ARRA Recovery Report - Blank.pdf

ARRA-Performance Progress Report SF-PPR-Recovery

(cover page) Page of

Pages

3a. DUNS Number

3.c. CFDA

1.Federal Agency and Organization Element to Which Report is Submitted

2. Federal Grant or Other Identifying Number Assigned by Federal Agency

AG-4419-

3b. EIN

4. Recipient Organization (Name and complete address including zip code)

5. Recipient Identifying Number or Account Number (optional)

6. Project/Grant Period 7. Reporting Period End Date 8. Final Report? Yes No

9. Report Frequency Start Date: (Month, Day, Year)

End Date: (Month, Day, Year)

(Month, Day, Year) annual semi-annual quarterly other (If other, describe: __________

10. Performance Narrative (Describe the Project or Activities for which recovery of funds were expended or obligated.)

LEAVE BLANK – DO NOT COMPLETE

11. Other Attachments (attach other documents as needed or as instructed by the awarding Federal Agency)

12. Certification: I certify to the best of my knowledge and belief that this report is correct and complete for performance of activities for the purposes set forth in the award documents.

12a. Typed or Printed Name and Title of Authorized Certifying Official

12c. Telephone (area code, number and extension)

12d. Email Address

12b. Signature of Authorized Certifying Official

12e. Date Report Submitted (Month, Day, Year)

13. Agency use only

OMB Approval No. TBD

Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is TBD. The time required to complete this information collection is estimated to average three (3) hours per response, including the time to review the instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have suggestions about the accuracy of the estimate, we would be happy to hear from you. You can email us at.

SF-PPR-Recovery-B

“Program Indicators”

Page of

3a. DUNS

1.Federal Agency and Organization Element to Which Report is Submitted

USDA FS –

2. Federal Grant or Other Identifying Number Assigned by Federal Agency

4. Reporting Period End Date

(Month, Day, Year)

Section 1 Award Recipient Information:

Please provide requested information.

(1) Label

(2) Question

(3) Response

(4)

ARRA-1-01 Name of Project or Activity

ARRA-1-02 Total Amount of Recovery Funds Received from Federal Agency Indentified in Block 1:

ARRA-1-03 Amount of recovery funds received that were obligated or expended to projects or activities:

3a. DUNS

USDA FS –

2. Federal Grant or Other

4. Reporting Period End Date (Month, Day, Year)

Section 2 Project / Activity Information Please provide requested information for each project of activity for which recovery funds were expended or obligated.

(1) Label

(2) Requested Information

(3)

ARRA-2-01 Name of Project or Activity

ARRA-2-02 Description of Project or Activity

ARRA-2-03 Evaluation of completion status of the project or activity.

(Please choose one.)

Not started

Less than 50% completed

Completed 50% or more

Fully Completed

ARRA-2-04 Estimate of the number of jobs created by this project or activity.

ARRA-2-05 Estimate of the number of jobs retained by this project or activity.

ARRA-2-06 Total cost of infrastructure investments made by State and local governments:

ARRA-2-07 For State/local infrastructure investment: What is the purpose of investment made by State and local governments for funding the infrastructure investment with funds made available under this Act?

ARRA-2-08 For State/local infrastructure investment: What is the rationale of the Award Recipient for funding the infrastructure investment with funds made available under this Act?

ARRA-2-09 For State/local infrastructure investment: Who should we contact if we have concerns about this infrastructure investment?

“Program Indicators”

ARRA-2-10 NEPA Compliance Status Completed

In progress: NEPA is not triggered

In progress: Categorical Exclusion

In progress: Environmental Assessment

In progress: Environmental Impact Statement

ARRA-2-11 NEPA Compliance Supporting Information

Note: This page can be duplicated for one or more projects or activities.

“Program Indicators” Page of

3a. DUNS 3c. CFDA

2. Federal Grant or Other

Leave blank

4. Reporting Period End Date (Month, Day, Year)

Section 3 Subawardee or Subcontract Award Information Please provide requested information for each sub-awardee or sub-contract for which $25,000 or more of recovery funds were obligated or expended.

(1) Label

(2) Requested Information

ARRA-3-01 Recipient DUNS Number

ARRA-3-02 Award Number or Other Identifying Number Assigned by the Awarding Entity

ARRA-3-03 Recipient Name

ARRA-3-04 Recipient Location Address:________________________ City:____________________________ County:_________________________ State Postal Code:______ Zip Code:_______-_______ Congressional District:_______

ARRA-3-05 Recipient Type:

(Select primary category. from the list of categories provided in the instructions.)

00 01 02 04 05 06 11 12

20 21 22 23 25

ARRA-3-06 Recipient Category.

(Select one or more that apply from the list of categories provided in the instructions.)

A B C D E F

G H I J K L M N O P Q R S T U V W X

ARRA-3-07 Amount of Subcontract or Subaward (Current Contract/Award Value)

ARRA-3-08 Amount of Subcontract or Subaward (Ultimate Contract/Award Value)

ARRA-3-09 Award Date $___________________

ARRA-3-10 Principal Performance Location: Address:________________________ City:____________________________ County:_________________________ State Postal Code:______ Zip Code:____________ Congressional District:_____

“Program Indicators”

ARRA-3-11 For the five most highly compensated officers of the entity: the names and total compensation (See instructions to determine if this information is required)

Name Total Compensation

1. $

2 $

3. $

4. $

5. $

Note: This page can be duplicated for one or more Subawardees or Subcontracts, 3a. DUNS 3c. CFDA

2. Federal Grant or Other

Leave blank

4. Reporting Period End Date (Month, Day, Year)

Section 4 SubAwardee or SubContract Award Information--Aggregate Report Please provide requested aggregated information for subawards or subcontracts for which less than $25,000 in recovery funds were obligated or expended.

(1) Label

(2) Requested Information

ARRA-4-01 Total Number of Subcontracts and Subawards less than $25,000/award

ARRA-4-02 Total Amount of Subcontracts and Subawards less than $25,000/award