DOE F 540.4 U.S. DOE Weatherization Annual Training, Technical Assis

DOE F 540.4 OMB Control No. 1910-5127

Expiration Date: 11/30/2016

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL TRAINING, TECHNICAL ASSISTANCE, MONITORING, AND LEVERAGING REPORT

State______________________ Program Year________________ Grant Number ______________

Reporting period ___/___/___ - ___/___/___

TRAINING AND TECHNICAL ASSISTANCE ACTIVITIES

Please describe the training and technical assistance (T&TA) activities conducted during the past program year.

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL TRAINING, TECHNICAL ASSISTANCE, MONITORING, AND LEVERAGING REPORT

State______________________ Program Year________________ Grant Number ______________

Reporting period ___/___/___ - ___/___/___

MONITORING ACTIVITIES

Please list the subgrantees monitored during the reporting period and indicate the focus and significant findings of each monitoring activity, as appropriate.

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL TRAINING, TECHNICAL ASSISTANCE, MONITORING, AND LEVERAGING REPORT

State______________________ Program Year________________ Grant Number ______________

Reporting period ___/___/___ - ___/___/___

LEVERAGING ACTIVITIES

For each leveraging activity, please describe the type of project, the project highlights, the organizations providing resources, the leveraged resources (funding and completed units), the participating subgrantees, and the status and impact.

Submitted by_________________________________________________________________ Date_____________

Type name___________________________________________________________________

Title ___________________________________________________________________

OMB Burden Disclosure Statement

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PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

U.S. Department of Energy

WEATHERIZATION ASSISTANCE PROGRAM

ANNUAL FILE WORKSHEET

INSTRUCTIONS

The Annual Training, Technical Assistance, Monitoring, and Leveraging Report is to be submitted annually, 30 days after the end of the reporting period.

State: Name of state or tribal organization submitting the report.

Program Year: The beginning and ending dates (mm/dd/yy) for the Program Year reported.

Grant number: The seven-digit Federal identification number assigned to the grant (R999999).

Reporting period: The starting and ending dates (mm/dd/yy) for the reporting period for the WAP program year.

			Item		Explanation
		Training and Technical Assistance Activities		Please describe the training and technical assistance (T&TA) activities conducted during the past year.
		Monitoring Activities		Please list the subgrantees monitored during the reporting period and indicate the focus and significant findings of each monitoring activity, as appropriate.
		Leveraging Activities		For each leveraging activity, please describe the type of project, the project highlights, the organizations providing resources, the leveraged resources (funding and completed units), the participating subgrantees, and the status and impact.

Submitted by: Signature of the person submitting the report.

Date signed.

Typed name and title of the submitter.

Application Package