6100-084 Workplan Form

Urban Waters Federal Partnership Workplan Form

Location:

Points of Contact:

Ambassador: ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­

Federal Agency Lead:

1. Location Background:

2. Partners: insert list of key partners:

Federal Agency Partners:

State Agency Partners:

Local Government Partners:

Nongovernmental Organizations/Community Organizations:

Private Sector:

Academia:

3. Overall Goals and Objectives:

4. Initiatives (upcoming projects)

Options are provided below if a partnership sets and tracks goals on an annual basis (Option 1), or on a three-five-year basis (Option 2).

Initiative 1

[Insert description/overview of project/vision]

Federal Partners:

Other Partners/Stakeholders:

Year 1 – Workplan Activities (add more as needed):

a.

b.

c.

Year 1 – Expected Outputs:

[Insert tangible achievements or milestones. For example, this can include the number of workshops, cleanup actions or youth programs held, or the number of green infrastructure systems installed.]

Year 1 – Expected Outcomes:

[Insert achievements related to environmental or community improvements. For example, this can include faith community members engaged, city officials’ cooperation to restore the watershed or residents connecting to local urban waters.]

Year 2 – Workplan Activities (add more as needed):

a.

b.

c.

Year 2 – Expected Outputs:

Year 2 – Expected Outcomes:

Initiative 2

[Insert description/overview of project/vision]

Federal Partners:

Other Partners/Stakeholders:

Year 1 – Workplan Activities (add more as needed):

a.

b.

c.

Year 1 – Expected Outputs:

Year 1 – Expected Outcomes:

Year 2 – Workplan Activities (add more as needed):

a.

b.

c.

Year 2 – Expected Outputs:

Year 2 – Expected Outcomes:

5. Other Partnership Activities (activities listed here are not required to be directly correlated to an initiative)

Project: [Insert description/overview of project/vision]

Federal Partners:

Partners/Stakeholders:

Milestones:

6. Additional Initiatives/Projects Suggested by {location}

These are initiatives that have been identified or suggested and should further be explored to determine viability.

OMB Control Number 2040-NEW

The public reporting and recordkeeping burden for this collection of information is estimated to average 60 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, including through the use of automated collection techniques, to the Director, Regulatory Support Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460.  Include the OMB control number in any correspondence.  Do not send the completed form to this address.

EPA Form Number 6100-084

Approval Expires XX/XX/XX