Form VA Form 10-10056 VA Form 10-10056 Quarterly/Annual Grantee Performance Report

OMB 2900-XXXX
Estimated Burden: 2.25 hours

U.S. Department of Veterans Affairs

Grants for Transportation of Veterans in Highly Rural Areas

Quarterly, Semi-Annual, Annual and Final Grantee Performance Report

Instructions: Please complete the following form quarterly, semi-annually, annually, and at the conclusion of the grant, and submit to the VA HRTG Program Office at HRTG@va.gov. Please indicate the timeframe for which the form is being submitted on the “timeframe of report” line (ex. Jan-Mar 2014). Your Quarterly Financial Reports should be submitted with this form when this form is submitted quarterly.

Grantee Name:

HRTG Grant Amount:

Timeframe of Report:

Program Evaluation Plan

Performance Measures

Information must be collected to ensure program efficacy and appropriate use of government funds. Applicants that receive funding under this solicitation must provide data that measure the results of their work. Any award recipient will be required, post award, to provide the data requested in the “Data Grantee Provides” column so that VA can calculate values for the “Performance Measures” column. Performance measures for this solicitation are as follows:

1. Record of time expended.

2. Record of grant funds expended.

3. Trips completed.

4. Total distance covered.

5. Veterans served.

6. Locations serviced.

7. Veteran satisfaction survey. (Provided by VA)

Submission of performance measures data is not required for the application. Instead, applicants must discuss in their application their proposed methods for collecting data for performance measures. Please refer to the section “What an Application Should Include” (below) for additional information.

Note on project evaluations: Applicants that propose to use funds awarded through this solicitation to conduct project evaluations should be aware that certain project evaluations (such as systematic investigations designed to develop or contribute to knowledge) may constitute “research.”   However, project evaluations that are intended only to generate internal improvements to a program or service, or are conducted only to meet VA’s performance measure data reporting requirements likely do not constitute “research.”  Research is subject to applicable VA human subjects protections.  Applicants should provide sufficient information for VA to determine whether the particular project they propose would either intentionally or unintentionally collect and/or use information in such a way that it meets the VA regulatory definition of research.

Research, for the purposes of VA-funded programs, is defined as, “a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge.”  28 C.F.R. § 46.102(d). 

Define measurable goals for determining the success of delivery of transportation services. How will you assess the program? How will you adjust the program, if needed? At a minimum the following should be measured:

Objective	Catalog ID [for internal use only, delete before posting]	Performance Measure(s)	Data Grantee Provides
Time it takes to pick up a veteran and drop the veteran at destination.			Record of time expended
A detailed record of grant funds expended.			Record of grant funds expended
Number of trips completed on a given day, week, month and year.			Trips completed
Total distance driven on a given day, week, month and year.			Total miles covered
Number of veterans served on a given day, week, month or year.			Number of veterans served
Location of veterans served			Locations of pick-up and drop-off (VA, Home, CBOC, etc)
Number of veterans satisfied with the service.			Veterans satisfaction

VA Form 10-10056
MAR 2013