Energy Efficiency and Conservation Block Grant Program

EECBG Perpetual Finance Program Annual Report

OMB control number (1910-5150)

Expiration Date XX/XX/XXXX

US Department of Energy

Steps:

1. Rename this form by changing file name from "GRANTEE NAME" to grant name.

2. Complete this form in its entirety and submit to: (insert email address)

Name Date

Phone Number Email

Finance Program Information

Retired Grant Number

Program Administration

2013-04-17 22:54:55

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initiator:ausmus.marburger@ee.doe.gov;wfState:distributed;wfType:email;workflowId:e12fe54291d6f644ab226dc44459e274

Type of Program Sector Served

Financial Metrics* - Fund Balances

Item	Previous Total	Change	Current Total
a. Program income
b. Administrative costs**
c. Dollar value of write-offs / loan losses
d. Funds returned to Treasury
e. Total Program Fund size***

Program Metrics* - Fund Performance Measures

Item	Previous Total	Change	Current Total
f. Dollar value of loans given or incentivized
g. Number of loans given or incentivized
h. Interest rate on loans given or incentivized****
i. Average calendar days required to re-lend or recommit funds*****
j. Number of write-offs / loan losses
k. Number of jobs created or retained
l. Cost Share Percentage of Program Funds

*Only report on funds and program income generated from initial capitalization of the Program via the EECBG Award Agreement including amended activities; for negative entries: place "-" in front of value

**Includes all costs required to administer and maintain the Program

***Includes all funds remaining in the program portfolio regardless of whether they are currently loaned out or committed

****Use weighted average if multiple rates apply

*****Report on calendar days starting with the day repaid or recovered funds are received.

Additional Cost Metrics*

Item*	Previous Total	Change	Current Total
m. Additional Cost Share required to administer the Program

*Report on Cost Share used to support and maintain the Program beyond in addition to that required by the the Award Agreement ; this information is voluntary and requested to gain insight into the true cost of maintaining a similar Finance Program; for negative entries: place "-" in front of value

Process Metrics - Underlying Activities supported by Finance Program

Select Metric Below	If "Other", Type Metric Below	Previous Total	Change	Current Total

Provide additional qualitative information on Program activities

Instructions for completing the Report

General Notes

1. Complete a separate report for each Finance Program and for each sector to which loans are made or incentivized.

2. When entering negative values in number fields, use a "-". This form will not accept parentheses "( )".

3. Make sure you rename this report by changing "GRANTEE NAME" in the file name to the Award name of your municipality or Tribe.

4. If you submit more than one report at a time, add a number to the end of the report file name: Example - "GRANTEE NAME 1".

5. Make sure you submit this report once a year by the required date, and that you only report on activities occurring within the established start and end date of the year for which you are reporting.

6. Submit this form to the following email address: (insert address)

Metrics - General

7. Explanation of columns:

   1. Previous Total - The cumulative value/amount as of your last annual report

   2. Change - The change in the value/amount over the past year

   3. Current Total - The current cumulative value/amount

Financial Metrics - Fund Balances

8. line (a) - Program Income: report on income earned through interest, buybacks, and other activities

9. line (b) - Administrative Costs: report on all award federal and cost share Award funds used to support and maintain the Program 10.line (c) - Dollar value of write offs / loan losses - report on lost and unrecoverable fund amounts due to making or supporting loans 11.line (d) - Funds returned to treasury - report on all funds you returned to the US Treasury in a partial or total unwinding of the Program 12.line (e) - Total Program Fund size - report on the fund size of your Program, including funds currently loaned out or committed;

note that you can check to make sure the values entered in lines (a) through (e) are correct with the following equation: Fund Size (Current,e) = Fund Size (Previous,e) + Program Income (Change,a) - Administrative Costs (Change,b)

- Dollar Value of Writeoffs / Loan losses (Change,c) - Funds returned to Treasury (Change,d)

Program Metrics - Fund Performance Measures

13. line (f) - Dollar value of loans given or incentivized: report on the cumulative total value over the life of the Program and the change in that value over the past year.

14. line (g) - Number of loans given or incentivized: report in the change in the cumulative total number over the life of the Program 15.line (h) - Interest rate on loans given or incentivized: Report on the average interest rate charged on loans; if loans very in size, use the

weighted average. Example: loan a = $50, ir = 2%; loan b = $20, ir = 4%: AVG(a,b) = ($50*0.02 + $20*0.04)/($50+$20) = 2.57% 16.line (i) - Average calendar days required to re-lend or recommit funds: track the number of days repaid or recovered funds sit in the

account before they are re-loaned or recommitted to supporting new loans and report on the average.

17. line (j) - Number of write-offs / loan losses - report on the number of lost and unrecoverable fund amounts due to making or supporting discrete loans.

18. line (k) - Number of jobs created or retained - report on the number of jobs created or retained through administering the Program and carrying out underlying activities supported by the Program.

19. line (l) - Cost Share percentage of Program funds - report on the percentage of Program funds that are derived from grantee Cost Share required by the Award Agreement and the change in that percentage over the past year.

Additional Cost Metrics

17. line (m) - Additional Cost Share required to administer the Program (Optional) - report on Cost Share used to support and maintain the Program beyond in addition to that required by the the Award Agreement ; this information is voluntary and requested to gain insight into the true cost of maintaining a similar Finance Program.

Process Metrics - Underlying Activities Supported by Finance Program

17. Report on underlying activities that were financed through or resulting from the Finance Program. Example: Building retrofits.

Provide Additional Information on Program Activities

17. Provide information that will help us to understand what was accomplished within the last year, any issues regarding the Program and their potential impact, plans for the Program in the coming year, and insights into the data provided in the quantitative fields within this report.

EECBG Perpetual Finance Program Annual Report

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