REPORTING: Funded Projects Pilot; Developing Standardized Forms

Pilot to Develop Standardized Reporting Forms for Federally Funded Public Health Projects and Agreements

Egg Contract Quarterly Summary Report.xlsx

REPORTING: Funded Projects Pilot; Developing Standardized Forms

OMB: 0910-0909

Document [xlsx]
Download: xlsx | pdf

Overview

Coversheet
StateReport
DivisionReport
Instructions


Sheet 1: Coversheet









































































Contract Number (auto-filled)
Select Agency





Agency Name (select from list)
Select

State or US Territory (auto-filled)
Select Agency





Contract Type
EGG





Date Completed (MM/DD/YYYY)







State Report Preparer's Name


State Report Preparer's Email



































Period of Performance Start Date












Period of Performance End Date












Reporting Period Start Date












Reporting Period End Date












Reporting Period Frequency
Select










Current Reporting Period
Select
















































































Sheet 2: StateReport







Contract Reporting Elements Line Item
(for current option)
Total Contract Requirement Total Completed
(this reporting period)
Total Remaining

Contract Work Accomplished Contract Inspection Types




1. Target Inspections 0 0 0 0

2. Visits (Out-of-Business, etc.) 0 0 0 0

Contract Samples




3. Evironmental Samples 0 0 0 0

4. In-Compliance Quantity

0

5. Not In-Compliance Quantity

0


6. Other - Training

0

State Contract Actions 7. Enforcement Notices (e.g. warning letters)

0

8. Embargoes/Seizures

0

9. Hearings Conducted

0

10. Prosecutions/Injunctions

0

Other Contract Actions List Below




11. [Replace bracketed text]

0

12. [Replace bracketed text]

0

13. [Replace bracketed text]

0

14. Re-Inspections (Follow-ups to violative Inspections)

0








State Contractor Challenges, Issues, and Highlights

15. Select the current status based on your assessment of contract performance for this reporting period. Select

16. List any major challenges encountered this reporting period and corrective actions taken. Include how these actions directly address those challenges.

17. Write a brief narrative detailing any positive, significant events identified during this reporting period.

18. If applicable, report a dollar value for Item 8. Embargos/Seizures from the table above.

19. Additional State Reporting Comments












Sheet 3: DivisionReport







Contract Performance Feedback

20. Indicate the overall status of the State contractor's performance this reporting period. Select

21. (Optional) If the contractor experienced challenges or issues during this reporting period, please list them and detail any corrective actions taken or agreed to by the contractor.

22. (Optional) Write a brief narrative detailing any positive, significant events identified during the contractor's performance this reporting period.

23. Indicate Division Approval or Disapproval by selecting from the drop-down menu. If this report is disapproved, provide your explanation below. Select



24. (Optional) Additional Division Reporting Comments.

25. Enter the name of the Division Representative approving this report.

26. Enter the date this Division Review was completed.









Sheet 4: Instructions









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