Sustainable Broadband Adoption Quarterly Performance Rep

RECIPIENT NAME: omb control no. 0660-xxxx

AWARD NUMBER: expiration date: xx-xx-xxxx

DATE:

Sustainable Broadband Adoption Quarterly Performance Report Introduction

SUBMISSION REQUIREMENTS:

All Broadband Technology Opportunities Program (BTOP) grant recipients are required to complete a quarterly performance report. The attached performance report form must be completed and submitted after the end of every quarter, and reports must be submitted separately for each BTOP award. The prime recipient is solely responsible for the accurate completion and timely submission of this form.

DEADLINE:

All recipients are required to submit their quarterly performance report by 11:59pm ET on the 30th calendar day after the fiscal quarter ends (for example, if the fiscal quarter ends on June 30, performance reports are due no later than 11:59pm ET on July 30). The timely submission of performance reports is a requirement of all BTOP awards as stated in the special award conditions. Incomplete submissions will be sent back to the recipient for further information.

COMPLETING THE PERFORMANCE REPORT:

The BTOP performance report form consists of three main sections:

• Section 1: General Information

• Section 2: Report Data Fields

• Section 3: Budget Data Fields

Each question must be answered fully and accurately (within word limits). If your answer to certain questions does not fit in the space provided, please provide additional information in a separate document or spreadsheet, using the format provided in the performance report form. If particular questions do not apply to your project, please write “N/A.” All fields should be filled out with the requested data or “N/A.” Please note that to the extent that only your subrecipient, contractor, and/or subcontractor has access to any of the information requested in the performance report, the prime recipient is responsible for collecting this information and submitting it to NTIA.

Please reference the attached line item instructions for assistance. If you have additional questions, please contact your assigned Federal Program Officer.

DATA REVIEW:

Program Office staff will be responsible for reviewing performance reports and may need to follow up with recipients regarding the submitted data. Recipients must promptly respond to any and all Program Office follow-up questions regarding the submitted data; in some cases, recipients will be required to revise and re-submit performance reports. The data provided will be compared to each recipient’s Baseline Project Plan and will help the Program Office monitor the progress and performance of each BTOP project.

All progress reports will be made publicly available via the Internet.  To the extent that recipients believe that the information they are providing is confidential, recipients may make a request for such information to be kept private and identify any information they believe should not be released to the public.  They should also file both a redacted and an unredacted version of their report.  Recipients should note, however, that the Recovery Act requires substantial transparency and that NTIA may not necessarily approve such requests.  If NTIA does approve, the agency will keep such information private from public disclosure to the extent permitted by law, including the Freedom of Information Act, as amended (5 U.S.C. 552), the Trade Secrets Act, as amended (18 U.S.C. 1905), and the Economic Espionage Act of 1996 (18 U.S.C. 1831 et seq.).

Proposed Quarterly Performance Report Questions for Sustainable Broadband Adoption

General Information
		Page	of	Pages
1. Federal Agency and Organization Element to Which Report is Submitted	2. Award Identification Number	3a. DUNS Number
		3b. EIN
4. Recipient Organization (Name and complete address including county, congressional district, and zip code)
5. Current Reporting Period End Date (MM/DD/YYYY)		6. Is this the Last Report of the Award Period?		□ Yes □ No
7. 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.
7a. Typed or Printed Name and Title of Certifying Official		7c. Telephone (area code, number and extension)
		7d. Email Address
7b. Signature of Certifying Official		7e. Date Report Submitted (MM/DD/YYYY)

Project Indicators (This Quarter)
1. Please describe significant project accomplishments completed during this quarter (150 words or less).
2. Please provide the percent complete for the following key milestones in your project. Write "N/A" in the second column if your project does not include this activity. If you provided additional milestones in your baseline plan, please insert them at the bottom of the table. Unless otherwise indicated in the instructions, figures should be reported cumulatively from award inception to the end of the most recent reporting quarter. Please provide a narrative description if the percent complete is different from the target provided in your baseline plan (100 words or less).
	Milestone			Percent Complete		Narrative (describe your reasons for any variance from the baseline plan or any other relevant information)
2.a.	Overall Project
2.b.	Equipment Purchases
2.c.	Awareness Campaigns
2.d.	Outreach Activities
2.e.	Training Programs
2.f.	Other (please specify):
3. Please describe any challenges or issues faced during this past quarter in achieving planned progress against the project milestones listed above. In particular, please identify any areas or issues where technical assistance from the BTOP program may be useful (150 words or less).
4a. In the chart below, please provide the requested information on your BTOP grant-funded SBA activities. Please also provide a short description of the activity (100 words or less). Unless otherwise indicated in the instructions, figures should be reported cumulatively from award inception to the end of the most recent reporting quarter.
Name of the SBA Activity		Location of SBA Activity	Description of Activity (100 words or less)				Size of Target Audience	Actual Number of Participants	New Subscribers (Households and/or Businesses)
Total
4b. Please describe your method for determining number of households and/or businesses subscribing to broadband as a result of your SBA programs (100 words or less).
4c. Please provide a narrative description if the total number of new subscribers is different from the targets provided in your baseline plan (100 words or less).
4d: Please provide the number of households and the number of businesses receiving discounted broadband service as result of BTOP funds.
Households:					Businesses:

Project Indicators (Next Quarter)
1. Please describe significant project accomplishments planned for completion during the next quarter (150 words or less).
2. Please provide the percent complete anticipated for the following key milestones in your project as of the end of the next quarter. Write "N/A" in the second column if your project does not include this activity. If you provided additional milestones in your baseline plan, please insert them at the bottom of the table. Unless otherwise indicated in the instructions, figures should be reported cumulatively from award inception to the end of the most recent reporting quarter. Please provide a narrative description if the planned percent complete is different from the target provided in your baseline plan (100 words or less).
	Milestone	Planned Percent Complete	Narrative (describe your reasons for any variance from the baseline plan or any other relevant information)
2.a.	Overall Project
2.b.	Equipment Purchases
2.c.	Awareness Campaigns
2.d.	Outreach Activities
2.e.	Training Programs
2.f.	Other (please specify):
3. Please describe any challenges or issues anticipated during the next quarter that may impact planned progress against the project milestones listed above. In particular, please identify any areas or issues where technical assistance from the BTOP program may be useful. (150 words or less)

Sustainable Broadband Adoption Budget Execution Details

Activity Based Expenditures (Sustainable Broadband Adoption)
1. Please provide details below on your total budget, cumulative actual expenditures (for the period ending the current quarter), and cumulative anticipated expenditures (for the period ending next quarter) for each line item, including detailed disbursements of both matching funds and federal funds from project inception through end of this quarter (actual) or next quarter (anticipated). Actual and anticipated figures should be reported cumulatively from award inception to the end of the applicable reporting quarter.
Budget for Entire Project						Actuals from Project Inception through End of Current Reporting Period			Anticipated Actuals from Project Inception through End of Next Reporting Period
COST CLASSIFICATION	Total Cost (plan)	Matching Funds (plan)	Federal Funds (plan)			Total Costs	Matching Funds	Federal Funds	Total Costs	Matching Funds	Federal Funds
a. Personnel	$0	$0	$0			$0	$0	$0	$0	$0	$0
b. Fringe Benefits	$0	$0	$0			$0	$0	$0	$0	$0	$0
c. Travel	$0	$0	$0			$0	$0	$0	$0	$0	$0
d. Equipment	$0	$0	$0			$0	$0	$0	$0	$0	$0
e. Supplies	$0	$0	$0			$0	$0	$0	$0	$0	$0
f. Contractual	$0	$0	$0			$0	$0	$0	$0	$0	$0
g. Construction	$0	$0	$0			$0	$0	$0	$0	$0	$0
h. Other	$0	$0	$0			$0	$0	$0	$0	$0	$0
I. Total Direct Charges (sum of a through h)	$0	$0	$0			$0	$0	$0	$0	$0	$0
j. Indirect Charges	$0	$0	$0			$0	$0	$0	$0	$0	$0
TOTALS (sum of i and j)	$0	$0	$0			$0	$0	$0	$0	$0	$0
2. Program Income: Please provide the program income you listed in your application budget and actuals to date through the end of the reporting period.
a. Application Budget Program Income:					b. Program Income to Date:

Sustainable Broadband Adoption Quarterly Performance Report Instructions

Line Item Instructions for the Performance Report Attachment

(BTOP Quarterly Report for Sustainable Broadband Adoption Projects)

Question Number	Reporting Item	Instructions	Clarification and Definitions
General Information
1	Federal Agency and Organizational Element to Which Report is Submitted	Enter the name of the Federal agency and organizational element identified in the award document or otherwise instructed by the agency.	Enter “Department of Commerce, National Telecommunications and Information Administration.”
2	Award Identification Number	Enter the award number assigned to each award by the Federal agency.	Enter your 10 digit grant award number listed on your award package CD-450 form.
3a	DUNS Number	Enter the recipient organization’s Data Universal Numbering System (DUNS) number or Central Contract Registry extended DUNS number.	The number entered should match the DUNS number listed on your award package CD-450 form.
3b	EIN	Enter the recipient organization’s Employer Identification Number (EIN).	The number entered should match the EIN number listed on your award package CD-450 form.
4	Recipient Organization	Enter the name and complete address of the recipient organization including zip code.	The data entered should match the data listed on your award package CD-450 form.
5	Reporting Period End Date	Enter the last day of the current reporting period.	The date entered should match a calendar year quarterly end date.
6	Is this the last report of the award period?	Check yes or no.	The last report is the final performance report submitted during the closeout of the grant.
7a	Certifying Official	Enter the name of your organization’s Certifying Official.	The Certifying Official should be the AOR or the Principal Investigator/Project Manager designated by the AOR.
7b	Certifying Official Signature	Enter the signature of your organization’s Certifying Official.	The Certifying Official should be the AOR or the Principal Investigator/Project Manager designated by the AOR.
7c	Telephone Number	Enter the telephone number of the Certifying Official.	The number may be needed in case of any follow-up questions regarding the performance report.
7d	Email Address	Enter the email address of the Certifying Official.	The email address may be needed in case of any follow-up questions regarding the performance report.
7e	Report Submission Date	Enter the date the report was submitted.	Reports are to be submitted by the quarterly due dates.
Project Indicators (This Quarter)
1	Project Accomplishments	Please describe significant project accomplishments during the quarter.	Include only accomplishments that took place during this reporting period. Accomplishments can be described quantitatively or qualitatively. For example, project accomplishments may include counts, percentages, targeted dates, time periods, or levels. It could also describe a condition, a result, or a status. Please limit narrative responses to 150 words or less.
2	Percent of Milestones Complete	Please provide the percent complete for the following key milestones in your project. Write "N/A" in the second column if your project does not include this activity. If you provided additional milestones in your baseline plan, please insert them at the bottom of the table. Figures should be reported cumulatively from award inception to the end of the most recent reporting quarter. Please provide a narrative description if the percent complete is different from the target provided in your baseline plan.	The percentage of completion for each milestone should be based primarily on the expenditure of your project budget, and the percentages should be reported cumulatively from award inception through the end of the each quarter. For example, if you expect to complete a particular milestone in the first three quarters of your project, the third quarter and all subsequent quarters should state 100%. “Outreach Activities” include activities and expenditures related to in person meetings or events with potential partner organizations, potential broadband subscribers, and potential program participants. “Awareness Campaigns” include activities and expenditures related to paid and earned media activities, advertisements, and the preparation and dissemination of broadband materials. Please limit narrative responses to 150 words or less.
3	Challenges or Issues	Please describe any challenges or issues faced during this past quarter in achieving planned progress against the project milestones listed above. In particular, please identify any areas or issues where technical assistance from the BTOP program may be useful.	Provide information on any challenges, incidents, barriers or issues that you have encountered. In your narrative, indicate whether the issue remains or has been corrected or mitigated. If corrected or mitigated, indicate how the issue was resolved. Please limit narrative responses to 150 words or less.
4a-d	SBA Activities and New Subscribers	4a. Please provide the requested information on BTOP grant-funded SBA activities. Figures should be reported cumulatively from award inception to the end of the most recent reporting quarter. 4b. Please describe your method for determining number of households and/or businesses subscribing to broadband as a result of your SBA programs. 4c. Please provide a narrative description if the total number of new subscribers is different from the targets provided in your baseline plan. 4d. Please provide the number of households and the number of businesses receiving discounted broadband service as result of BTOP funds.	Location of the SBA Activity: Describe the area (e.g., town/city, state) that your SBA program targets. If more than one location is included, please complete a separate line for each city or region (e.g., Northern Virginia). Description of Activity: Provide a short description of the SBA program(s). Size of Target Audience: Provide the number of individuals targeted by your SBA activity (in the area defined). Actual Number of Participants: Provide the actual number of participants in each particular SBA activity Number of New Subscribers: Indicate the number of new broadband subscriptions in the identified area since the start of your project. A new subscriber is defined as a household or business that did not subscribe to broadband prior to the start of your project. Methods for calculating the number of subscribers may include use of broadband provider statistics, surveys, interviews, campaign attendance records, or any other measurable data collection method. Please limit narrative responses to 100 words or less.
Project Indicators (Next Quarter)
1	Planned Project Accomplishments	Please describe significant project accomplishments planned for completion during the next quarter.	Include only anticipated accomplishments that will take place during the next reporting period. Accomplishments can be described quantitatively or qualitatively. For example, project accomplishments may include counts, percentages, targeted dates, time periods, or levels. It could also describe a condition, a result, or a status. Please limit narrative responses to 150 words or less.
2	Anticipated Milestone Completion	Please provide the percent complete anticipated for the following key milestones in your project as of the end of the next quarter. Write "N/A" in the second column if your project does not include this activity. If you provided additional milestones in your baseline plan, please insert them at the bottom of the table. Figures should be reported cumulatively from award inception to the end of the most recent reporting quarter. Please provide a narrative description if the planned percent complete is different from the target provided in your baseline plan.	The percentage of completion for each milestone should be based primarily on the expenditure of your project budget, and the percentages should be reported cumulatively from award inception through the end of the each quarter. For example, if you expect to complete a particular milestone in the first three quarters of your project, the third quarter and all subsequent quarters should state 100%. Please limit narrative responses to 100 words or less.
3	Anticipated Challenges or Issues	Please describe any challenges or issues anticipated during the next quarter that may impact planned progress against the project milestones listed above. In particular, please identify any areas or issues where technical assistance from the BTOP program may be useful.	Provide information on any challenges, incidents, barriers or issues that you have encountered. In your narrative, indicate whether the issue remains or has been corrected or mitigated. If corrected or mitigated, indicate how the issue was resolved. Please limit narrative responses to 150 words or less.
Activity-Based Expenditure and Revenues (Sustainable Broadband Adoption)
1a-1j	Actual Budget Costs and Anticipated Budget Costs	Please provide details below on your total budget, cumulative actual expenditures (for the period ending the current quarter), and cumulative anticipated expenditures (for the period ending next quarter) for each line item, including detailed disbursements of both matching funds and federal funds from project inception through end of this quarter (actual) or next quarter (anticipated). Actual and anticipated figures should be reported cumulatively from award inception to the end of the applicable reporting quarter.	The budget line item definitions remain consistent with those in the original grants application.
2a-2b	Program Income	Please provide the program income you listed in your application budget and actuals to date through the end of the reporting period.	Program income is gross income earned by the recipient from Federally supported activities. Recipients are required to account for program income related to projects financed in whole or in part with Federal funds. Program income excludes interest earned on advances and includes, but is not limited to, income from service fees, conference fees, sale of commodities, usage or rental fees, and royalties on patents and copyrights. Proceeds from the sale of real and personal property purchased in whole or in part with Federal funds is not program income and shall be handled in accordance with the property management provisions set forth in the award. Recipients have no obligation to the Federal Government with respect to program income earned from license fees and royalties copyrighted material, patents, patent applications trademarks, and inventions produced under the award.

Notwithstanding any other provision of law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with, a collection of information subject to the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average 3.97 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Anthony G. Wilhelm, Director, Broadband Technology Opportunities Program, Office of Telecommunications and Information Applications, National Telecommunications and Information Administration, U.S. Department of Commerce (DOC), 1401 Constitution Avenue, N.W., HCHB, Room 4887, Washington, D.C. 20230

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