Appendix B - Performance Progress Report.pdf

Form FNS-908 (12-18) Previous Editions Obsolete SBU Electronic Form Version Designed in Adobe 10.0 Version

OMB Control Number: 0584-0512 Expiration Date: xx/xx/xxxx

The public burden statement: According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0512. The time required to complete this information collection is estimated to average 3 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of in formation. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302, ATTN: PRA (0584 - 0512*). Do not return the completed form to this address.

1. Recipient Organization

a. Organization Name:

b. Street Address:

City: State: Zip:

5. Recipient Account Number (FAIN):

2. Grant Federal Fiscal Year & Quarter:

Federal Fiscal Year and Quarter should reflect the time this Progress Report is submitted

b. Federal Quarter:a: Federal Fiscal Year:

6. Type of Report (Select One):

Final Semi-Annual

Reporting Period:Quarterly

3. Program Information:

Program Area:

Program:

7. Federal Grant Agreement Number:

4. Primary POC:

a. First Name: Last Name: b. Title:

c. Telephone (Area Code & Number): d. Email Address:

8. Additional POC (Optional)

10. Certification I certify by checking this box that, to the best of my knowledge and belief, this report is correct and complete for performance of activities set forth in the award documents.

9. Report Submitted By:

a. First Name: b. Title:

11. Date Report Submitted:

UNITED STATES DEPARTMENT OF AGRICULTURE

Food and Nutrition Service

PERFORMANCE PROGRESS REPORT

Last Name:a. First Name: b. Title:

d. Email Address:c. Telephone (Area Code & Number):

Tag:

Last Name:

Submit by Email

Appendix B

Program Management Information

1. Progress Summary

2. Personnel Information

Provide summary of progress this reporting period, highlighting your greatest achievements and challenges to date in this reporting period. For challenges, how did you resolve or overcome them? (Max 2000 characters):

a. Number of FTEs: b. Were there any changes in key personnel?

c. If yes, please describe the changes in key personnel, including the individual leaving/joining the project as well as the name and contact information (email address, phone number, and name of organization) of the individual. Note: This information does not serve as a formal request to approve the change in key personnel. This request must be forwarded to the Grants Officer in a separate request (Max 2000 Characters):

3. Projected Amendments (Cost and No-Cost)

4. Expenditures/Purchases:

a. Were there any significant expenditures or purchases, including any contracts entered during this reporting period?

b. If so, please describe (Max 2000 Characters):

a. Number of amendments projected this upcoming quarter?

b. Do the projected amendment(s) require FNS approval?

c. Please describe the type of amendment(s) projected and justification for each. Note: This information does not serve as a formal request to approve amendments. This request must be forwarded to the Grants Officer in a separate request (Max 2000 characters:):

Yes No

Yes No

Yes No

a. Have there been any deviations?

5. Deviations (Changes this quarter outside of the agreed upon scope, timeline, or budget):

b. Type:

c. Describe any deviation(s), including a justification and impacts to budget/timeline (Max 2000 characters):

d. Please describe proposed activities to mitigate the impact of the deviation(s) (Max 2000 characters):

Yes No

Program Management Information (Continued)

6. Upcoming Activities and Anticipated Changes

a. Please describe activities planned for next quarter (Max 2000 Characters):

b. Do you anticipate any changes in your project timeline, activities or cost?

c. If yes, please explain the anticipated changes (Max 2000 Characters):

NoYes

7. Final Reporting Summary (Final Reporting Period Only)

a. Are all goals and objectives completed at this time?

b. Briefly describe the goals and objectives that were not completed and why they were not completed (Max 2000 Characters):

c. Was the project budget sufficient for meeting the project goals?

d. If no to answer 7c, briefly describe why the budget was insufficient for meeting the project goals (Max 2000 Characters):

Yes No

Yes No

8. Additional Comments

Program Activities

Objective :1

Optional Activity Type

Anticipated Completion

Date

Actual Completion

Date Location Beneficiaries/ Audience

Topic (if training)

Outcome Indicators

Objective :1

Activity

Indicator Description Indicator Type

Actual (Cumulative) CommentsTarget

Final Program Metrics (Final Reporting Period Only)

Metric Type:

Prompt:

Answer Value 1: Answer Value 2: Answer Value 3: Answer Value 4: Answer Value 5:

Item 1:

Item 2:

Item 3:

Comments:

Final Program Metrics (Final Reporting Period Only)

Metric Type:

Prompt:

Answer Value 1: Answer Value 2: Answer Value 3: Answer Value 4: Answer Value 5:

Item 1:

Item 2:

Final Program Metrics (Final Reporting Period Only)

Metric Type:

Prompt:

Answer Value 1: Answer Value 2: Answer Value 3: Answer Value 4: Answer Value 5:

Item 1:

Item 2:

Final Program Metrics (Final Reporting Period Only)

Metric Type:

Prompt:

Answer Value 1: Answer Value 2: Answer Value 3: Answer Value 4: Answer Value 5:

Item 1:

Item 2: