DOE F 540.4 SERC Form - T&TA. Monitoring, and Leveraging Report

DOE F 540.4

U.S. Department of Energy WEATHERIZATION ASSISTANCE PROGRAM

_{OMB #} 1910-5157

Expiration Date: ^05/31/2025

ANNUAL TRAINING, TECHNICAL ASSISTANCE, MONITORING, AND LEVERAGING REPORT

State Program Year Grant Number Reporting Period / / - / /

TRAINING AND TECHNICAL ASSISTANCE ACTIVITIES

Please describe the training and technical assistance (T&TA) activities conducted during the past program year.

MONITORING ACTIVITIES

Please list the subgrantees monitored during the reporting period and indicate the focus and significant findings of each monitoring activity, as appropriate.

LEVERAGING ACTIVITIES

For each leveraging activity, states are to describe the type of project, the amount and source of funding (Note: the number of leveraged completed units will be reported on line D of the Quarterly Program Report).

Submitted by Date Type name

Title

U.S. Department of Energy WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL FILE WORKSHEET INSTRUCTIONS

The Annual Training, Technical Assistance, Monitoring, and Leveraging Report is to be submitted annually, 30 days after the end of the reporting period.

State: Program Year: Grant number:

Reporting Period:

Name of state or tribal organization submitting the report.

The beginning and ending dates (mm/dd/yy) for the Program Year reported. The seven-digit Federal identification number assigned to the grant (R999999).

The starting and ending dates (mm/dd/yy) for the reporting period for the WAP program year.

Item Explanation

Training and Technical Assistance Activities

Monitoring Activities Leveraging Activities

Identify the training and technical assistance activities conducted during the past program year; may also include publications such as brochures, or articles that highlight the states’ weatherization activities

Identify the subgrantees monitored during the reporting period and indicate the focus and significant findings of each monitoring activity, as appropriate

Identify and describe the type of projects executed and the amount and source of funding successfully leveraged

Submitted by: Signature of the person submitting the report. Date signed.

Typed name and title of the submitter.