Form TAB D TAB D TAB D - TBCP Annual Report
Tribal Broadband Connectivity Program (TBCP) Reporting Requirements
Tribal Broadband Connectivity Program Report Forms (FINAL).xlsx
TBCP Annual Report - TAB D
OMB: 0660-0047
Document [xlsx]
Download: xlsx | pdf
Baseline Report
Performance (Technical) Report
Annual Report
TBCP Reports Addendum A
TBCP Reports Addendum B
TBCP Reports Addendum C
Overview
TBCP Data Report Form CoverBaseline 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
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| Tribal Broadband Connectivity Program Data Report Form |
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| 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. |
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| 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. |
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| 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. |
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| 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%. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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 
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| Reporting Period End Date (MM/DD/YYYY): | No
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| 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. |
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| 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. |
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| 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. |
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| 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. |
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| 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 | ||||||||||||
| 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: | ||||||||||||||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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