Form 6200-04 Job Training Reporting Form

United States
ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460

EPA Form: 6200-04
OMB Control No.: 2050-0192
Exp. Date: XX-XX-XXXX

JOB TRAINING REPORTING FORM
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2050-0192). Responses to
this collection of information are mandatory (2 CFR 200.328, 2 CFR 200.333, 2 CFR 200.335, 40 CFR 30-31). An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and
recordkeeping burden for this collection of information is estimated to be 3 hours per response. Send comments on the Agency’s need for this information,
the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to the Regulatory Support Division Director,
U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any
correspondence.

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

2. Cooperative Agreement Number:

PART II - PERFORMANCE MEASURES INFORMATION
THIS FEDERAL
FISCAL
QUARTER

3a. Number of Training Cohorts Completed
3b. Cohort Start Dates
3c. Cohort End Dates
4. Number of Participants Entering Training
5. Number of Veterans Entering Training
6. Number of Participants Completing Training
7a. Number of Participants Obtaining Employment
7b. Number of Individuals that did not Obtain Employment but are
Pursuing Education (e.g., GED, college courses, etc.)
7c. Number of Participants entering Registered Apprenticeships,
Labor Management Partnerships, or other Workforce Training
Programs, including Pre-Apprenticeships (tied to Registered
Apprenticeships) and Local Hire Agreements
8. Average Hourly Wage of Participants Obtaining Employment
9. Funds Leveraged (total)
9-1. Funding Source Name:
9-2. Activity Funded:
9-3. Funds Leveraged:
9-1. Funding Source Name:
9-2. Activity Funded:
9-3- Funds Leveraged:

EPA Form 6200-04

________________________________

CUMULATIVE

10. Success Story:

11. Supplemental Performance Measures Information (optional):

EPA Form 6200-04