Form DOE F 540.1 DOE F 540.1 SEP Annual File Worksheet

DOE F 540.6

OMB Control No: 1910-5126
Expiration Date: XX/XX/2023

U.S. Department of Energy

SEP QUARTERLY PROGRAM REPORT
Grant Number:
Grant Period:

/

/

-

/

/

Title:
Market:
Program Year:
State:
Status:
% of work complete:
Final:

MILESTONES:
Milestone

Q1
/ - /

Q2
/ - /

Q3
/ - /

Q4
/ - /

To date

FINANCIAL METRICS:
Source of Funds
Federal
Local

Q1
/ - /

Q2
/ - /

Q3
/ - /

Q4
/ - /

To date

Q4
- /

To date

OBLIGATION METRICS:
/

Q1
- /

/

Q2
- /

/

Q3
- /

/

1

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DOE F 540.6

OMB Control No: 1910-5126
Expiration Date: XX/XX/2023

U.S. Department of Energy

SEP QUARTERLY PROGRAM REPORT
Grant Number:
Grant Period:

/

/

-

/

/

QUALITATIVE DESCRIPTIONS:
Accomplishments, publicity, good news

Infrastructure Investment Rationale

Performance outcome data collected

Remarks (problems, issues, variance from plan)

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DOE F 540.6

OMB Control No: 1910-5126
Expiration Date: XX/XX/2023

U.S. Department of Energy

SEP QUARTERLY PROGRAM REPORT
Financial Programs Reporting
Reporting Period:

/

/

-

/

/

Financial Program Title:
Linked Grant:
Description:
Program Administered:

In-House

Third Party

Final ARRA Program Funding:
Financial Program Status:

FINANCIAL METRICS SUMMARY:
Program Size
Previous Program Size
+ Non-Principal Income (Including Interest and Fees)
+ Inter-Program Transfer
- Outlays
= Program Size
Funds Available
Program Size
- Loans Given (cumulative to date)
+ Principal Repaid (cumulative to date)
= Funds Available
FINANCIAL METRICS (Funds):
Description
Non-Principal Income
(Including Interest and
Fees)
Principal Repaid
Inter-Program Transfers
Total Funds

/

Q1
- /

/

Q2
- /

/

Q3
- /

/

Q4
- /

To date

4

DOE F 540.6

OMB Control No: 1910-5126
Expiration Date: XX/XX/2023

U.S. Department of Energy

SEP QUARERLY PROGRAM REPORT
Financial Programs Reporting
Reporting Period:

/

/

-

/

/

FINANCIAL METRICS (Outlays):
Description
Administrative Outlays
Total Loans Supported by
Loan Loss Reserves Written
Off*
Total Grants Given*
Total Outlays
* From metrics below

/

Q1
- /

/

Q2
- /

/

Q3
- /

/

Q4
- /

To date

Q3
/ - /

Q4
/ - /

To date

FINANCIAL METRICS (Loans/Loans Supported by LLRs/Grants):
Metric (description, group, metric
item)

Q1
/ - /

Q2
/ - /

RLF – LOAN DEFAULT DETAILS:
Recipient

Orig. Loan Amt.
Loan Orig. Date

Amount in
Default

Amt. of Last Pmt.
Last Pmt. Date

Status

FINANCIAL METRICS (Leveraged Funds):
Description
Value of private capital
Total Leveraged Funds

/

Q1
- /

/

Q2
- /

/

Q3
- /

Q4
- /

To date

Q4
/ - /

To date

/

PROCESS METRICS
Metric (description, group, metric
item)

Q1
/ - /

Q2
/ - /

Q3
/ - /

5

DOE F 540.6

OMB Control No: 1910-5126
Expiration Date: XX/XX/2023

U.S. Department of Energy

SEP QUARTERLY PROGRAM REPORT
Financial Programs Reporting
Reporting Period:

/

/

-

/

/

REMARKS:

PAPERWORK REDUCTION ACT STATEMENT
This data is being collected to adequately monitor programmatic and financial expenditures and obligations and ensure
transparency and accountability. The data you supply will be used by DOE to determine program outcomes and respond
to Congressional, budget, and OMB requests.
Public reporting burden for this collection of information is estimated to average 33.3 hours per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information
Officer, IM-22, Paperwork Reduction Act Office, U.S. Department of Energy, 1000 Independence Ave, SW Washington
DC 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project,
Washington, DC 20503.
Submission of this data is mandatory as appropriate and grant recipients can only view their own reporting using
multifactor authentication.

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