TAB B TAB B - TBCP Baseline Report

Tribal Broadband Connectivity Program (TBCP) Reporting Requirements

FINAL Tribal Broadband Connectivity Program Report v2.xlsx

OMB: 0660-0047

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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
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.


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. For Infrastructure Deployment projects, the Baseline Report is due 30 days after NEPA approval. For Use and Adoption projects, the Baseline Report is due 45 days after the close of the first calendar quarter of the award.
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
GENERAL INFORMATION
GENERAL Recipient Organization:
Award Identification Number:
Recipient Street Address:
City, State, Zip Code:
DUNS/UEI Number:
Period of Performance Start Date (MM/DD/YYYY):
Report Submission Date (MM/DD/YYYY):
Period of Performance End Date (MM/DD/YYYY):
Reporting Period Start Date (MM/DD/YYYY):
Reporting Period End Date (MM/DD/YYYY):
BROADBAND USE & ADOPTION AND INFRASTRUCTURE MILESTONES/KEY INDICATORS
INFRASTRUCTURE PROJECT MILESTONE CATEGORIES
1 Please use the table provided to report your projected cumulative totals for each semi-annual reporting period within each year of your project. Year One begins on your effective start date.
The cumulative total is based on the expenditure of your project budget and should be reported cumulatively from the effective 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 the projected final count.
MILESTONE CATEGORIES Year 1 Year 2 Year 3 Year 4 Year 5
Period 1 -
Projected		 Period 2 - Projected 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 projected cumulative totals for each semi-annual reporting period within each year of your project. Year One begins on your effective start date.
The cumulative total is based on the expenditure of your project budget and should be reported cumulatively from the effective 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 the projected final count.
NETWORK BUILD PROGRESS MIDDLE OR LAST MILE Year 1 Year 2 Year 3 Year 4 Year 5
Period 1 -
Projected		 Period 2 - Projected 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. Obtained licenses: 2.5 (EBS), 3.5 (CBRS)










2j. Other (please specify










BROADBAND 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 an indicator.
PROJECTED NUMBER OF SUBSCRIBERS AND SPEED Year 1 Year 2 Year 3 Year 4 Year 5
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		 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. Tribal Businesses Number of Tribal Businesses connected to broadband infrastructure









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









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









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









Number of Tribal Businesses connected to broadband infrastructure by wireless connection









Number of Tribal 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 an indicator.
PROJECTED NUMBER OF SUBSCRIBERS AND SPEED Year 1 Year 2 Year 3 Year 4 Year 5
BENEFICIARY 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		 Period 1 - Projected Period 2 -
Projected
4a. Unserved Tribal Households Number of Unserved Tribal Households passed/serviceable









Number of Unserved Tribal Households with new access










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









Number of Tribal Households with new access










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 with new access










4d. Tribal Businesses Number of Tribal Businesses passed/serviceable









Number of Tribal Businesses with new access










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









Number of Tribal Community Anchor Institutions with new access









BROADBAND USE & ADOPTION DEMOGRAPHIC INDICATORS
5 Please use the following table to report the demographic information of funded service areas.
For each, list projected cumulative total for each population. This information should be reported cumulatively from effective start date through the end of each semi-annual reporting period. Please write “NA” if your project does not include an indicator.
DEMOGRAPHIC INDICATORS Year 1 Year 2 Year 3 Year 4 Year 5
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		 Period 1 - Projected Period 2 -
Projected
5a. Unserved Tribal Population Number of Unserved Native American/Alaska Native/Native Hawaiian Households in funded service area









Number of Unserved Native American/Alaska Native/Native Hawaiian Tribal Businesses in funded service area









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









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










5b. Tribal Population Number of Tribal Households in funded service area









Number of Tribal Businesses in funded service area









Number of Tribal Community Anchor Institutions in funded service area









Number 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 an indicator.
WORKFORCE INDICATORS Year 1 Year 2 Year 3 Year 4 Year 5

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		 Period 1 - Projected Period 2 -
Projected
6a. Telework 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. New Positions Number of new positions created









Number of new positions filled










6c. Participation in Workforce Development Trainings Number of individuals who attended workforce development training event










6d. Workforce Development Trainings 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 each 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 an indicator.
EDUCATIONAL SUCCESS INDICATORS Year 1 Year 2 Year 3 Year 4 Year 5

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		 Period 1 - Projected Period 2 -
Projected
7a. Access to Online Learning 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. Participation in Online Learning Number of individuals who attend online learning classes









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











7c. Parental Participation in School Activities Number of parents/legal guardians who attend virtual/in-person school activities










7d. High School Enrollment and Completion Number of individuals enrolled in high school









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










7e. School Participation in Remote Learning Number of schools in program









Number of schools engaged in remote learning model










7f. School Participation in In-Person Learning Number of schools in program









Number of schools engaged in in-person learning model










7g. School Participation in Hybrid Learning 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 an indicator.
TELEHEALTH INDICATORS Year 1 Year 2 Year 3 Year 4 Year 5

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		 Period 1 - Projected Period 2 - Projected
8a. Access to Telehealth Services 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. New Access to Telehealth Services Number of individuals with new access to telehealth services










8c. 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 the award start date through the end of each semi-annual period. Please write “NA” if your project does not include an indicator.
DIGITAL INDICATORS Year 1 Year 2 Year 3 Year 4 Year 5

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		 Period 1 - Projected Period 2 - Projected
9a. Participation in Affordable Broadband Connectivity Program Number of households in affordable broadband connectivity programs










9b. Digital Literacy Trainings Number of digital literacy training events held










9c. Tribal Programs Transitioned to Online Platform Number of Tribal programs transitioned to online platform now (after receiving TBCP grant funds)










9d. Devices Distributed to Individuals Number of individuals given device










9e. Devices Distributed to Households Number of households given device










9f. Devices Distributed to Other Entities (i.e., community anchor institutions, schools, Tribal businesses) Number of other entities given device









TYPE OF INTERNET DEVICES
10 Please describe the Internet Devices you will acquire using TBCP funding.
Device Type Number of Devices Total Cost





















TYPE OF COLLABORATORS
11 Please list all projected funded and unfunded collaborators in table below.
COLLABORATORS
Collaborator Organization Type 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
GENERAL INFORMATION
GENERAL Recipient Organization:
Award Identification Number:
Recipient Street Address:
City, State, Zip Code:
DUNS/UEI Number:
Period of Performance Start Date (MM/DD/YYYY):
Report Submission Date (MM/DD/YYYY):
Period of Performance 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 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 the 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
Total Narrative (Describe reasons for variance 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. Obtained licenses: 2.5 (EBS), 3.5 (CBRS)

2j. Other (please specify)

BROADBAND 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 effective 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 SPEED TYPE Total Narrative (Describe reasons for variance 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. Tribal Businesses Number of Tribal Businesses connected to broadband infrastructure

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

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

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

Number of Tribal Businesses connected to broadband infrastructure by wireless connection

Number of Tribal 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 beneficiary category and access type for your project.
Except as indicated, information should be reported cumulatively from effective 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
BENEFICIARY TYPE ACCESS TYPE Total Narrative (Describe reasons for variance from baseline plan or subsequent written updates provided to your Program Officer)
4a. Unserved Tribal Households Number of Unserved Tribal Households passed/serviceable

Number of Unserved Tribal Households with new access


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

Number of Tribal Households with new access


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 with new access


4d. Tribal Businesses Number of Tribal Businesses passed/serviceable

Number of Tribal Businesses with new access


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

Number of Tribal Community Anchor Institutions with new access

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

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

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

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


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

Number of Tribal Households in funded service area

Number Tribal Community Anchor Institutions in funded service area

Number 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 the award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
WORKFORCE INDICATORS

QUESTIONS Total Narrative (Describe reasons for variance from baseline plan or subsequent written updates provided to your Program Officer)
6a. Telework 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. New Positions Number of new positions created

Number of new positions filled


6c. Participation in Workforce Development Trainings Number of individuals who attended workforce development training event


6d. Workforce Development Trainings 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 the 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

QUESTIONS Total Narrative (Describe reasons for variance from baseline plan or subsequent written updates provided to your Program Officer)
7a. Access to Online Learning 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. Participation in Online Learning Number of individuals who attend online learning classes

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


7c. Parental Participation in School Activities Number of parents/legal-guardians who attend virtual/in-person school activities


7d. High School Enrollment and Completion Number of individuals enrolled in high school

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


7e. School Participation in Remote Learning Number of schools in program

Number of schools engaged in remote learning model


7f. School Participation in In-Person Learning Number of schools in program

Number of schools engaged in in-person learning model


7g. School Participation in Hybrid Learning 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 the award start date through the end of each semi-annual period. Please write “NA” if your project does not include this indicator.
TELEHEALTH INDICATORS


QUESTIONS Total Narrative (Describe reasons for variance from baseline plan or subsequent written updates provided to your Program Officer)
8a. Access to Telehealth Services 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. New Access to Telehealth Services Number of individuals with new access to telehealth services


8c. 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 the 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

QUESTIONS Total Narrative (Describe reasons for variance from baseline plan or subsequent written updates provided to your Program Officer)
9a. Participation in Affordable Broadband Connectivity Program Number of households in affordable broadband connectivity program


9b. Digital Literacy Trainings Number of digital literacy training events held


9c. Tribal Programs Transitioned to Online Platform 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. Devices Distributed to Individuals Number of individuals given device


9e. Devices Distributed to Households Number of households given device


9f. Devices Distributed to Other Entities (i.e., community anchor institutions, schools, Tribal businesses) Number of other entities given device

TYPE OF INTERNET DEVICES
10 Please describe the Internet Devices you will acquire using TBCP funding.
Device Type Number of Devices Total Cost





















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



































INFRASTRUCTURE DEPLOYMENT 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 federal funds obligated from project inception through end of this reporting period. Figures should be reported cumulatively from the award start date to the end of the applicable reporting period.
ACTUAL BUDGET Federal Funds Expended Total Funds Expended
12a. Administrative and legal expenses $- $-
12b. Land, structures, rights-of way, appraisals, etc. $- $-
12c. Relocation expenses and payments $- $-
12d. Architectural and engineering fees $- $-
12e. Other architectural and engineering fees $- $-
12f. Project inspection fees $- $-
12g. Site work $- $-
12h. Demolition and removal $- $-
12i. Construction $- $-
12j. Equipment $- $-
12k. Miscellaneous $- $-
Subtotal $- $-
12l. Contingencies $- $-
Totals $- $-
BROADBAND USE & ADOPTION BUDGET EXECUTION DETAILS
13 Please provide details below on your total budget and total funding expended to date for each budget element, including detailed disbursements of federal funds obligated from project inception through end of this reporting period. Figures should be reported cumulatively from the award start date to the end of the applicable reporting period.
ACTUAL BUDGET Grant Program, Function, or Activity Total Funds Expended
13a. Personnel
$-
13b. Fringe Benefits
$-
13c. Travel
$-
13d. Equipment
$-
13e. Supplies
$-
13f. Contractual
$-
13g. Construction
$-
13h. Other
$-
13i. Total Direct Charges (sum of 13a thru 13h)
$-
13j. Indirect Charges
$-
13k. Totals (sum of 13i+13j)
$-
OTHER INDICATORS
14 Please use the following table to provide the maximum upload and download speed in Mbps 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
14a. Maximum available speed upon project completion What is the maximum available speeds for Tribal Households in your eligible area?

What is the maximum available speeds for Tribal Businesses in your eligible area?

What is the maximum available speeds for Tribal 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:
Period of Performance Start Date (MM/DD/YYYY):
Report Submission Date (MM/DD/YYYY):
Period of Performance End Date (MM/DD/YYYY):
Reporting Period Start Date (MM/DD/YYYY):
Reporting Period 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 use and adoption or broadband infrastructure deployment work that you experienced during the reporting period of this award to date. 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 or broadband infrastructure deployment work. (600 words or less)

8 Please describe your project's achieved accomplishments during this reporting period. (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 connected to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier for 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 Tribal Businesses within each of the eligible tribal block groups along with their Location ID that you connected to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier for 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 connected to your network. The locations should match and conform to the Federal Communications Commission (FCC) Broadband Serviceable Location Fabric, which is a unique identifier for 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 Submission Date (MM/DD/YYYY):
City, State, Zip Code:
DUNS/UEI Number:
Reporting Period Start Date (MM/DD/YYYY):
Report Type: Baseline Report
Reporting 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 Submission Date (MM/DD/YYYY):
City, State, Zip Code:
DUNS/UEI Number:
Reporting Period Start Date (MM/DD/YYYY):
Report Type: Baseline Report
Reporting Period End Date (MM/DD/YYYY):
Annual Report





















Tribal 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 Submission Date (MM/DD/YYYY):
City, State, Zip Code:
DUNS/UEI Number:
Reporting Period Start Date (MM/DD/YYYY):
Report Type: Baseline Report
Reporting Period End Date (MM/DD/YYYY):
Annual Report





















Community Anchor Institution (CAI) 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:
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File Modified0000-00-00
File Created0000-00-00
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