
Report Submission Date (MM/DD/YYYY):
Award End Date (MM/DD/YYYY):






BROADBAND USE & ADOPTION AND INFRASTRUCTURE MILESTONES/KEY INDICATORS
9o-j
1
MILESTONE CATEGORIES Year 1 Year 2 Year 3 Year 4
Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
1a. Overall Project







1b. Environmental Assessment







1c. Network Design







1d. Rights Of Way







1e. Construction Permits And Other Approvals







1f. Site Preparation







1g. Equipment Procurement







1h. Network Build (all components - owned, leased, Indefeasible Rights of Use, etc.)







1i. Equipment Deployment







1j. Network Testing







1k. Other (please specify)







NETWORK BUILD PROGRESS
2 Please use the table provided to report your estimated percentage of completion for each semi-annual reporting period within each year of your project. Year One begins on your award start date.
The percentage of completion is based on the expenditure of your project budget and should be reported cumulatively from the award start date through the end of each semi-annual period. For example, if you expect to complete a particular milestone within the first three periods of your project, the third period and all subsequent periods should state 100%.
NETWORK BUILD PROGRESS MIDDLE OR LAST MILE Year 1 Year 2 Year 3 Year 4
Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
2a. Number of new fiber miles (aerial or underground)








2b. Number of fiber miles leased








2c. Number of existing fiber miles upgraded








2d. Number of new wireless links








2e. Number of new towers








2f. Number of new interconnection points








2g. Number of signed agreements with broadband wholesalers or last mile providers








2h. Number of potential agreements (i.e., agreements currently being negotiated) with broadband wholesalers or last mile providers (This number should NOT be reported cumulatively)








2i Other (please specify)








2j. Obtained licenses: 2.5 (EBS), 3.5 (EBS)








INFRASTRUCTURE KEY INDICATORS
3 Please use the following table to provide projected cumulative totals for each subscriber type and speed category for your project.
Except as indicated, information is reported cumulatively from start of award through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
PROJECTED NUMBER OF SUBSCRIBERS AND SPEED Year 1 Year 2 Year 3 Year 4
SUBSCRIBER TYPE SPEED TYPE Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
3a. Unserved Tribal Households Number of Unserved Tribal Households connected to broadband infrastructure







Number of Unserved Tribal Households connected to broadband infrastructure at speeds of at least 100/20







Number of Unserved Tribal Households connected to broadband infrastructure at speeds of at least 25/3







Number of Unserved Tribal Households connected to broadband infrastructure by copper or DSL cable line







Number of Unserved Tribal Households connected to broadband infrastructure by wireless connection







Number of Unserved Tribal Households connected to broadband infrastructure by fiber optic connection








3b. Tribal Households Number of Tribal Households connected to broadband infrastructure







Number of Tribal Households connected to broadband infrastructure at speeds of at least 100/20







Number of Tribal Households connected to broadband infrastructure at speeds of at least 25/3







Number of Tribal Households connected to broadband infrastructure by copper or DSL cable line







Number of Tribal Households connected to broadband infrastructure by wireless connection







Number of Tribal Households connected to broadband infrastructure by fiber optic connection








3c.Tribal Households At or Below 150% of the Poverty Line Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure







Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure at minimum speeds of at least 100/20







Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure at minimum speeds of 25/3







Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure by copper or DSL cable line







Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure by wireless connection







Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure by fiber optic connection








3d. Tribal Community Anchor Institutions (CAIs) Number of Tribal CAIs connected to broadband infrastructure







Number of Tribal CAIs connected to broadband infrastructure at minimum speeds of at least 100/20







Number of Tribal CAIs connected to broadband infrastructure at minimum speeds of at least 25/3







Number of Tribal CAIs connected to broadband infrastructure by copper or DSL cable line







Number of Tribal CAIs connected to broadband infrastructure by wireless connection







Number of Tribal CAIs connected to broadband infrastructure by fiber optic connection








3e. Businesses Number of businesses connected to broadband infrastructure







Number of businesses connected to broadband infrastructure at speeds of at least 100/20







Number of businesses connected to broadband infrastructure at speeds of at least 25/3







Number of businesses connected to broadband infrastructure by copper or DSL cable line







Number of businesses connected to broadband infrastructure by wireless connection







Number of businesses connected to broadband infrastructure by fiber optic connection







BROADBAND USE & ADOPTION KEY INDICATORS
4 Please use the following table to provide projected cumulative totals for each subscriber and access type for your project.
Except as indicated, information is reported cumulatively from the award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
PROJECTED NUMBER OF SUBSCRIBERS AND SPEED Year 1 Year 2 Year 3 Year 4
SUBSCRIBER TYPE ACCESS TYPE Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
4a. Unserved Tribal Households Number of Unserved Tribal Households passed/serviceable







Number of Unserved Tribal Households served















Number of Unserved Tribal Households with new access







Number of Unserved Tribal Households with improved access







Number of projected broadband speed subscriptions







Number of projected broadband speed delivered







Using the Excel spreadsheet template titled "TBCP Reports Addendum A", please provide an updated count of Households within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Baseline Report' checkbox when completing the addendum.

4b. Tribal Households Number of Unserved Tribal Households passed/serviceable







Number of Tribal Households served







Number of Tribal Households with new access







Number of Tribal Households with improved access







Number of projected broadband speed subscriptions







Number of Projected average broadband speed to be provided







Using the Excel spreadsheet template titled "TBCP Reports Addendum A", please provide an updated count of Households within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Baseline Report' checkbox when completing the addendum.

4c.Tribal Households At or Below 150% of the Poverty Line Number of Tribal Households At or Below 150% of the Poverty Line passed/serviceable







Number of Tribal Households At or Below 150% of the Poverty Line served







Number of Tribal Households At or Below 150% of the Poverty Line with new access







Number of Tribal Households At or Below 150% of the Poverty Line with improved access







Number of projected broadband speed subscriptions







Number of projected broadband speed delivered







Using the Excel spreadsheet template titled "TBCP Reports Addendum A", please provide an updated count of Households within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Baseline Report' checkbox when completing the addendum.

4e. Businesses Number of Businesses passed/serviceable







Number of Businesses served







Number of Businesses with new access







Number of Businesses with improved access







Number of projected broadband speed subscriptions







Number of projected broadband speed delivered







Using the Excel spreadsheet template titled "TBCP Reports Addendum B", please provide an updated count of Businesses within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Baseline Report' checkbox when completing the addendum.

4d. Tribal Community Anchor Institutions Number of Tribal Community Anchor Institutions passed/serviceable







Number of Tribal Community Anchor Institutions served







Number of Tribal Community Anchor Institutions with new access







Number of Tribal Community Anchor Institutions with improved access







Number of projected broadband speed subscriptions







Number of projected broadband speed delivered








Using the Excel spreadsheet template titled "TBCP Reports Addendum C", please provide an updated count of Community Anchor Institutions (CAIs) within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Baseline Report' checkbox when completing the addendum.
BROADBAND USE & ADOPTION DEMOGRAPHIC INDICATORS
5 Please use the following table to report the demographic information of funded service areas.
For each, list projected percentage of population for each field. This information should be reported cumulatively from award start date through the end of each semi-annual reporting period. Please write “NA” if your project does not include this indicator.
DEMOGRAPHIC INDICATORS Year 1 Year 2 Year 3 Year 4
SUBSCRIBER TYPE ESTIMATED POPULATION IN SERVICE AREA Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
5a. Unserved Tribal Population Percentage of Unserved Native American Alaska Native/Native Hawaiian Businesses in funded service area







Percentage of Unserved Native American Alaska Native/Native Hawaiian Households in funded service area







Percentage of Unserved Native American Alaska Native/Native Hawaiian Community Anchor Institutions in funded service area







Percentage of Unserved Native American Alaska Native/Native Hawaiian Households At or Below 150% of the Poverty Line in funded service area








5b. Tribal Population Percentage of Tribal Businesses in funded service area







Percentage of Tribal Households in funded service area







Percentage of Total Percentage of Tribal Community Anchor Institutions in funded service area







Percentage of Tribal Households At or Below 150% of the Poverty Line in funded service area







BROADBAND USE & ADOPTION WORKFORCE INDICATORS
6 Please use the following table to provide estimated totals for each workforce expansion and development indicator.
For each indicator, report the estimated figure for the corresponding project period. This information should be reported cumulatively from the award start date through the end of each semi-annual reporting period. Please write “NA” if your project does not include this indicator.
WORKFORCE INDICATORS Year 1 Year 2 Year 3 Year 4
OUTCOMES QUESTIONS Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
6a. Percentage of individuals with access to telework funded through TBCP grant Number of individuals with ability to telework prior to receiving TBCP grant funds

Number of individuals with ability to telework after receiving TBCP grant funds








6b. Percentage of new positions available funded through TBCP grant Number of new positions created







Number of new positions filled








6c. Number of individuals trained at workforce development training event funded by TBCP grant Number of individuals who attended workforce development training event








6d. Workforce development training events held funded through TBCP grant Number of workforce development training events held







BROADBAND USE & ADOPTION EDUCATIONAL SUCCESS INDICATORS
7 Please use the following table to provide anticipated totals for each educational attainment indicator.
For reach indicator, report the projected number for all corresponding project periods. This information should be reported cumulatively from the award start date through the end of each semi-annual reporting period. Please write “NA” if your project does not include this indicator.
EDUCATIONAL SUCCESS INDICATORS Year 1 Year 2 Year 3 Year 4
OUTCOMES QUESTIONS Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
7a. Percentage of individuals with access to online learning funded through TBCP grant Number of individuals with ability to participate in online learning prior to receiving TBCP grant funds

Number of individuals with ability to participate in online learning after receiving TBCP grant funds








7b. Percentage of individuals who actively engage in online learning activities success Number of individuals who attend online learning classes







Number of individuals who attend virtual/in-person school activities

























7c. Percentage of parents providing educational support for individuals Number of parents in program







Number of parents who attend virtual/in-person school activities








7d. Percentage of individuals who completed high school Number of individuals enrolled in high school







Number of individuals who successfully exited high school program with degree (diploma/GED)








7d. Total number of schools that are engaged in remote learning model Number of schools in program







Number of schools engaged in remote learning model








7e. Total number of schools that are engaged in-person learning model Number of schools in program







Number of schools engaged in-person learning model








7f. Total number of schools that are engaged in hybrid learning model Number of schools in program







Number of schools engaged in hybrid learning model







BROADBAND USE & ADOPTION TELEHEALTH INDICATORS
8 Please use the following table to provide anticipated totals for each telehealth expansion indicator.
For each indicator, list the projected number for all corresponding project periods. This information should be reported cumulatively from the award start date through the end of each semi-annual reporting period. Please write “NA” if your project does not include this indicator.
TELEHEALTH INDICATORS Year 1 Year 2 Year 3 Year 4
OUTCOMES QUESTIONS Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
8a. Percentage of individuals with access to telehealth services learning funded through TBCP grant Number of individuals with ability to participate in telehealth services prior to receiving TBCP grant funds

Number of individuals with ability to participate in telehealth service after receiving TBCP grant funds








8b. Number of individuals enrolled in telehealth services for the first time Number of individuals with new access to telehealth services

























8c. Total number of telehealth appointments scheduled Estimated number of telehealth appointments scheduled







BROADBAND USE & ADOPTION DIGITAL INCLUSION INDICATORS
9 Please use the following table to provide anticipated totals for each digital inclusion indicator.
For each indicator, list the projected number for all corresponding project periods. This information should be reported cumulatively from award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
DIGITAL INDICATORS Year 1 Year 2 Year 3 Year 4
OUTCOMES QUESTIONS Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected Period 1 - Projected Period 2 - Projected
9a. Total number of households participating in affordable broadband connectivity program Number of households in affordable broadband connectivity program








9b. Total number of digital literacy trainings held Number of digital literacy training events held








9c. Number of Tribal programs transitioned to online platform funded through TBCP grant Number of Tribal programs transitioned to online platform now (after receiving TBCP grant funds)








9d. Number of individuals given device Number of individuals given device








9e. Number of households given device Number of households given device








9f. Number of other entities (i.e., community anchor institutions, schools, businesses) given device Number of other entities given device







TYPE OF INTERNET DEVICES
10 Please describe the Internet Devices you will acquire using TBCP funding.
LAPTOP/COMPUTER INDICATORS Wi-Fi Hotspot Tablet Devices Other
NUMBER OF DEVICES TOTAL COST Number of Devices Total Cost Number of Devices Total Cost Number of Devices Total Cost





























































































TYPE OF COLLABORATORS
11 Please list all projected funded and unfunded collaborators in table below.
COLLABORATORS
Collaborator Organization Name Collaborator POC Name Collaborator POC Email Funded or Unfunded Collaboration







































































CERTIFICATION I certify to the best of knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
Typed or printed name and title of Authorized Certifying Official: Telephone (area code, number and extension):

Signature of Certifying Official: Email Address:

Date:

Sheet 3: Performance (Technical) Report

OMB Control No. XXX-XXXX Expiration Date: TBD
TRIBAL BROADBAND CONNECTIVITY PROGRAM PERFORMANCE (TECHNICAL) REPORT
GENERAL INFORMATION
GENERAL Recipient Organization:
Award Identification Number:
Recipient Street Address:
City, State, Zip Code:
DUNS/UEI Number:
Award Start Date (MM/DD/YYYY):
Report Submission Date (MM/DD/YYYY):
Award End Date (MM/DD/YYYY):
Reporting Period Start Date (MM/DD/YYYY):
Final Report Yes
Reporting Period End Date (MM/DD/YYYY):
No
BROADBAND USE & ADOPTION AND INFRASTRUCTURE MILESTONES/KEY INDICATORS
INFRASTRUCTURE PROJECT MILESTONE CATEGORIES
1 Please use the table provided to indicate the percentage of completion for cumulative activities conducted with TBCP grant funds. The percentage of completion is based on the expenditure of your project budget and should be reported cumulatively from the award start date through the end of each semi-annual reporting period. For example, if you expect to complete a particular milestone within the first three periods of your project, the third period and all subsequent periods should state 100%.

Please also provide a brief description (100 words or less) of the primary activities involved in meeting each milestone (a single description should be provided for each milestone, covering all periods in years one through N). Please write “NA” if your project does not include an activity. If necessary, please insert additional milestones at the bottom of the chart.

MILESTONE CATEGORIES

Percent Complete Narrative (Describe reasons for variance of 5% or more from baseline plan or subsequent written updates provided to your Program Officer )

1a. Overall Project


1b. Environmental Assessment


1c. Network Design


1d. Rights Of Way


1e. Construction Permits And Other Approvals


1f. Site Preparation


1g. Equipment Procurement


1h. Network Build (all components - owned, leased, Indefeasible Rights of Use, etc.)


1i. Equipment Deployment


1j. Network Testing


1k. Other (please specify)


1l. Please describe significant project accomplishments during this reporting period funded through TBCP grant. (600 words or less)



1m. Please describe any challenges to achieving project accomplishments during this reporting period funded through TBCP grant. (600 words or less)


NETWORK BUILD PROGRESS
2 Please use the following table to report key indicators and progress of your Infrastructure project.
Except as indicated, information should be reported cumulatively from award start date through the end of the semi-annual period. Please write “NA” if your project does not include this indicator.
NETWORK BUILD PROGRESS
Percent Complete Narrative (Describe reasons for variance of 5% or more from baseline plan or subsequent written updates provided to your Program Officer )
2a. Number of new fiber miles (aerial or underground)

2b. Number of fiber miles leased

2c. Number of existing fiber miles upgraded

2d. Number of new wireless links

2e. Number of new towers

2f. Number of new interconnection points

2g. Number of signed agreements with broadband wholesalers or last mile providers

2h. Number of potential agreements (i.e., agreements currently being negotiated) with broadband wholesalers or last mile providers (This number should NOT be reported cumulatively)

2i Other (please specify)

2j. Obtained licenses: 2.5 (EBS), 3.5 (EBS)

INFRASTRUCTURE KEY INDICATORS
3 Please use the following table to provide the cumulative totals for each subscriber category and speed type for your project.
Except as indicated, information should be reported cumulatively from award start date through the end of the semi-annual period. Please write “NA” in narrative text if your project does not include this indicator.
PROJECTED NUMBER OF SUBSCRIBERS AND SPEED
SUBSCRIBER TYPE ACCESS TYPE Total Narrative (Describe reasons for variance of 5% or more from baseline plan or subsequent written updates provided to your Program Officer )
3a. Unserved Tribal Households Number of Unserved Tribal Households connected to broadband infrastructure

Number of Unserved Tribal Households connected to broadband infrastructure at speeds of at least 100/20

Number of Unserved Tribal Households connected to broadband infrastructure at speeds of at least 25/3

Number of Unserved Tribal Households connected to broadband infrastructure by copper or DSL cable line

Number of Unserved Tribal Households connected to broadband infrastructure by wireless connection

Number of Unserved Tribal Households connected to broadband infrastructure by fiber optic connection


3b. Tribal Households Number of Tribal Households connected to broadband infrastructure

Number of Tribal Households connected to broadband infrastructure at speeds of at least 100/20

Number of Tribal Households connected to broadband infrastructure at speeds of at least 25/3

Number of Tribal Households connected to broadband infrastructure by copper or DSL cable line

Number of Tribal Households connected to broadband infrastructure by wireless connection

Number of Tribal Households connected to broadband infrastructure by fiber optic connection


3c.Tribal Households At or Below 150% of the Poverty Line Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure

Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure at minimum speeds of at least 100/20

Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure at minimum speeds of 25/3

Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure by copper or DSL cable line

Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure by wireless connection

Number of Tribal Households At or Below 150% of the Poverty Line connected to broadband infrastructure by fiber optic connection


3d. Tribal Community Anchor Institutions Number of Tribal Community Anchor Institutions connected to broadband infrastructure

Number of Tribal Community Anchor Institutions connected to broadband infrastructure at minimum speeds of at least 100/20

Number of Tribal Community Anchor Institutions connected to broadband infrastructure at minimum speeds of at least 25/3

Number of Tribal Community Anchor Institutions connected to broadband infrastructure by copper or DSL cable line

Number of Tribal Community Anchor Institutions connected to broadband infrastructure by wireless connection

Number of Tribal Community Anchor Institutions connected to broadband infrastructure by fiber optic connection


3e. Businesses Number of businesses connected to broadband infrastructure

Number of businesses connected to broadband infrastructure at speeds of at least 100/20

Number of businesses connected to broadband infrastructure at speeds of at least 25/3

Number of businesses connected to broadband infrastructure by copper or DSL cable line

Number of businesses connected to broadband infrastructure by wireless connection

Number of businesses connected to broadband infrastructure by fiber optic connection

BROADBAND USE & ADOPTION KEY INDICATORS
4 Please use the following table to provide the cumulative totals for each subscriber category and access type for your project.
Except as indicated, information should be reported cumulatively from award start date through the end of the semi-annual period. Please write “NA” in narrative text if your project does not include this indicator.
PROJECTED NUMBER OF SUBSCRIBERS AND SPEED
SUBSCRIBER TYPE ACCESS TYPE Total Narrative (Describe reasons for variance in total of 5 or more from baseline plan or subsequent written updates provided to your Program Officer )
4a. Unserved Tribal Households Number of Unsubscribed Tribal Households passed

Number of Unsubscribed Tribal Households served








Number of Unsubscribed Tribal Households with new access








Number of Unsubscribed Tribal Households with improved access








Number of projected broadband speed subscriptions








Number of projected broadband speed delivered









4b. Tribal Households Number of Unsubscribed Tribal Households passed/serviceable

Number of Tribal Households served

Number of Tribal Households with new access

Number of Tribal Households with improved access

Number of projected broadband speed subscriptions

Number of Projected average broadband speed to be provided


4c.Tribal Households At or Below 150% of the Poverty Line Number of Tribal Households At or Below 150% of the Poverty Line passed/serviceable

Number of Tribal Households At or Below 150% of the Poverty Line served

Number of Tribal Households At or Below 150% of the Poverty Line with new access

Number of Tribal Households At or Below 150% of the Poverty Line with improved access

Number of projected broadband speed subscriptions

Number of projected broadband speed delivered


4e. Businesses Number of Businesses passed/serviceable

Number of Businesses served

Number of Businesses with new access

Number of Businesses with improved access

Number of projected broadband speed subscriptions

Number of projected broadband speed delivered


4d. Tribal Community Anchor Institutions Number of Tribal Community Anchor Institutions passed/serviceable

Number of Tribal Community Anchor Institutions served

Number of Tribal Community Anchor Institutions with new access

Number of Tribal Community Anchor Institutions with improved access

Number of projected broadband speed subscriptions

Number of projected broadband speed delivered

BROADBAND USE & ADOPTION DEMOGRAPHIC INDICATORS
5 Please use the following table to provide demographics of funded service areas.
For each demographic, list projected percentage of population in indicators with the projected amount. This information should be reported cumulatively from award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
DEMOGRAPHIC INDICATORS
SUBSCRIBER TYPE ESTIMATED POPULATION IN SERVICE AREA Percent Complete Narrative (Describe reasons for variance from baseline plan or subsequent written updates provided to your Program Officer )
5a. Unserved Tribal Population Percentage of Unserved Native American Alaska Native/Native Hawaiian Businesses in funded service area

Percentage of Unserved Native American Alaska Native/Native Hawaiian Households in funded service area

Percentage of Unserved Native American Alaska Native/Native Hawaiian Community Anchor Institutions in funded service area

Percentage of Unserved Native American Alaska Native/Native Hawaiian Households At or Below 150% of the Poverty Line in funded service area


5b. Tribal Population Percentage of Tribal Businesses in funded service area

Percentage of Tribal Households in funded service area

Percentage Tribal Community Anchor Institutions in funded service area

Percentage of Tribal Households At or Below 150% of the Poverty Line in funded service area

BROADBAND USE & ADOPTION WORKFORCE INDICATORS
6 Please use the following table to provide totals for each workforce outcome and question.
For each question, list the projected for each project period. This information should be reported cumulatively from award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
WORKFORCE INDICATORS
OUTCOMES QUESTIONS Total Narrative (Describe reasons for variance in total of 5 or more from baseline plan or subsequent written updates provided to your Program Officer )
6a. Percentage of individuals with access to telework funded through TBCP grant Number of individuals with ability to telework prior to receiving TBCP grant funds

Number of individuals with ability to telework after receiving TBCP grant funds


6b. Percentage of new positions available funded through TBCP grant Number of new positions created

Number of new positions filled


6c. Number of individuals trained at workforce development training event funded by TBCP grant Number of individuals who attended workforce development training event


6d. Workforce development training events held funded through TBCP grant Number of workforce development training events held

BROADBAND USE & ADOPTION EDUCATIONAL SUCCESS INDICATORS
7 Please use the following table to provide totals for each educational success outcome and question.
For each question, list projected for each project period. This information should be reported cumulatively from award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
EDUCATIONAL SUCCESS INDICATORS
OUTCOMES QUESTIONS Total Narrative (Describe reasons for variance in total of 5 or more from baseline plan or subsequent written updates provided to your Program Officer )
7a. Percentage of individuals with access to online learning funded through TBCP grant Number of individuals with ability to participate in online learning prior to receiving TBCP grant funds

Number of individuals with ability to participate in online learning after receiving TBCP grant funds


7b. Percentage of individuals who actively engage in online learning activities success Number of individuals who attend online learning classes

Number of individuals who attend virtual/in-person school activities


7b. Percentage of parents providing educational support for individuals Number of parents in program

Number of parents who attend virtual/in-person school activities


7d. Percentage of individuals who completed high school Number of individuals enrolled in high school

Number of individuals who successfully exited high school program with degree (diploma/GED)


7d. Total number of schools that are engaged in remote learning model Number of schools in program

Number of schools engaged in remote learning model


7e. Total number of schools that are engaged in-person learning model Number of schools in program

Number of schools engaged in-person learning model


7f. Total number of schools that are engaged in hybrid learning model Number of schools in program

Number of schools engaged in hybrid learning model

BROADBAND USE & ADOPTION TELEHEALTH INDICATORS
8 Please use the following table to provide totals for each telehealth outcome and question.
For each question, list projected for each project period. This information should be reported cumulatively from award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
TELEHEALTH INDICATORS

OUTCOMES QUESTIONS Total Narrative (Describe reasons for variance in total of 5 or more from baseline plan or subsequent written updates provided to your Program Officer )
8a. Percentage of individuals with access to telehealth services learning funded through TBCP grant Number of individuals with ability to participate in telehealth services prior to receiving TBCP grant funds

Number of individuals with ability to participate in telehealth service after receiving TBCP grant funds


8b. Number of individuals enrolled in telehealth services for the first time Number of individuals with new access to telehealth services


8c. Total number of telehealth appointments scheduled Estimated number of telehealth appointments scheduled

BROADBAND USE & ADOPTION DIGITAL INCLUSION INDICATORS
9 Please use the following table to provide totals for each digital inclusion outcome and question.
For each question, list projected for each project period. This information should be reported cumulatively from award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
DIGITAL INCLUSION INDICATORS
OUTCOMES QUESTIONS Total Narrative (Describe reasons for variance in total of 5 or more from baseline plan or subsequent written updates provided to your Program Officer )
9a. Number of households participating in affordable broadband connectivity program Number of households in affordable broadband connectivity program


9b. Number of digital literacy trainings held Number of digital literacy training events held


9c. Number of Tribal programs transitioned to online platform funded through TBCP grant Number of Tribal programs transitioned to online platform previously (before receiving TBCP grant funds)

Number of Tribal programs transitioned to online platform now (after receiving TBCP grant funds)


9d. Number of individuals given device Number of individuals given device


9e. Number of households given device Number of households given device


9f. Number of other entities (i.e.: community anchor institutions, schools, businesses) given device Number of other entities given device

TYPE OF INTERNET DEVICES
10 Please describe the Internet Devices you acquired using TBCP funding.
LAPTOPS/COMPUTERS Tablet Devices Other
NUMBER OF DEVICES TOTAL COST Number of Devices Total Cost Number of Devices Total Cost































































TYPE OF COLLABORATORS
11 Please list all funded and unfunded collaborators in table below. Please note, you can update this information at anytime.
COLLABORATORS
Collaborator POC Name Collaborator POC Email Funded or Unfunded Collaboration





















BUDGET EXECUTION DETAILS
12 Please provide details below on your total budget and total funding expended to date for each budget element, including detailed disbursements of both matching funds approved and federal funds obligated from project inception through end of this reporting period. Figures should be reported cumulatively from award start date to the end of the applicable reporting period.
ACTUAL BUDGET Federal Funds Expended Total Funds Expended
Administrative and legal expenses $ $
Land, structures, rights-of way, appraisals, etc. $- $-
Relocation expenses and payments $- $-
Architectural and engineering fees $- $-
Other architectural and engineering fees $- $-
Project inspection fees $- $-
Site work $- $-
Demolition and removal $- $-
Construction $ $
Equipment $- $-
Miscellaneous $- $-
Subtotal $- $-
Contingencies $- $-
2% Admin Cap $- $-
Totals $- $-
OTHER INDICATORS
13 Please use the following table to provide the maximum upload and download speed for each question. Information should be reported as of the report date. Please write "N/A" if your project does not include this indicator.
Project Speed Upload Download
Outcome Questions
6a. Maximum available speed upon project completion 1. What is the maximum available speeds for HH in your eligible area

2. What is the maximum available speeds for Businesses in your eligible area

3. What is the maximum available speeds for CAIs in your eligible area


CERTIFICATION I certify to the best of knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
Typed or printed name and title of Authorized Certifying Official: Telephone (area code, number and extension):

Signature of Certifying Official: Email Address:

Date:

Sheet 4: Annual Report

OMB Control No. XXX-XXXX Expiration Date: TBD
TRIBAL BROADBAND CONNECTIVITY PROGRAM ANNUAL REPORT
GENERAL INFORMATION
GENERAL Recipient Organization:
Award Identification Number:
Recipient Street Address:
City, State, Zip Code:
DUNS/UEI Number:
Project Period Start Date (MM/DD/YYYY):
Report Submission Date (MM/DD/YYYY):
Project Period End Date (MM/DD/YYYY):
Award Start Date (MM/DD/YYYY):
Award End Date (MM/DD/YYYY):
1 Provide the number of locations or geographic areas at which broadband service was provided using the grant funds. (Please attach associated shapefiles of geographic areas) (600 words or less)

2 Please describe each service provided with grant funds. (600 words or less)

3 If applicable, please list subcontractors and describe how they expended funds. (600 words or less)

4 Please describe how the recipient and subrecipient (if applicable) expended the funds. (600 words or less)

5 If applicable, please list each subrecipients that received a subgrant through funding. (600 words or less)

6 Please provide the barriers to broadband adoption that you experienced during the life cycle of this award. What steps did you take to address them? (600 words or less)

7 Please describe whether or not your organization connected NOFO purpose areas to broadband adoption and use deployment work. (600 words or less)

8 Please describe your project's achieved accomplishments during the life cycle of this grant. (600 words or less)

9 Using the Excel spreadsheet template titled "TBCP Reports Addendum A", please provide an updated count of Households within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Annual Report' checkbox when completing the addendum.
10 Using the Excel spreadsheet template titled "TBCP Reports Addendum B", please provide an updated count of Businesses within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Annual Report' checkbox when completing the addendum.
11 Using the Excel spreadsheet template titled "TBCP Reports Addendum C", please provide an updated count of Community Anchor Institutions (CAIs) within each of the eligible tribal block groups along with their Location ID that you plan to connect to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier the geographic coordinates, and where available, the address(es) associated with each location. Please be sure to select 'Annual Report' checkbox when completing the addendum.

CERTIFICATION I certify to the best of knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
Typed or printed name and title of Authorized Certifying Official: Telephone (area code, number and extension):

Signature of Certifying Official: Email Address:

Date:

Sheet 5: TBCP Reports Addendum A

OMB Control No. XXX-XXXX Expiration Date: TBD
TRIBAL BROADBAND CONNECTIVITY PROGRAM REPORTS ADDENDUM A
Recipient Organization

Award Identification Number
Recipient Street Address

Report Date (MM/DD/YYYY)
City, State, Zip Code
DUNS/UEI Number
Performance Period Start Date (MM/DD/YYYY)

Report Type Baseline Report
Performance Period End Date (MM/DD/YYYY)
Annual Report





















Household Locations in the Service Area
The Location ID is the Fabric ID associated with the Federal Communications Commission maps required by the Broadband Deployment Broadband Deployment Accuracy and Technology Availability (DATA) Act, Pub. L. No. 116-130, 134 Stat. 228 (2020) (codified at 47 U.S.C. §§ 641-646) (Broadband DATA Maps). The “location_id” data element is a unique identifier for the location served. A Location ID should be included for each location in the Broadband Serviceable Location Fabric when the Fabric is made available to filers. Number of units refers to one location that has multiple units within that one location. Please insert rows at the bottom of the table to report additional location data if needed.
Location ID Street Address City State ZIP Latitude Longitude Tribal Block Group # of Units




































































































































































































































































































































































































































































































































































































































































































































































































































CERTIFICATION I certify to the best of knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
Typed or printed name and title of Authorized Certifying Official:
Telephone (area code, number and extension):
Signature of Certifying Official:
Email Address:
Date:


Sheet 6: TBCP Reports Addendum B

OMB Control No. XXX-XXXX Expiration Date: TBD
TRIBAL BROADBAND CONNECTIVITY PROGRAM REPORTS ADDENDUM B
Recipient Organization

Award Identification Number
Recipient Street Address

Report Date (MM/DD/YYYY)
City, State, Zip Code
DUNS/UEI Number
Performance Period Start Date (MM/DD/YYYY)

Report Type Baseline Report
Performance Period End Date (MM/DD/YYYY)
Annual Report





















Business Locations in the Service Area
The Location ID is the Fabric ID associated with the Federal Communications Commission maps required by the Broadband Deployment Broadband Deployment Accuracy and Technology Availability (DATA) Act, Pub. L. No. 116-130, 134 Stat. 228 (2020) (codified at 47 U.S.C. §§ 641-646) (Broadband DATA Maps). The “location_id” data element is a unique identifier for the location served. A Location ID should be included for each location in the Broadband Serviceable Location Fabric when the Fabric is made available to filers. Number of units refers to one location that has multiple units within that one location. Please insert rows at the bottom of the table to report additional location data if needed. Number of units refers to one location that has multiple units within that one location. Please insert rows at the bottom of the table to report additional location data if needed.
Location ID Street Address City State ZIP Latitude Longitude Tribal Block Group # of Units




































































































































































































































































































































































































































































































































































































































































































































































































































CERTIFICATION I certify to the best of knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.
Typed or printed name and title of Authorized Certifying Official:
Telephone (area code, number and extension):
Signature of Certifying Official:
Email Address:
Date:


Sheet 7: TBCP Reports Addendum C

OMB Control No. XXX-XXXX Expiration Date: TBD
TRIBAL BROADBAND CONNECTIVITY PROGRAM REPORTS ADDENDUM C
Recipient Organization

Award Identification Number
Recipient Street Address

Report Date (MM/DD/YYYY)
City, State, Zip Code
DUNS/UEI Number
Performance Period Start Date (MM/DD/YYYY)

Report Type Baseline Report
Performance Period End Date (MM/DD/YYYY)
Annual Report





















Community Anchor Institutions (CAIs) Locations in the Service Area
The Location ID is the Fabric ID associated with the Federal Communications Commission maps required by the Broadband Deployment Broadband Deployment Accuracy and Technology Availability (DATA) Act, Pub. L. No. 116-130, 134 Stat. 228 (2020) (codified at 47 U.S.C. §§ 641-646) (Broadband DATA Maps). The “location_id” data element is a unique identifier for the location served. A Location ID should be included for each location in the Broadband Serviceable Location Fabric when the Fabric is made available to filers. Number of units refers to one location that has multiple units within that one location. Please insert rows at the bottom of the table to report additional location data if needed.
Location ID Street Address City State ZIP Latitude Longitude Tribal Block Group # of Units