Quarterly Reporting Measure

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Overview

1. YTD Deliverable Progress
2. YTD Budget
3. Equipment Purchases
4. Activity Details
5. Partnership Details
6. Unique Veterans
7. Training
8. Success Stories
9. Challenges-Issues

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Sheet 1: 1. YTD Deliverable Progress

Grant Recipient

Deliverables

Deliverables Percentage Complete

Deliverable Progress YTD Facts and Specifics

VA Comments/Action Items

Grant Amount

Expense Actuals YTD*

Percent Funds Remaining

Unique Veteran Participants

NAME

Q1

Q2

Q3

Q4

YTD

Deliverable 1.

0

0

0

0

0

Deliverable 2.

Deliverable 3.

Deliverable 4.

Instructions:

Please complete the purple reporting areas.

YTD Deliverables Percent Complete - Update percent complete (YTD progress, cannot exceed 100%). For equipment deliverables (purchases), divide the amount spend on equipment by the total equipment budget. Enter the percentage of the equipment budget spent.

Deliverable Progress YTD Facts and Specifics - For each deliverable, list the activities/events that support the progress of the deliverable and the program. Include only facts and specifics, for example include the activity/event description and the date it occurred. For equipment deliverables (purchases), list the type of equipment purchased and the amount. For single piece of equipment purchases $5,000 and over, complete the table in Tab 3 - Equipment Purchases.

Expense Actuals YTD - Update total award expenditures (YTD cumulative expenses, cannot exceed 100%). Enter the total cumulative amount of the budget spent.

Percent Funds Remaining - Update the total funds remaining divided by the Grant Amount. Enter the percentage of the budget funds remaining.

Unique Veteran participant - count each disabled Veteran or service member that participated in one or more award activities during the quarter.

For equipment deliverables (purchases), divide the amount spend on equipment by the total equipment budget. Enter the percentage of the equipment budget spent.

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Sheet 2: 2. YTD Budget

Award Expenditures
YTD October 1, 2016 - Sept. 30, 2016
	Operations	Equipment	Travel	Supplies	Administrative	Personnel (Operational)	Personnel (Administrative)	Other	Totals
NAME
Budget:								$0
Q1 Expenses (Oct. 1 - Dec. 31)
Amount Remaining
Comments
Q2 Expenses (Jan. 1 - Mar. 31)		-
Amount Remaining
Comments
Q3 Expenses (April 1 - June 30)		-
Amount Remaining
Comments
Q4 Expenses (July 1 - Sept 30)		-
Amount Remaining
Comments
Instructions:
Update the amount spent in each category for the respective quarter. If you have deviations please explain in the comment section.
Should be completed by appropriate Finance/Accounting personnel. Needs to tie back to the Accounting System (General Ledger).
ONLY include amounts spent against this award. DO NOT report expenditures that are funded by other sources.
For further information regarding below categories and allowable costs, please reference appropriate OMB and VA guidance, including 2 CFR 200 and 38 CFR 77.
Operations - Expenditures associated with implementing this grant program such as coaching fees, lift tickets and facility fees.
Equipment - Sport equipment purchased to meet program objectives. To be categorized as equipment must have a useful life of more than one year and a unit price equal to or greater than $5,000. Equipment expenditures must have prior approval or be identified in your Grant Agreement. Record further detail on tab 3. Equipment Purchases. Further detail requested on tab 3.
Travel - Expenses for transportation, lodging, subsistence, and related items incurred to meet program objectives. Costs must be consistent with those allowed in 2 CFR 200.474 Travel Costs guidance that includes consideration of GSA lodging and subsistence rates for designated locations (http://www.gsa.gov/portal/category/100120) and if applicable, established organizational policies.
Supplies - Consumable items in direct support of carrying out the award or equipment purchases with a per-unit value less than $5,000.
Administrative (non-Personnel) - Sum of Administrative and Indirect Costs that do not include Personnel (Administrative). When combined with Personnel (Administrative) costs, may not exceed 5.0% of the total award. Costs must be clearly identified and associated with the implementation and tracking of the award.
Personnel (Operational) - Includes both Personnel and Fringe Benefit expenses that should be based on documented payrolls approved by a responsible official(s) of the organization. Reports need to reflect the distribution of activity for those whose compensation is charged, in whole or in part, directly to this award. Operational activities are identified as "time spent by such employee directly providing coaching or training for participants" per 38 CFR 77.14(c)(2). The reports must reflect an after-the-fact determination of the actual activity worked on the program. Reports must account for the total activity for which employees are compensated.
Personnel (Administrative) - Includes both Personnel and Fringe Benefits expenses that should be based on documented payrolls approved by a responsible official(s) of the organization. Reports need to reflect the distribution of activity for those whose compensation is charged, in whole or in part, directly to this award. Administrative activities are identified as all personnel activities that are not "time spent by such employee directly providing coaching or training for participants" per 38 CFR 77.14(c)(2). The reports must reflect an after-the-fact determination of the actual activity worked on the program. Reports must account for the total activity for which employees are compensated.
Other - Other allowable costs identified in execution of the grant program deliverables.

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Sheet 3: 3. Equipment Purchases

NAME
Equipment Purchases
* Report the purchase of single units/pieces of equipment equal to or in excess of $5,000. This is only for equipment purchased using this award. Report must include cost of the unit/piece of equipment, date of purchase, serial number, and its location.
Make and Model	Type of Equipment	Cost of the unit/piece of equipment	Date Purchase (mm/dd/yy)	Serial Number	Location of this equipment

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Sheet 4: 4. Activity Details

Instructions:
Activity Type - A session, event, clinic,camp, competition, practice, training made available and at least one Veteran with a disability participated. For example, your organization offered quad rugby practices once per week over a 12-week period with a three-day tournament at the end of the season. The number of opportunities is 13 - one practice per week for 12 weeks (12) and one two-day competition (1). Count the two-day competition as one opportunity.
Activity Location(s): list the location(s) of the activity in which at least one Veteran with a disability participated.
Time Spent in Direct Interaction: Identify the number of hours spent providing the activity in which at least one Veteran with a disability participated
Opportunities – List the number of opportunities for each activity offered over this reporting period. Multi-day events/activities, such as a weeklong camp or a two-day competition, are counted as one opportunity.
1st Quarter					2nd Quarter
NAME
Activity/Event Details					Activity/Event Details
October 1, 2015 - December 31, 2015					January 1, 2016 - March 31, 2016
Activity Type	Activity Location(s)	Hours Spent in Direct Personal Interaction w. Veterans	Opportunities (Number Held)		Activity Type	Activity Location(s)	Hours Spent in Direct Personal Interaction w. Veterans	Opportunities (Number Held)
Practice/Training					Practice/Training
Camps					Camps
Clinic					Clinic
Competitions					Competitions
Opportunities Held this Quarter			0		Opportunities Held this Quarter			0
3rd Quarter					4th Quarter
Activity/Event Details					Activity/Event Details
April 1, 2016 - June 30, 2016					July 1, 2016 - September 30, 2016
Activity Type	Activity Location(s)	Hours Spent in Direct Personal Interaction w. Veterans	Opportunities (Number Held)		Activity Type	Activity Location(s)	Hours Spent in Direct Personal Interaction w. Veterans	Opportunities (Number Held)
Practice/Training					Practice/Training
Camps					Camps
Clinic					Clinic
Competitions					Competitions
Opportunities Held this Quarter			0		Opportunities Held this Quarter			0

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Sheet 5: 5. Partnership Details

Instructions:
Organization - List the organization you partnered or collaborated with during this reporting period (Community Partner, VA Medical Center, VA Facility, Rehabilitation Hospital, Veteran Service Organization, US Air Force, US Army, US Coast Guard, US Marine Corps, US Navy, State or Local Government, College or University, National Governing Body in Paralympic or Adaptive Sport).
Collaboration Description – Describe the activities conducted in partnership or in collaboration.
1st Quarter			2nd Quarter			3rd Quarter			4th Quarter
Oct. 1, 2015 - Dec. 31, 2015			Jan 1, 2016 - March 31, 2016			April 1, 2016 - June 30, 2016			July 1, 2016 - Sept. 30, 2016
Organization	Collaboration Description		Organization	Collaboration Description		Organization	Collaboration Description		Organization	Collaboration Description

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Sheet 6: 6. Unique Veterans

Instructions:

Unique Veteran Participants - For each disabled veteran or service member that participated in one or more award activities during the quarter, provide their last name, first name and zip code of where the veteran lives and is considered his home of record.

Q1 Unique Veteran Participants

Q2 Unique Veteran Participants

Q3 Unique Veteran Participants

Q4 Unique Veteran Participants

October 1, 2015 - December 31, 2015

January 1, 2016 - March 31, 2016

April 1, 2016 - June 30, 2016

July 1, 2016 - Septmeber 30, 2016

Last Name

First Name

Zip Code

Last Name

First Name

Zip Code

Last Name

First Name

Zip Code

Last Name

First Name

Zip Code

Total

0

Total

0

Total

0

Total

0

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Sheet 7: 7. Training

Instructions:

This reporting tool is intended to capture training and technical assistance provided to program administrators, coaches, recreational therapists, instructors, Department of Veterans Affairs employees, Department of Defense employees, and other appropriate individuals to enable them to better provide adaptive sport support to disabled Veterans and disabled members of the Armed Forces. Trainees may include disabled Veterans and disabled Servicemembers, but their training would have to be for the purpose of enabling them to participate in provision of adaptive sports to disabled Veterans and disabled members of the Armed Forces. If a unique Veteran is trained at an event for purposes of participation in an adaptive sport but not to enable providing services to help support an adaptive sport activity, the event would not be included in Tab 7 Training and would be reported in Tab 4, Activity Details, and the Veteran’s name would be recorded in Tab 6, Unique Veterans. List the name of the training event, date and location along with last name, first name and organization of attendees. Add rows as necessary to account for multiple training events and/or multiple personnel during a given quarter.

Q1 Training Events

Q2 Training Events

Q3 Training Events

Q4 Training Events

Training Event

Date/Location

Last Name

First Name

Organization

Training Event

Date/Location

Last Name

First Name

Organization

Training Event

Date/Location

Last Name

First Name

Organization

Training Event

Date/Location

Last Name

First Name

Organization

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Sheet 8: 8. Success Stories

Instructions: Identify outreach activities and success stories within a particular quarter. Add rows as necessary to account for additional outreach activities and success stories that may have occurred during a given quarter.
Outreach Activity - An account of how outreach activities were conducted to affect awareness and effectiveness of grant- and non-grant-funded adaptive sports activities for disabled Veterans and disabled members of the Armed Forces.
Success Story- An anecdotal account of how grant funds impacted any aspect of a Veteran with disabilities or member of the Armed Forces’ life by demonstrating their strength to overcome their respective disability and reintegration into the community through participating in adaptive athletic activities.
Q1 Outreach Activities & Success Stories			Q2 Outreach Activities & Success Stories
NAME			NAME
October 1, 2015 - December 31, 2015			January 1, 2016 - March 31, 2016
#1: Who or what was involved? What happened? What were the results? If a success story, why?			#1: Who or what was involved? What happened? What were the results? If a success story, why?
#2: Who or what was involved? What happened? What were the results? If a success story, why?			#2: Who or what was involved? What happened? What were the results? If a success story, why?
#3: Who or what was involved? What happened? What were the results? If a success story, why?			#3: Who or what was involved? What happened? What were the results? If a success story, why?
Q3 Outreach Activities & Success Stories			Q4 Outreach Activities & Success Stories
NAME			NAME
April 1, 2016 - June 30, 2016			July 1, 2016 - September 30, 2016
#1: Who or what was involved? What happened? What were the results? If a success story, why?			#1: Who or what was involved? What happened? What were the results? If a success story, why?
#2: Who or what was involved? What happened? What were the results? If a success story, why?			#2: Who or what was involved? What happened? What were the results? If a success story, why?
#3: Who or what was involved? What happened? What were the results? If a success story, why?			#3: Who or what was involved? What happened? What were the results? If a success story, why?

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Sheet 9: 9. Challenges-Issues

Instructions:
Challenge/Issue: Share any challenges or issues you have faced throughout the grant cycle. Explain what the challenge or issue was, how you were impacted, and how we could/can help. Add rows as necessary to account for additional challenges that may have occurred during a given quarter.
Q1 Challenges/Issues			Q2 Challenges/Issues
NAME			NAME
October 1, 2015 - December 31, 2015			January 1, 2016 - March 31, 2016
Challenge/Issue #1:			Challenge/Issue #1:
Challenge/Issue #2:			Challenge/Issue #2:
Q3 Challenges/Issues			Q4 Challenges/Issues
NAME			NAME
April 1, 2016 - June 30, 2016			July 1, 2016 - September 30, 2016
Challenge/Issue #1:			Challenge/Issue #1:
Challenge/Issue #2:			Challenge/Issue #2: