Sustainable Broadband Adoption Annual Performance Report

RECIPIENT NAME: OMB CONTROL NO. 0660-XXXX

AWARD NUMBER: EXPIRATION DATE: XX-XX-XXXX

DATE:

Sustainable Broadband Adoption Annual Performance Report Introduction

SUBMISSION REQUIREMENTS:

All Broadband Technology Opportunities Program (BTOP) grant recipients are required to complete an annual performance report. The attached performance report form must be completed and submitted after the end of every calendar year, 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 annual performance report each year on January 30^th, by 11:59pm ET. 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 Annual reports are to be submitted in addition to the required quarterly report which is due concurrently. The reports are different in scope and must be answered separately.

COMPLETING THE PERFORMANCE REPORT:

The BTOP performance report form consists of three main sections:

• Section 1: General Information

• Section 2: Report 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 Annual 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
1. Does your Sustainable Broadband Adoption (SBA) project foster a particular broadband technology or technologies? If so, please describe this technology (or technologies) (150 words or less).
2a. Please list all of the broadband equipment and/or supplies you have purchased using BTOP grant funds or other (matching) funds, including any customer premises equipment or end-user devices. If additional space is needed, please attach a list of equipment and/or supplies. Unless otherwise indicated in the instructions, figures should be reported cumulatively from award inception to the end of the most recent calendar year. Please also describe how the equipment and supplies have been deployed (100 words or less).
Manufacturer	Item		Unit Cost per Item	Number of Units		Narrative description of how the equipment and supplies were deployed
Totals
2b. To the extent you distribute equipment/supplies to beneficiaries of your project, please describe the equipment/supplies you distribute, the quantities distributed, and the specific populations to whom the equipment/supplies are distributed (150 words or less).
3. For SBA access and training provided with BTOP grant funds, please provide the information below. Unless otherwise indicated in the instructions, figures should be reported cumulatively from award inception to the end of the most recent calendar year.
Types of Access or Training			Number of People Targeted		Number of People Participating		Total Training Hours Offered
Open Lab Access
Multimedia
Office Skills
ESL
GED
College Preparatory Training
Basic Internet and Computer Use
Certified Training Programs
Other (please specify):
Total
4. Please describe key economic and social successes of your project during the past year, and why you believe the project is successful thus far (150 words or less).
5. Please estimate the level of broadband adoption in the community(ies) and/or area(s) your project serves, explain your methodology for estimating the level of broadband adoption, and explain how the broadband adoption level has changed, if any. from the adoption level when the project began.
5a. Adoption Level (%):		Narrative description of level, methodology, and change from the level at project inception (150 words or less).
6. Please describe the two most common barriers to broadband adoption that you have experienced this year in connection with your project. What steps did you take to address them (150 words or less)?
7. To the extent that you have made any subcontracts or subgrants, please identify any subcontracts or subgrants that have been made to socially and economically disadvantaged small business concerns as defined by 8(a) of the Small Business Act, 15 U.S.C. 647, as modified by NTIA’s adoption of an alternative small business size standard for use in BTOP.
8. Please describe any best practices/lessons learned that can be shared with other similar BTOP projects (250 words or less).

Sustainable Broadband Adoption Annual Performance Report Instructions

Line Item Instructions for the Performance Report Attachment

(BTOP Annual 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
1	Broadband Technology	Does your Sustainable Broadband Adoption (SBA) project foster a particular broadband technology or technologies? If so, please describe this technology (or technologies).	If your SBA project does not foster a particular broadband technology, please write “N/A.” Please limit narrative responses to 150 words or less.
2a	SBA Equipment	Please list all of the broadband equipment and/or supplies you have purchased using BTOP grant funds or other (matching) funds, including any customer premises equipment or end-user devices. If additional space is needed, please attach a list of equipment and/or supplies. Please also describe how the equipment and supplies have been deployed.	Equipment is defined as tangible, nonexpendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. Supplies are defined as all tangible personal property other than “equipment”. Please limit narrative responses to 100 words or less.
2b	SBA Equipment	To the extent you distribute equipment/supplies to consumers, please describe the equipment/supplies you distribute, the quantities distributed, and the specific populations to whom the equipment/supplies are distributed.	Please limit narrative responses to 250 words or less.
3	SBA Access and Training	For SBA access and training provided with BTOP grant funds, please provide the information below.	Participants may be counted more than once if they attended multiple types of training. You may specify additional types of training or access as needed. To calculate “Total Hours of Training Offered,” multiply the hours per program by the number of participants. For example, if 10 people took a one hour class, that program provided 10 training hours.
4	Economic and Social Successes	Please describe key economic and social successes of your project during the past year, and why you believe the project is successful thus far.	You may reference other data provided in this report (key indicators) or provide additional information that is not included in your typical quarterly and annual reports. This may include statistics or objective data, but it may also include examples of individual successes experienced by your organization or the individuals benefiting from your program. Please limit narrative responses to 150 words or less.
5	Adoption Level	Please estimate the level of broadband adoption in the community(ies) and/or area(s) your project serves, explain your methodology for estimating the level of broadband adoption, and explain how the broadband adoption rate has changed, if any, from the baseline adoption level at the time of the project’s inception.	Methods for calculating the adoption level may include use of broadband provider statistics, surveys, or any other measurable data collection method. You should explain why your estimate and methodology are reasonable. You should also explain how the adoption level compares to the baseline adoption level that existed when your project was initiated. Please limit narrative responses to 150 words or less.
6	Barriers to Adoption	Please describe the two most common barriers to broadband adoption that you have experienced this year in connection with your project. What steps did you take to address them?	Provide two specific examples. For each, please explain either 1) how you have overcome the barrier or 2) how you are currently trying to overcome the barrier. Responses should be limited to 150 words or less.
7	Small Business Concern	To the extent that you have made any subcontracts or subgrants, please identify any subcontracts or subgrants that have been made to socially and economically disadvantaged small business concerns as defined by 8(a) of the Small Business Act, 15 U.S.C. 647, as modified by NTIA’s adoption of an alternative small business size standard for use in BTOP.	BTOP defines a “socially and economically disadvantaged small business concern as “ a firm, together with its controlling interests and affiliates, with average revenues not exceeding  $40 million for the preceding three years, and that meets the definition of a socially and economically disadvantaged small business concern under the Small Business Act.”
8	Best Practices	Please describe any best practices/lessons learned that can be shared with other similar BTOP projects, if any.	Responses should be limited to 250 words or less.

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 requirements of 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 2.94 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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