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Attachment D Gen Info
| Attachment D, Collection of Progress Reports Template: |
| These are guidance templates for the content required for the progress reports. Please refer to progress report tasks for requirements. |
| At the post-award, in-person, site visit, CORs will explain the content and reporting requirements in detail. |
| The reports may be provided in a different format as agreed to by the COR. The content of the reports may be changed by the Government. |
CBU CLIN Reference number (#) is the number assigned to each CBU delivered for the respective CLIN. Reference numbers shall be in chronological order. The first CBU delivered to that CLIN is 1, the second CBU is 2, and so forth, through the CLIN target. If in the first month, two units are delivered to a CLIN, then the second's month report on that same CLIN will start with Reference# 3. Each CLIN shall have a separate report sheet. All sub CLINs shall be reported on the same CLIN report sheet. For example, report for "primary" CLIN 0001 shall include report for 0001a/b/c. If target for CLIN 0001 is 100, CLIN Reference #s for CLIN 0001 would be 1-100.
| First Month: Reference # "1"&"2" | | | Second Month: Reference # is "3"&"4" | | |
| "CBU CLIN Reference #" | Contract Line Item Number (CLIN) | CBB CBU ID# | "CBU CLIN Reference #" | Contract Line Item Number (CLIN) | CBB CBU ID# |
| "1" | 0001b | | "3" | 0001a | |
| "2" | 0001a | | "4" | 0001c | |
1 Contract Key Item Updates Progress Report# 1: Contract Key Item Updates
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY): |
| Report Date: |
| Describe new information/change and any affect on NCBI contract or delivered CBU, corrective action or resolution with timeline (if applicable), and any other pertinent information. Reports on contract activity should be reported to the COR using progress reports except for information that the Contractor deems urgent and should not be delayed by monthly reporting or as specified by task and schedule of deliverables. | | | | | |
| Key Personnel | | | | | |
| Key Personnel Title | Name | | | Designation Date | Award or Mod # |
| Project Director | | | | | |
| Coordinator | | | | | |
| Current FY notifications to COR about Key Personnel | | | | | |
| Date | Description | | | | |
| XX/XX/20XX | | | | | |
| FDA | | | | | |
| FDA, HPC BLA | Date | | | | |
| Approval | | | | | |
| Current FY notifications to COR about FDA changes affecting the contract | | | | | |
| Date | Description | | | | |
| XX/XX/20XX | | | | | |
| Cord Blood Bank Accreditation | | | | | |
| Accrediting Organization(s) | | Inspection Dates | Accreditation Dates | | |
| Current FY notifications to COR about accreditation(s) changes affecting the contract | |
| Date | Description |
| XX/XX/20XX | |
2 CBU Collection Schedule Progress Report #2: CBU Collection Schedule
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year: |
| Report Date: |
| Collection Site Details (List all sites for NCBI collections since entry date of contract): | | | | | | Collection Site Agreements | | | |
| Hospital Name | City | State | Collection Model(s) | Number of Births | Collection Hrs/Mo | Start Date | Expiration date | Open Date | Close Date |
| Collection Site 1 | | | | | | | | | |
| Collection Site 2 | | | | | | | | | |
| Collection Site 3 | | | | | | | | | |
| Collection Site 4 | | | | | | | | | |
| Collection Site 5 | | | | | | | | | |
| | | Total | | | | | | |
| CBU Collection Schedule | Contract Year 1/CLIN 0001 for FY 2020 Deliveries | | | Jul | | Aug | | Sep | | Oct | | Nov | | Dec | | 2020 Jan | | Feb | | Mar | | Apr | | May | | Jun | | Jul | | Aug | | Sep | |
| P=Planned; A= Actual | CBU Total Planned | CBU Total Actual to date | CBU Total Delta to date | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A |
| B/AA | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Asian | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| White, Non-Hispanic | | | | | | | | | | | | | | | ` | | | | | | | | | | | | | | | | | | |
| White, Hispanic | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Multi-race, NH/PI, AI/AN | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| CBU Totals | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 1 name | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 2 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 3 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 4 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 5 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| CBU Totals | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Number of Collection Sites | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
3 CBU Delivery Schedule Progress Report #3: CBU Delivery Schedule
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY): |
| Report Date: |
| CBU Delivery Schedule | Contract Year 1/CLIN 0001 | | | Jul | | Aug | | Sep | | Oct | | Nov | | Dec | | 2020 Jan | | Feb | | Mar | | Apr | | May | | Jun | | Jul | | Aug | | Sep | |
| Correlates with Monthly Deliveries on SF 1034 P=Planned; A= Actual | CBU Total Planned | CBU Total Actual to date | CBU Total Delta to date | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A | P | A |
| B/AA | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Asian | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| White, Non-Hispanic | | | | | | | | | | | | | | | ` | | | | | | | | | | | | | | | | | | |
| White, Hispanic | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Multi-race, NH/PI, AI/AN | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| CBU Totals | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 1 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 2 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 3 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 4 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Collection Site 5 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| CBU Totals | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| CBU (Planned)Delivery Schedule by Site for Year 1 (a table for each year in B.2 Price) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Cord Blood Unit Race and Ethnicity | | | | Site 1 | Site 2 | Site 3 | Site 4 | Site 5 | TOTAL | | | | | | | | | | | | | | | | | | | | | | | | |
| B/AA | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Asian | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| White, Non-Hispanic | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| White, Hispanic | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| Multi-race, NH/PI, AI/AN | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| CBU Totals | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
4 NCBI CBU Delivery
| Progress Report #4: NCBI CBU Delivery |
| Submit a separate report for each Contract Line Item Number (CLIN) from contract). |
| Submit each month an invoice is submitted for the CLIN. |
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period (Delivery Service Period): |
| Fiscal Year (FY): |
| Report Date: |
| CLIN: 0001 (includes all subsets of 0001 such as 0001a, 0001b, etc.) |
| Contract Year: |
| Date CLIN funds added to the contract: XX/XX/XX |
| Earliest CBU Collection Date for CLIN: As specified by contract. |
| Final CBU Collection Date for CLIN: As specified by contract |
| Each CBU reported on this table as a delivery shall receive a permanent reference number in chronological order. The reference numbers by primary CLIN shall begin at 1 through the final quantity of CBU per CLIN. For example, the first CBU shall be assigned the number "1" and if the total CLIN quantity is 20, the final reference number shall be assigned 20. If a CLIN has several subsets, for example, CLIN 0001 is comprised of 0001a, 0001b, and so forth, the total quantity of 0001 (sum of all subsets) shall be used as the quantity for progress reporting. Each CLIN (and subsets) shall be reported on separated CLIN CBU Delivery Reports; mixture of CLINs and contract years on a single report shall be rejected. |
| PDF version submitted with invoices as supporting documentation. |
| Excel and PDF versions submitted as monthly progress reports. |
| | | | | | | | NCBI CBU Minimum Acceptable Values by R/E per Del. #22 | | | | | | | | |
| | | | | | | | TNC | | | | | | | | |
| | | | | | | | CD34 | | | | | | | | |
| | | | | | | | Viability | | | | | | | | |
| CBU CLIN Delivery Reference # | Contract Line Item Number (CLIN)/FY awarded | CBB CBU ID# | Registry CBU ID# | Collection Date | SPA-CC Registration Date | CBU Specs TNC | CBU Specs CD34 | CBU Specs Viability | AI/AN | B/AA | Asian | NH/PI | White (non Hispanic) | White His-panic | Multi-race | |
| 1 | 0001a | | | | | | | | | | | | | | | |
| 2 | 0001a | | | | | | | | | | | | | | | |
| 3 | 0001b | | | | | | | | | | | | | | | |
| 4 | | | | | | | | | | | | | | | | |
| 5 | | | | | | | | | | | | | | | | |
| 6 | | | | | | | | | | | | | | | | |
| 7 | | | | | | | | | | | | | | | | |
| 8 | | | | | | | | | | | | | | | | |
| 9 | | | | | | | | | | | | | | | | |
| 10 | | | | | | | | | | | | | | | | |
| 11 | | | | | | | | | | | | | | | | |
| 12 | | | | | | | | | | | | | | | | Total |
| | | | | | | Report Period (Monthly) Total | | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| | | | | | | CLIN Total | | | | | | | | | |
5 B1 Inv Summary & Cum Reports Progress Report #5: B-1 Invoicing Summary and Cumulative Reports
| Contract #: HHSH | | | | | | | | | | | | | | |
| Contractor: As listed on HRSA Contract | | | | | | | | | | | | | | |
| Deliverable # | | | | | | | | | | | | | | |
| Delivery Service Period (invoice month): | | | | | | | | | | | | | | |
| Fiscal Year (FY): | | | | | | | | | | | | | | |
| Report Date: | | | | | | | | | | | | | | |
| Submit PDF version with invoices as supporting documentation. | | | | | | | | | | | | | | |
| Submit Excel as monthly progress report to COR. | | | | | | | | | | | | | | |
| | | | | *Delivered includes units on the current invoice | | | | | | | | | |
| B-1 Monthly Invoice | | | | | B-1 Cumulative Summary | | | | | | | Delivery Performance Achievements | | |
| CLIN 0001 Year 1 | CLIN | Price/CBU | Number of CBU Invoiced | Amount Current Invoice | Target | Delivered* | Remain | $Target | $Paid | $ Remain | % Paid | Percent Delivered | Performance Standard Date* | Met Performance Standard Date |
| B/AA | 0001a | | 4 | $0.00 | 100 | 10 | 90 | | | | | 50% | | |
| Asian | 0001a | | 2 | $0.00 | 50 | 10 | 40 | | | | | 75% | | |
| White, non-Hispanic | 0001b | | 1 | $0.00 | 50 | 25 | 25 | | | | | 100% | | |
| White, Hispanic | 0001a | | 0 | $0.00 | 100 | 20 | 80 | | | | | | | |
| Multi-race, NH/PI, AI/AN | 0001a | | 4 | $0.00 | 50 | 10 | 40 | | | | | | | |
| Total CLIN 0001 | | | 11 | $0.00 | 350 | 75 | 275 | | | | | | | |
| B-1 Monthly Invoice | | | | | B-1 Cumulative Summary | | | | | | | Delivery Performance Achievements | | |
| CLIN 0002 Year 2 | CLIN | Price/CBU | Number of CBU Invoiced | Amount Current Invoice | Target | Paid | Remain | $Target | $Paid | $ Remain | % Paid | Percent Delivered | Performance Standard Date | Met Performance Standard Date |
| B/AA | | | | | | | | | | | | 50% | | |
| Asian | | | | | | | | | | | | 75% | | |
| White, non-Hispanic | | | | | | | | | | | | 100% | | |
| White, Hispanic | | | | | | | | | | | | | | |
| Multi-race, NH/PI, AI/AN | | | | | | | | | | | | | | |
| Total CLIN 0002 | | | | | 0 | 0 | 0 | | | | | | | |
| B-1 Monthly Invoice | | | | | B-1 Cumulative Summary | | | | | | |
| Invoice Total all CLINs | FY $ obligated | CLIN | Number of CBU Invoiced | Amount Invoiced to Date | Target | Paid | Remain | $Target | $Paid | $ Remain | % Paid |
| Total Contract Year 1 | 2019 | 0001 | | | 350 | 75 | 275 | $0.00 | $0.00 | $0.00 | 0.0% |
| Total Contract Year 2 | 2020 | 0002 | | | 400 | 0 | 0 | $0.00 | $0.00 | $0.00 | 0.0% |
| Total Contract Year 3 | 2021 | 0003 | | | | | | | | | |
| Total Contract Year 4 | 2022 | 0004 | | | | | | | | | |
| Total Contract Year 5 | 2023 | 0005 | | | | | | | | | |
| Contract Total | | | | | 750 | 75 | 275 | $0.00 | $0.00 | $0.00 | 10.0% |
| CBU Contract Total by Race and Ethnicity | TARGETS all CLINs | Remain All CLINs | Invoiced All CLINs | CBU Race and Ethnicity | Established Minimum TNC Count by Race/Ethnicity for non-contracted CBUs (As submitted per Deliverable #22) | Established Minimum TNC Count by Race/Ethnicity for contracted CBUs (As submitted per Deliverable #22) |
| B/AA | | | | B/AA | | |
| Asian | | | | Asian | | |
| White, non-Hispanic | | | | White, non-Hispanic | | |
| White, Hispanic | | | | White, Hispanic | | |
| Multi-race, NH/PI, AI/AN | | | | Multi-race | | |
| TOTAL as of Report Period | | | | NH/PI | | |
| | | | AI/AN | | |
6CBU for Peer Reviewed Research Progress Report #6: CBU for Peer-Reviewed Research
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY): |
| Report Date: |
| Peer Reviewed Research | CBU Quantity | | | | | | | | | | | | | |
| Study Title or Investigator | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | CBU Total | Total Fees Charged |
| 1 | | | | | | | | | | | | | | | |
| 2 | | | | | | | | | | | | | | | |
| 3 | | | | | | | | | | | | | | | |
| 4 | | | | | | | | | | | | | | | |
| 5 | | | | | | | | | | | | | | | |
| 6 | | | | | | | | | | | | | | | |
| 7 | | | | | | | | | | | | | | | |
| 8 | | | | | | | | | | | | | | | |
| 9 | | | | | | | | | | | | | | | |
| 10 | | | | | | | | | | | | | | | |
| Report Period Total | | | | | | | | | | | | | | |
| Total Year 1, FY 2020 | | | | | | | | | | | | | | |
| Total Year 2, FY 2021 | | | | | | | | | | | | | | |
| Total Year 3, FY 2022 | | | | | | | | | | | | | | |
| Total Year 4, FY 2023 | | | | | | | | | | | | | | |
| Total Year 5, FY 2024 | | | | | | | | | | | | | | |
| CONTRACT TOTAL | | | | | | | | | | | | | | |
7 CBU Availability Stat Summary Progress Report #7: CBU Availability Status Summary
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY): |
| Report Date: |
| CBU Contract Total by Race and Ethnicity (Monthly Reporting) | CBU TARGETS all ClINs | CBU Remain All CLINs | CBU Delivered All CLINs | TOTAL CBU Available, Distributed, Not Available, and CBU not yet replaced | NCBI CBU Available through CW Program | NCBI CBU Distributed for therapy to a designated patient through FDA BLA or IND | NCBI CBU Not Available for < 12 consecutive months | NCBI CBU Removed not yet replaced (<30 days from removal date) | NCBI CBU Replaced | NCBI Removed |
| B/AA | | | | | | | | | | |
| Asian | | | | | | | | | | |
| White, Non-Hispanic | | | | | | | | | | |
| White, Hispanic | | | | | | | | | | |
| Multi-race, NH/PI, AI/AN | | | | | | | | | | |
| Report Period Total | | | | | | | | | | |
| *Total Year 1, FY 2020 | | | | | | | | | | |
| *Total Year 2, FY 2021 | | | | | | | | | | |
| *Total Year 3, FY 2022 | | | | | | | | | | |
| *Total Year 4, FY 2023 | | | | | | | | | | |
| *Total Year 5, FY 2024 | | | | | | | | | | |
| *FY totals entered only at the end of each FY. |
| After the report period for the FY ends, on Sep 30, the FY total is the "final" totals for CBU activity that occurred during that FY (Oct 1-Sep 30) |
8 NCBI CBU Shipped
| Progress Report # 8: NCBI CBU Shipped |
| Submit a separate report for each CLIN (CLIN: Contract Line Item Number from HRSA Contract). |
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year: |
| Report Date: |
| | | | | | | Enter "1" for HRSA R/E Category and for CBU shipped | | | | | | | | CBU Distribution Information | | | SCTOD |
| Contract Line Item Number (CLIN) | CBU CLIN (Delivery) Reference # | CBB CBU ID# | Other CBU ID# | Shipment Date | Collect Date | AI AN | B/AA | Asian | NH PI | White non-Hispanic | White His-panic | Multi-race | Recipient Race | Method (Direct, CWBYCTP, Other) | IND | BLA | SCTOD received CBU pre-transplant data |
| 1 | 0001 | | | | | | | | | | | | | | | | | |
| 2 | | | | | | | | | | | | | | | | | | |
| 3 | | | | | | | | | | | | | | | | | | |
| 4 | | | | | | | | | | | | | | | | | | |
| 5 | | | | | | | | | | | | | | | | | | |
| 6 | | | | | | | | | | | | | | | | | | |
| 7 | | | | | | | | | | | | | | | | | | |
| 8 | | | | | | | | | | | | | | | | | | |
| 9 | | | | | | | | | | | | | | | | | | |
| 10 | | | | | | | | | | | | | | | | | | |
| 11 | | | | | | | | | | | | | | | | | | |
| 12 | | | | | | | | | | | | | | | | | | |
| | | | | Report Period Total | | | | | | | | | | | | | |
| | | | | Total Year 1, FY 2020 | | | | | | | | | | | | | |
| | | | | Total Year 2, FY 2021 | | | | | | | | | | | | | |
| | | | | Total Year 3, FY 2022 | | | | | | | | | | | | | |
| | | | | Total Year 4, FY 2023 | | | | | | | | | | | | | |
| | | | | Total Year 5, FY 2024 | | | | | | | | | | | | | |
| | | | | CONTRACT TOTAL | | | | | | | | | | | | | |
9 CBU Shipped Summary
| Progress Report #9: CBU Shipped Summary |
| Identify NCBI CBU shipped as pursuant to this contract and previous NCBI contracts: Transplant, Unrelated Donor |
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY) : |
| Report Date: |
| | Cumulative CBU Shipped | | | | CBU Shipped | | | | |
| Cumulative CBU SHIPPED (all contract years) | Cumulative # of recipients by R/E | Total Number of CBU shipped | CBU NCBI - current contract | NCBI -previous contracts | Non-NCBI | Total for FY 2020 | FY 2021 | FY 2022 | FY 2023 | FY 2024 |
| AI/AN | 1000 | 1000 | 500 | 400 | 100 | 500 | 500 | | | |
| B/AA | | | | | | | | | | |
| Asian | | | | | | | | | | |
| NH/PI | | | | | | | | | | |
| White Hispanic | | | | | | | | | | |
| White Non-Hispanic | | | | | | | | | | |
| Multi-race | | | | | | | | | | |
| Cumulative Total | | | | | | | | | | |
| FY 20XX - CBU SHIPPED (NCBI, previous NCBI contracts, Non-NCBI) | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Current FY TOTAL |
| AI/AN | | | | | | | | | | | | | |
| B/AA | | | | | | | | | | | | | |
| Asian | | | | | | | | | | | | | |
| NH/PI | | | | | | | | | | | | | |
| White Hispanic | | | | | | | | | | | | | |
| White Non-Hispanic | | | | | | | | | | | | | |
| Multi-race | | | | | | | | | | | | | |
| Report Period Total | | | | | | | | | | | | | |
| Total Year 1, FY 2020 | | | | | | | | | | | | | |
| Total Year 2, FY 2021 | | | | | | | | | | | | | |
| Total Year 3, FY 2022 | | | | | | | | | | | | | |
| Total Year 4, FY 2023 | | | | | | | | | | | | | |
| Total Year 5, FY 2024 | | | | | | | | | | | | | |
| CONTRACT TOTAL | | | | | | | | | | | | | |
10 CBU Removed Replaced by CLIN
| Progress Report #10: CBU Removed/Replaced by CLIN |
| For monthly reporting, a new sheet shall be started for EACH CLIN. Once an entry is made, the entry remains on the sheet and new entries are entered below it. The September report for each year should have all entries for that FY. |
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY): |
| Report Date: |
| Removed CBU Information | | | | | | | Replacement CBU Information | | | | | Enter "1" for R/E Category of removed CBU | | | | | | | | |
| Contract Line Item Number (CLIN) | CBU CLIN (Delivery) Reference # | CBB CBU ID# | Other CBU ID# | Collection Date | Removal Date | Replacement Date | CBU CLIN Reference # | CBB CBU ID# | Other CBU ID# | Collection Date | SPA-CC Registration Date | AI AN | B/AA | Asian | NH PI | White | White His-panic | Multi-race | *If AI/AN or NH/PI replaced by another R/E, provide R/E of replacement CBU. | Reason for CBU removal |
| 1 | 0001 | | | | | | | R0001-1 | | | | | | | | | | | | | |
| 2 | | | | | | | | R0001-2 | | | | | | | | | | | | | |
| 3 | | | | | | | | | | | | | | | | | | | | | |
| 4 | | | | | | | | | | | | | | | | | | | | | |
| 5 | | | | | | | | | | | | | | | | | | | | | |
| 6 | | | | | | | | | | | | | | | | | | | | | |
| 7 | | | | | | | | | | | | | | | | | | | | | |
| 8 | | | | | | | | | | | | | | | | | | | | | |
| 9 | | | | | | | | | | | | | | | | | | | | | |
| 10 | | | | | | | | | | | | | | | | | | | | | |
| 11 | | | | | | | | | | | | | | | | | | | | | |
| 12 | | | | | | | | | | | | | | | | | | | | | |
| | | | | | TOTAL | | | | | | | | | | | | | | *Per contract requirements | |
11 CBU Removed Summary Progress Report # 11: CBU Removed Summary
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period |
| Fiscal Year (FY): |
| Report Date: |
| CLIN, CBU Removed | Oct | Nov | Dec | Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | TOTAL |
| 0001a/b/c | | | | | | | | | | | | | |
| 0002 | | | | | | | | | | | | | |
| 0003 | | | | | | | | | | | | | |
| 0004 | | | | | | | | | | | | | |
| 0005 | | | | | | | | | | | | | |
| Report Period Total | | | | | | | | | | | | | |
| Total Year 1, FY 2020 | | | | | | | | | | | | | |
| Total Year 2, FY 2021 | | | | | | | | | | | | | |
| Total Year 3, FY 2022 | | | | | | | | | | | | | |
| Total Year 4, FY 2023 | | | | | | | | | | | | | |
| Total Year 5, FY 2024 | | | | | | | | | | | | | |
| CONTRACT TOTAL | | | | | | | | | | | | | |
12NCBI CBU Transfer or Receipt Progress Report #12: NCBI CBU Transfer or Receipt
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Report Date: |
| Transfer Date: |
| Receipt Date: |
| CLIN: 0001 (includes all subsets of 0001 such as 0001a, 0001b, etc.) |
| Contract Year: Year 1 |
| Contractor Receiving NCBI CBU: |
| Contractor Transferring NCBI CBU: |
CBU Transfer (units transferred to and from the contract): Each CBU reported on this table shall receive a permanent transfer number in chronological order. The transfer number shall begin at 1 through the final quantity of CBU transferred. For example, the first CBU shall be assigned the number "1" through the total numbered transferred.
| CBU Transfer # or Receipt # (as applicable) | CBU CLIN (Delivery) Reference # (reported to HRSA for initial delivery to NCBI) | Contract Line Item Number (CLIN)/FY awarded | CBB CBU ID# | Registry CBU ID# | Collection Date | AI AN | B/AA | Asian | NH PI | White | White His-panic | Multi-race | |
| 1 | | 0001a | | | | | | | | | | | |
| 2 | | | | | | | | | | | | | |
| 3 | | | | | | | | | | | | | |
| 4 | | | | | | | | | | | | | |
| 5 | | | | | | | | | | | | | |
| 6 | | | | | | | | | | | | | |
| 7 | | | | | | | | | | | | | |
| 8 | | | | | | | | | | | | | |
| 9 | | | | | | | | | | | | | |
| 10 | | | | | | | | | | | | | |
| 11 | | | | | | | | | | | | | |
| 12 | | | | | | | | | | | | | Total |
| | | | Report Period Total | | | | | | | | | |
| | | | Total Year 1, FY 2020 | | | | | | | | | |
| | | | Total Year 2, FY 2021 | | | | | | | | | |
| | | | Total Year 3, FY 2022 | | | | | | | | | |
| | | | Total Year 4, FY 2023 | | | | | | | | | |
| | | | Total Year 5, FY 2024 | | | | | | | | | |
| | | | CONTRACT TOTAL | | | | | | | | | |
13 Self Sufficiency Progress Report #13: Self-Sufficiency
| Contract #: HHSH |
| Contractor: As listed on HRSA Contract |
| Deliverable # |
| Report Period: |
| Fiscal Year (FY): |
| Report Date: |
| Self-Sufficiency Report | Year 1 (EDOC 2019 - Sep 2020) | | Year 2 (Oct 2020-Sep 2021) | | Year 3 (Oct 2021-Sep 2022) | | Year 4 (Oct 2022-Sep 2023) | | Year 5 (Oct 2023-Sep 2024) | | Cunulative Contract Total FY to Date) | |
| Annual Self-Sufficiency | Plan | Actual | Plan | Actual | Plan | Actual | Plan | Actual | Plan | Actual | Plan | Actual |
| Number of cord blood units collected | | | | | | | | | | | | |
| Number of CBU (NCBI and non-NCBI) added to the public inventory | | | | | | | | | | | | |
| Number of cord NCBI blood units reimbursed | | | | | | | | | | | | |
| Number of Collection Sites | | | | | | | | | | | | |
| Total Expenses | | | | | | | | | | | | |
| Revenue from CBU shipments | | | | | | | | | | | | |
| Revenues from other than CBU shipments | | | | | | | | | | | | |
| NCBI Reimbursement Amount | | | | | | | | | | | | |
| HRSA funding through CW Program contractors | | | | | | | | | | | | |
| Total Revenues | | | | | | | | | | | | |
| Difference = Exp - Rev | | | | | | | | | | | | |
| Self-Sufficiency Report | Year 1 (EDOC 2019 - Sep 2020) | | Year 2 (Oct 2020-Sep 2021) | | Year 3 (Oct 2021-Sep 2022) | | Year 4 (Oct 2022-Sep 2023) | | Year 5 (Oct 2023-Sep 2024) | | Cumulative Contract Total FY to Date) | |
| Number of CBU (NCBI and non-NCBI) added to the public inventory by race and ethnicity | Plan | Actual | Plan | Actual | Plan | Actual | Plan | Actual | Plan | Actual | Plan | Actual |
| AI/AN | | | | | | | | | | | | |
| B/AA | | | | | | | | | | | | |
| Asian | | | | | | | | | | | | |
| NH/PI | | | | | | | | | | | | |
| White Hispanic | | | | | | | | | | | | |
| White Non-Hispanic | | | | | | | | | | | | |
| Multi-race | | | | | | | | | | | | |
| Total | | | | | | | | | | | | |