FNS-908_Clean Copy.pdf

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. Name:

b. Address:

City: State: Zip:

5. Recipient Account Number (FAIN):

2. Grant Federal Fiscal Year & Quarter:

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. Name: b. Title:

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

8. Additional POC (Optional)

9. 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.

10. Authorized Certifying Official

a. Name: b. Title: c. Signature of Authorized Certifying Official:

13. Date Report Submitted (Month, Day, Year):

UNITED STATES DEPARTMENT OF AGRICULTURE

Food and Nutrition Service

PERFORMANCE PROGRESS REPORT

a. Name: b. Title:

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

Electronic Form Version Designed in Adobe 10.0 VersionSBUForm FNS-908 (09-18) Previous Editions Obsolete

Program Management Information

1. Progress Summary

2. Personnel Information

Progress Summary, 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 the project as well as the name and contact information (email address, phone number, and name of organization) of the individual joining the project. 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. Amendments (Cost and No-Cost)

5. Deviations

4. Expenditures/Purchases:

a. Were there any significant expenditures or purchases, including any contracts entered during this reporting period? If so, please describe (Max 2000 Characters):

a. Number of amendments this quarter?

a. Have there been any deviations? b. Type:

b. Type of amendments?

c. Proposed Plan Activities:

c. Did the amendment(s) require FNS approval?

d. Budget Impact:

d. Please describe the no-cost amendments this quarter (Max 2000 Characters):

e. Timeline:

f. Justification:

Yes No

Yes No

Yes No

Program Management Information (Continued)

6. Upcoming Activities and Anticipated Changes

7. Final Reporting Summary (Final Reporting Period Only)

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

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 (75 words or less):

b. Do you anticipate any changes in your project timeline, activities or cost? (Max 2000 Characters):

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

d. If no to answer 6c, briefly describe why the budget was insufficient for meeting the project goals (50 words or less):

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

8. Additional Comments

Yes No

Yes No

Program Activities Objective 1:

Optional Activity

Type Anticipated Completion Date

Actual Completion Date Location Beneficiaries/Audience Topic (if training)

Outcome Indicators

Activity #:

Indicator Description Indicator Type Quantitative Qualitative

NarrativeTarget Actual (Cumulative) Comments % Complete

(Cumulative) Performance

Status Comments

Objective #:

Activity #:

Activity #:

Final Program Metrics (Final Reporting Period Only)

Evaluation Metric #: Type: Checklist

Prompt:

Answer Value 1:

Item 1:

Item 2:

Item 3:

Item 4:

Item 5:

Item 6:

Item 7:

Item 8:

Item 9:

Item 10:

Comments:

Type: Free Form

Comments:

Evaluation Metric #:

Prompt:

The Privacy Act Statement:

Authority: Section 9 of the Food and Nutrition Act of 2008, as amended, (7 U.S.C. 2018); section 205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)); and section 6109(f) of the Internal Revenue Code of 1986 (26 U.S.C. 6109(f)), authorizes collection of the information on this application.

Purpose: Information is collected primarily for use by the Food and Nutrition Service in the administration of the Supplemental Nutrition Assistance Program;

Routine Use: Information may be disclosed for any of the routine uses listed in the published System of Record notice https://www.federalregister.gov/documents/2010/12/27/2010-32457/privacy-act-revision-of-privacy-act-systems-of-records#p-30.

Disclosure: Furnishing the information on this form, including your SSN and EIN, is voluntary but failure to do so will result in withdrawal of store authorization to accept SNAP benefits.

Evaluation Metric #: Type: Cross Table

Prompt:

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

Item 1:

Item 2:

Item 3:

Item 4:

Item 5:

Item 6:

Item 7:

Item 8:

Item 9:

Item 10:

Comments:

https://www.federalregister.gov/documents/2010/12/27/2010-32457/privacy-act-revision-of-privacy-act-systems-of-records#p-30

11.0.1.20130830.1.901444

PERFORMANCE PROGRESS REPORT

FNS-908

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. Name:

b. Address:

City:

State:

Zip:

5. Recipient Account Number (FAIN):

2. Grant Federal Fiscal Year & Quarter:

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. Name:

b. Title:

c. Telephone (Area Code & Number):

d. Email Address:

8. Additional POC (Optional)

9. 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.

10. Authorized Certifying Official

a. Name:

b. Title:

c. Signature of Authorized Certifying Official:

13. Date Report Submitted (Month, Day, Year):

UNITED STATES DEPARTMENT OF AGRICULTURE Food and Nutrition Service

PERFORMANCE PROGRESS REPORT

a. Name:

b. Title:

d. Email Address:

c. Telephone (Area Code & Number):

Electronic Form Version Designed in Adobe 10.0 Version

SBU

Form FNS-908 (09-18) Previous Editions Obsolete Program Management Information

1. Progress Summary

2. Personnel Information Progress Summary, 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 the project as well as the name and contact information (email address, phone number, and name of organization) of the individual joining the project. 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. Amendments (Cost and No-Cost)

5. Deviations

4. Expenditures/Purchases:

a. Were there any significant expenditures or purchases, including any contracts entered during this reporting period? If so, please describe (Max 2000 Characters):

a. Number of amendments this quarter?

a. Have there been any deviations?

b. Type:

b. Type of amendments?

c. Proposed Plan Activities:

c. Did the amendment(s) require FNS approval?

d. Budget Impact:

d. Please describe the no-cost amendments this quarter (Max 2000 Characters):

e. Timeline:

f. Justification:

Program Management Information (Continued)

6. Upcoming Activities and Anticipated Changes

7. Final Reporting Summary (Final Reporting Period Only)

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

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 (75 words or less):

b. Do you anticipate any changes in your project timeline, activities or cost? (Max 2000 Characters):

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

d. If no to answer 6c, briefly describe why the budget was insufficient for meeting the project goals (50 words or less):

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

8. Additional Comments Program Activities Objective 1:

Optional Activity Type Anticipated Completion Date Actual Completion Date Location Beneficiaries/Audience Topic (if training) Outcome Indicators Activity #:

Indicator Description Indicator Type Quantitative Qualitative Narrative Target Actual (Cumulative) Comments % Complete (Cumulative) Performance Status Comments Objective #:

Activity #:

Activity #:

Final Program Metrics (Final Reporting Period Only) Evaluation Metric #:

Type: Checklist Prompt:

Answer Value 1:

Item 1:

Item 2:

Item 3:

Item 4:

Item 5:

Item 6:

Item 7:

Item 8:

Item 9:

Item 10:

Comments:

Type: Free Form Comments:

Evaluation Metric #:

Prompt:

The Privacy Act Statement:

Authority: Section 9 of the Food and Nutrition Act of 2008, as amended, (7 U.S.C. 2018); section 205(c)(2)(C) of the Social Security Act (42 U.S.C. 405(c)(2)(C)); and section 6109(f) of the Internal Revenue Code of 1986 (26 U.S.C. 6109(f)), authorizes collection of the information on this application.

Purpose: Information is collected primarily for use by the Food and Nutrition Service in the administration of the Supplemental Nutrition Assistance Program;

Routine Use: Information may be disclosed for any of the routine uses listed in the published System of Record noticehttps://www.federalregister.gov/documents/2010/12/27/2010-32457/privacy-act-revision-of-privacy-act-systems-of-records#p-30.

Disclosure: Furnishing the information on this form, including your SSN and EIN, is voluntary but failure to do so will result in withdrawal of store authorization to accept SNAP benefits.

Evaluation Metric #:

Type: Cross Table Prompt:

Answer Value 1:

Answer Value 3:

Answer Value 5:

Answer Value 4:

Answer Value 2:

Item 1:

Item 2:

Item 3:

Item 4:

Item 5:

Item 6:

Item 7:

Item 8:

Item 9:

Item 10:

Comments: