Impact Story Request

Coronavirus State and Local Fiscal Recovery Funds Program

Impact Story Request

Impact Story Submissions

OMB: 1505-0271

Document [docx]
Download: docx | pdf

State and Local Fiscal Recovery Funds: Impact Story Template

As recipients carry out their State and Local Fiscal Recovery Funds (SLFRF) projects, Treasury would like to learn about specific projects that recipients consider “impact stories.” These impact stories capture how state, local, territorial, and Tribal leaders use one-time, direct emergency funds to make lasting change in their communities. They also highlight how receiving the funds enabled communities to avoid an insuperable crisis, work toward long-term goals while meeting immediate needs, and address the needs of underserved people. Please note that any story you provide may be included in the Treasury SLFRF Anniversary Map, remarks from Treasury officials, the SLFRF Newsletter, or other resources that uplift exemplary uses of SLFRF dollars to your recipient peers.

Please note that providing details for an impact story is completely optional, and if you choose to use this template, you may choose to respond to as many or as few prompts are you would like. Submitting this Impact Story Request form is not sufficient for meeting reporting and compliance requirements. While basic details are helpful, please consider submitting additional information to add color to this impact story. When completed, we encourage you to submit quotes or any media that correspond to the story (e.g., photos or videos). Prior to using any quote or media you provide, we will seek your approval. Treasury thanks you for your partnership.

Date: _______________________________________________________________

Contact Person: ____________________________________________________

Email: ______________________________________________________________



Recipient & Program Information:

Recipient Name: ____________________________________________

Program Partner(s)/Implementing Entity(ies): ______________________________

Program Name: ______________________________________________________



Narrative Questions:

  1. Brief description of program (please include as much detail as possible - including amount of SLFRF dollars provided, purpose of the program, background on the issue the program targets, etc.).

  2. Please share the beneficiary’s story. How did this investment accomplish the goals of the project, fill a need, or impact community members? Why was the investment needed?

  3. Please briefly describe the economic/social impact of the investment (for example, number of jobs created, number of participants affected, or how supporting the project helped the local community).

  4. Did you work with any partners to ensure success of the project (e.g., technical assistance provider, non-profits, state or local agency, Tribal Governments, etc.)?

  5. Do you have existing stories, media coverage, photos, or videos related to the program and its impact on local community? If so, please provide URL links where possible. Please note that by submitting these materials to Treasury, the recipient is confirming that it has sought and received individual approval to share and publish the content.

  6. To what extent did community engagement strategies used by recipients provide greater government accountability, incorporate community concerns, and create more transparency in the implementation of SLFRF?

  7. Do you have a quote about the project from a local leader or impacted community member, or a quote from the recipient?

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBond, James
File Modified0000-00-00
File Created2024-08-01

© 2024 OMB.report | Privacy Policy