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pdfDOL EMPLOYMENT AND TRAINING ADMINISTRATION
OMB Control Number 1205-0489
Expiration Date: 07/31/2018
Trade Adjustment Assistance Community College and
Career Training Grants:
Annual and Quarterly Program Reporting Forms & Instructions
Rounds 2/3/4
Revised 2018
Prepared By
Employment and Training Administration
United States Department of Labor
This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0489, expiring
07/31/2018. Persons are not required to respond to this collection of information unless it displays a currently valid OMB
number. Public reporting burden for this collection of information is estimated to average 22 hours per quarterly report and 48
hours per annual report per grantee, including time for reviewing instructions, searching existing data sources, gathering and
reviewing the collection of information. Respondent’s obligation to reply is required to obtain or retain benefits (Workforce
Investment Act [Section 185(a)(2)]. The reason for the collection of information is general program oversight, evaluation and
performance assessment. Send comments regarding this burden estimate or any other aspect of this collection, including
suggestions for reducing this burden, to the U. S. Department of Labor, Employment and Training Administration, Office of
Performance and Technology, 200 Constitution Avenue, NW, Room S-5206, Washington, D.C. 20210.
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I.
GENERAL INSTRUCTIONS
The Trade Adjustment Assistance Community College and Career Training (TACT) grantees are
required to submit quarterly and annual program reports to the United States Department of
Labor’s Employment and Training Administration (USDOL/ETA) in order to comply with the
reporting and record keeping requirements of the grant. Each grantee must submit a Quarterly
Progress Report (QPR) containing updates on the progress and implementation measures specified
in each grant. Each grantee must also submit an Annual Performance Report (APR) that reflects
the longer-term outcomes of program participants. Both the Quarterly and Annual Reports
include narrative information. The instructions and performance reporting forms for completing
these two types of reports can be found under Section II below. Should changes in definitions
resulting from new legislation or related regulations occur, appropriate revisions will be issued to
reflect these changes.
II.
REPORT FORMS AND INSTRUCTIONS
A. Quarterly Narrative Progress Report –The quarterly progress report provides narrative updates
on the capacity building taking place, and a self-assessment of the grantee’s progress each
quarter. The instructions for grantees to complete the QNPR can be found in Appendix A of
this document. The format for the Quarterly Narrative Progress Report can be found in the
accompanying document titled “TAACCCT Round 2-3-4 QNPR Form 2018”
B. Trade Adjustment Assistance Community College and Career Training (TAACCCT) Grants
For consortia, the lead institution is responsible for gathering all information and data from
participating consortium members and reporting in aggregate each quarter.
C. Annual Performance Report – In addition to providing a fourth Quarterly Narrative Progress
Report each year, grantees will complete the APR form, which provides information on
participants in the programs funded by the grant, as well as minimal narrative. The
instructions for grantees to complete the Annual Performance Report can be found under
Appendix B in this document. The format for the Annual Performance Report can be found in
the accompanying document titled “TAACCCT Round 2-3-4 APR Form 2018”
D. For consortia, the lead institution is responsible for gathering all information and data from
participating consortium members and reporting in aggregate each year.
The last Quarterly Narrative Progress and Annual Performance Reports will serve as the grant’s
Final Performance and Outcomes Report. Together, these reports will provide both quarterly
and cumulative information on the grant’s activities. The last Quarterly Narrative Progress
Report will summarize project activities, employment outcomes and other deliverables, and
related results of the project, and will thoroughly document the approaches used by the
grantee, as well as a summary of that quarter’s activities. The Final Performance Report will
provide only annual data on the final year of the grant.
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III.
DUE DATES
A. All Quarterly reports under Section II are due to ETA no later than 45 days after the end of each
reporting quarter. The table below shows the expected due dates for each reporting quarter.
Reporting
Quarters
Due
Dates
October 1st – December 31st
February 14th
January 1st – March 31st
May 15th
April 1st – June 30th
August 14th
July 1ST – September 30th
November 14th
Should the due date of the report fall on a Saturday, Sunday, or holiday, the report is due the
business day before.
B. All Annual reports are due to ETA no later than 45 days after the end of each reporting year,
which will be October – September. The due date for each annual report will be November 14th.
Should the due date of the report fall on a Saturday, Sunday, or holiday, the report is due the
business day before.
IV.
SUBMISSION PROCEDURES
Information contained in the TAACCCT Quarterly and Annual reports must be submitted directly
to ETA via technical instructions issued through the USDOL/ETA national office and available via
the ETA performance website
(https://www.etareports.doleta.gov/CFDOCS/grantee_prod/reporting/index.cfm). Grantees
will certify the data submission and then an ETA Federal Project Officer will review it. Once an
ETA Federal Project officer has accepted a report, it is locked from grantee modifications unless
specifically requested through the FPO.
Accompanying Documents
•
•
•
TAACCCT Round 2-3-4 APR Form 2018
TAACCCT Round 2-3-4 Participant-Level Data Elements 2018
TAACCCT Round 2-3-4 QNPR Form 2018
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Appendix A
Instructions for Completing the
Trade Adjustment Assistance Community College and Career Training (TAACCCT)
Grant Quarterly Narrative Progress Report
General Grant Information
Grantee Name:
Project Name:
Grant Number:
Report Quarter Ending:
Date of Submission:
Program Contact Information:
A. Summary of Grant Activities
This section is an executive summary of grant activities for the quarter, and should serve
as the annual summary each fourth quarter. In one page or less, please provide a short
summary of all activities supported by the grant for the current quarter, highlighting key
activities in line with the grant Statement of Work. This section is not intended to be a
list of every meeting or communication.
B. Status Update on Leveraged Resources
Leveraged resources must be reported quarterly on the Financial Status Report (ETA9130). In addition, please use this section of the narrative to report leveraged resources
used to support grant activities. Leveraged resources include both Federal and nonFederal funds, and may take the form of cash or in-kind contributions. Examples of inkind contributions include personnel services provided by volunteers or non-grantee
staff, donated equipment, supplies, or space. This section may include an update on: (1)
the organizations that contributed the resources; and (2) the ways in which the
resources were used during the current quarter. Also, respond to the yes or no
question in this section as follows:
• During this quarter, did you receive any additional leveraged resources beyond
what is listed in your statement of work?
C. Status Update on Employer(s) Involvement
This section should be used to: (1) discuss how the required employer(s) has been
involved during the current phase of the project; (2) outline specific roles and
contributions of the employer(s) during this quarter; (3) identify any challenges
encountered/resolved in the development and management of the employer
involvement; and (4) discuss new employers and commitments that may have been
added to support the project. The grantees must also respond to four yes or no
questions in this section as follows:
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•
•
•
•
Have you had any consultation or advisory meetings with business or employer
partners during this quarter?
Were there any direct hires of program of study completers by employer
partners during this quarter?
Were internships or other work-based learning opportunities posted during this
quarter?
Did you acquire any additional employer partners during this quarter?
D. Timeline for Grant Activities and Deliverables
Use this section to provide a timeline of the progress of grant activities, key deliverables
for this quarter, and if applicable, deliverables available this quarter for broad
dissemination. Use the timeline in the grant’s statement of work to identify all major
program activities for the entire life of the grant. The timeline will paint a picture of
project flow that includes start and end dates, schedule of activities, and projected
outcomes. In order to reap the most benefit from the timeline, it is important that it be
updated each quarter noting the actual date of completion as each activity is
accomplished. Items to incorporate in the timeline include: project goals, benchmarks,
milestones, special events, important deadlines and deliverables. Respond to two
questions in this section as follows:
• How many programs are you planning to offer? This number should align with
your statement of work.
• As of this quarter, how many programs have you launched to date?
F. Key Issues and Technical Assistance Needs
Summarize any significant issues or problems encountered during the quarter and
resolution of previous issues and challenges identified in previous quarters. Describe
any actions taken or plans for addressing issues, any question you have for DOL, and any
need for assistance from DOL or others. If grantees have nothing to report, that should
be specified.
G. Best Practices, Promising New Strategies and Success Stories
Describe promising approaches, innovative processes, and grant-level and/or participant
level success stories. Examples may include developing and implementing an outreach
plan, developing new or enhancing existing curriculum, and creating new career
assistance tools and resources. Throughout the implementation of the program,
grantees may discover new strategies that emerge as a result of data-driven continuous
improvement. The new strategies may or may not have significant levels of evidence at
this point in the program; however, they should still be described here. As progress is
made with a new and promising strategy, or as data/evidence is gathered to support it,
grantees should document the progress and data/evidence each quarter. Grantees may
also describe any lessons learned and how those lessons learned will be implemented.
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H. Additional Outcome Information
This section allows grantees to report any grant-specific outcomes not captured in other
sections of the quarterly narrative progress report, including, but not limited to, any
specific outcomes included in the statement of work. For every fourth quarterly report,
this update may include additional information about activities and outcomes to
supplement data submitted on the Annual Performance Report form.
I. Name of Grantee Certifying Official
The name of the grantee official who is certifying submission of the report to the
Department.
J. Telephone Number
The area code (###) and telephone number (###-####) of the authorized official.
K. Email Address
The email address of the authorized official.
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Appendix B
Instructions for Completing the
Trade Adjustment Assistance Community College and Career Training (TAACCCT)
Grant Annual Performance Report
It is the expectation and design of the TAACCCT program that the first year of funding will
primarily be used by grantees to build capacity based on the priority(ies) identified in their
proposal. As such, ETA recognizes that annual data submitted in the Annual Performance
Report Table 1 is likely to reflect minimal, if any, participant data for Year 1. However, given
the Federal investment in these grants, grantees must report information on participants
enrolled during all four years.
Table 1 (Annual Performance Report Form) contains a count of all participants in all
programs for that year only, as well as narrative information on yearly progress. Table 1
will reflect the data on the annual number of participants enrolled and outcomes
achieved as reportable in each of the years the grant is active. The form and
instructions for completing Table 1 can be found below and in Annual Performance
Report Form.
Demographic and outcome data reported should be based on individual-level participant data
maintained by each individual grantee and each member of a grantee consortium, if applicable.
Data will be reported on participants at the aggregate level, not the individual level. For
consortia, the lead institution is responsible for gathering all relevant information and reporting
it in aggregate for consortium members in the Annual Performance Report.
Tracking Individual Enrollee/Participant Outcomes
In order to track and report participant employment outcomes, and per the Statement of Work
(via the Solicitation for Grant Applications), applicants may use administrative data to track
employment, retention, and earnings outcomes. In order to conduct matches to student
records with administrative wage data, the individual level data should include personally
identifiable participant information (i.e., Social Security Numbers) as well as other data
elements such as employment status, date of withdrawal, and reason for withdrawal, which can
be matched with employment data available from state Unemployment Insurance and other
administrative wage records. The individual-level data will not be provided to DOL through the
quarterly or annual reports, but it may be provided to an independent evaluator to assess the
impact of grantee programs. Grantees must ensure the confidentiality of personally identifiable
information.
The Data Collector should ensure that when he or she is collecting this information from
students that they are informed of why they are being asked to provide their Social Security
numbers, in accordance with the Privacy Act statement below.
PRIVACY ACT
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In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are
hereby notified that the Department of Labor is authorized to collect information to implement
the Trade Adjustment Assistance Community College and Career Training Program under 19
USC 2372 – 2372a. The principal purpose for collecting this information is to administer the
program, including tracking and evaluating participant progress. Providing this information,
including a social security number (SSN) is voluntary; failure to disclose a SSN will not result in
the denial of any right, benefit or privilege to which the participant is entitled. The information
that is collected on this form will be retained in the program files of the grantee and may be
released to other Department officials in the performance of their official duties.
(Note: The following is the citation from the Solicitation for Grant Applications (SGA) regarding
administrative records: “Applicants must describe their existing or planned approach to
tracking and reporting employment, retention, and earnings outcomes using administrative
records. This may include working with the State Directory of New Hires, the State Labor
Market Information units (that house the Local Employment Dynamic survey data), the State
Workforce Agency that is responsible for tracking and reporting outcomes on TAA for Workers
program participants using the Trade Act Participant Report
(http://workforcesecurity.doleta.gov/dmstree/tegl/tegl2k/tegl_11-00a3.pdf)
http://www.doleta.gov/Performance/pfdocs/12050392_TAPR_Revision_Track_Changes_Draft_
TEGL_Change_112909.pdf), or other federally-supported administrative record data. This may
also include working with the State Workforce Agency to access employment data available in
unemployment wage records. For example, if the applicant does not have an existing
relationship with its State’s agency responsible for collecting wage record information to verify
employment, it should describe the process that it will use to obtain employment outcome
information, which may include establishing data sharing agreement(s) to access administrative
records containing this information.)
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See Annual Performance Report Form – Table 1
Section A. Grantee Identifying Information
A.1
Grantee Name – Enter the grantee name as it appears on the appropriate Notice of
Obligation (NOO) or equivalent official document from the U.S. Department of Labor.
A.2
Grant Number – Enter the grant number as it appears on the appropriate Notice of
Obligation (NOO) or equivalent official document from the U.S. Department of Labor.
A.3
Program/Project Name – Enter the name of the TACT Grant program or project.
A.4
Grantee Address – Enter the mailing address as it appears on the appropriate NOO or
equivalent official document from the U.S. Department of Labor.
A.5
Report Year End Date – Enter the year (yyyy) for which the report is being prepared.
A.6
Report Due Date – Enter the month, day, and year (mm/dd/yyyy) on which the report is
due to the Department. For example, if the report is being prepared for the year ending
09/30/2012, the Report Due Date format should be represented as 11/14/2012.
Section B. Participant Outcomes (ALL GRANT PARTICIPANTS)
Grantees are required to submit information for Rows B.1-B.10 only through the end of the
year in which the data is being reported for participants enrolled in programs funded by the
Trade Adjustment Assistance Community College and Career Training Grant. Grantees should
report information on participants in Year 1 if it is available. For each additional year (Years 2, 3
and 4), information should be provided annually for the time period since the last report was
completed, and not cumulative to date.
For all data collection items contained within this section, the data format is Integer with a
maximum field length of 6-digits. Information should be provided as follows:
B.1
Unique Participants Enrolled – Enter the total number of individuals who entered any of
the grant-funded programs of study offered (including certificate or degree programs or
other training activities). Participants should only be included once in the year they first
enroll, even if they enroll in multiple programs or are still enrolled in subsequent years.
A program of study is broadly defined as an educational program in which a degree or
certificate is earned.
B.2
Total Number of Participants Who Have Completed a Grant-Funded Program of Study
– Enter the total number of unique participants (B.1) who completed any grant-funded
program. Completion is defined as having earned all of the credit hours (formal award
units) needed for the award of a degree or certificate in that program of study.
Participants should only be included once, even if they complete multiple programs of
study.
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B.2a
Total Number of Grant-Funded Program of Study Completers Who Are Incumbent
Workers– Enter the total number of incumbent workers (those employed at enrollment)
who complete any grant-funded program. Completion is defined as having earned all of
the credit hours (formal award units) needed for the award of a degree or certificate in
that program of study. Participants should only be included once, even if they complete
multiple programs.
B.3
Total Number of Participants Still Retained in Their Program of Study (or Other GrantFunded Programs) – Of the total number of unique participants enrolled (B.1) who have
not completed their programs, enter the total number of enrollees who were still
enrolled either in their original program of study or a different grant-funded program of
study at the end of the reporting year. (Note: A participant counted in B.2 should not
be counted again in B.3).
B.4
Total Number of Participants Retained in Other Education Program(s) – Of the total
number of unique participants enrolled, enter the total number of enrollees who
dropped out of a grant-funded program of study, but have enrolled in another
education program not funded by the grant. (Note: A participant counted in B.2 or B.3
should not be counted in B.4).
B.5
Total Number of Grant-Funded Credit Hours Completed – Enter the total number of
grant-funded credit hours that have been completed by all participants during the
reporting year. regardless of the year in which the participants enrolled. This number
should be reported for all enrollees, even if the participant is no longer enrolled in the
grant-funded program of study or did not complete the program of study.
B.5a
Total Number of Participants Completing Credit Hours – Enter the total number of
participants that have completed any number of grant-funded credit hours during the
reporting year.
B.6
Total Number of Earned Certificates/Degrees – Enter the total number of degrees or
certificates earned during the reporting year by participants in grant-funded programs.
This number should be reported for all enrollees, including multiple certificates and
degrees earned by the same participant.
B.6a
Total Number of Participants Earning Certificates (less than one year) – Enter the total
number of participants who earned certificates designed to be completed in one year or
less. A participant can be counted only once in this field, even if multiple certificates
were earned by that participant.
B.6b
Total Number of Participants Earning Certificates (more than one year) – Enter the
total number of participants who earned certificates designed to be completed in more
than one year. A participant can be counted only once in this field, even if multiple
certificates were earned by that participant.
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DOL EMPLOYMENT AND TRAINING ADMINISTRATION
B.6c
Total Number of Participants Earning Degrees – Enter the total number of participants
who earned degrees. A participant can be counted only once in this field, even if
multiple degrees were earned by that participant.
B.7
Total Number of Participants Enrolled in Further Education After Program of Study
Completion and Exit– Of the number of participants who completed at least one grantfunded program (B.2), enter the total number of participants who entered another
program of study after exiting the institution. Exit is defined as being no longer enrolled
at the college in any program of study and can include formal withdrawal, expulsion,
graduation, and other reasons. (Note: A participant counted in B.7 cannot be counted
again in B.8).
B.8
Total Number of Participants Employed After Program of Study Completion and Exit –
Of the participants in the reporting year who were not incumbent workers and who
completed at least one grant-funded program of study (B.2), enter the total number of
participants who entered unsubsidized employment after completion and who were still
employed in the first quarter after the quarter in which the student exits the college.
Incumbent workers are defined as participants employed at enrollment. Exit is defined
as being no longer enrolled at the college in any program of study and can include
formal withdrawal, expulsion, graduation, and other reasons. (Note: A participant
counted in B.7 cannot be counted in B.8. A participant counted in B.8 may be counted
again in B.9).
B.9
Total Number of Participants Retained in Employment After Program of Study
Completion and Exit – Of the non-incumbent participants who were employed in the
first quarter after the quarter in which the student exits the college (B.8), enter the total
number of participants who were employed in the second and third quarters after exit,
regardless of whether they entered employment in this reporting year or the previous
reporting year. Incumbent workers are defined as participants employed at
enrollment. Exit is defined as being no longer enrolled at the college in any program of
study and can include formal withdrawal, expulsion, graduation, and other reasons.
(Note: A participant counted in B.9 must have been counted in B.8).
B.10
Total Number of Participants Employed at Enrollment Who Received a Wage Increase
Post-Enrollment – Of incumbent workers who enter a grant-funded program, enter the
number who received an increase in their wages at any time after becoming enrolled.
Report the first wage increase only and report the wage increase in the reporting year in
which it occurred. Incumbent workers are defined as participants employed at
enrollment.
Section C. Participant Summary Information (ALL GRANT PARTICIPANTS)
Demographic characteristics of new participants contained in this section should be based on
information collected from the individual at the time of participation in the program and
reported for new participants through the end of the reporting year. Grantees should submit
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DOL EMPLOYMENT AND TRAINING ADMINISTRATION
all of the information below for the participants enrolled and funded by the Trade Adjustment
Assistance Community College and Career Training Grant. For all data collection items
contained within this section, the data format is Integer with a maximum field length of 6digits.
C.1a
Male – Enter the total number of new participants who self-identify their gender as
male.
C.1b
Female – Enter the total number of new participants who self-identify their gender as
female.
C.2a
Hispanic/Latino – Enter the total number of new participants who self-identify their
ethnicity as Hispanic/Latino. The term Hispanic/Latino includes persons of Cuban,
Mexican, Puerto Rican, South or Central American, or other Spanish culture in origin,
regardless of race.
C.2b
American Indian or Alaskan Native – Enter the total number of new participants who
self-identify their race as American Indian or Alaskan Native. The racial category
American Indian or Alaska Native includes persons having origins in any of the original
peoples of North America and South America (including Central America), and who
maintains cultural identification through tribal affiliation or community recognition.
C.2c
Asian – Enter the total number of new participants who self-identify their race as Asian.
The racial category Asian includes persons having origins in any of the original peoples
of the Far East, Southeast Asia, or the Indian Subcontinent (e.g., Bangladesh, Bhutan,
India, Nepal, Pakistan, Sri Lanka, and Sikkim). This area includes, for example,
Cambodia, China, Japan, Korea, Malaysia, the Philippine Islands, Thailand, and Vietnam.
C.2d
Black or African American – Enter the total number of new participants who selfidentify their race as Black or African American. The racial category Black or African
American includes persons having origins in any of the black racial groups of Africa.
C.2e
Native Hawaiian or Other Pacific Islander - Enter the total number of new participants
who self-identify their race as Native Hawaiian or Other Pacific Islander. The racial
category Hawaiian Native or Other Pacific Islander includes persons having origins in any
of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
C.2f
White - Enter the total number of new participants who self-identify their race as White.
The racial category White includes persons having origins in any of the original peoples
of Europe, the Middle East, or North Africa.
C.2g
More Than One Race - Enter the total number of new participants who self-identify
more than one of the racial categories outlined in Rows C.2b through C.2f above.
C.3a
Full-time Status - Enter the total number of new participants who are enrolled in college
courses on a full-time basis. Full-time basis is defined as enrollment into 12 or more
credit hours in the Fall or Spring semester and 6 or more credit hours in the Summer.
C.3b
Part-time Status - Enter the total number of new participants who are enrolled in
college courses on a part-time basis. Part-time basis is defined as enrollment into less
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DOL EMPLOYMENT AND TRAINING ADMINISTRATION
than 12 credit hours in the Fall or Spring semester and less than 6 credit hours in the
Summer.
C.4a
Incumbent Workers - Enter the total number of new participants who are already
employed at the time of enrollment.
C.5
Eligible Veterans - Enter the total number of new participants who meet one of the
following conditions as a veteran:
1. Is a person who served at least one day in the active military, naval, or air service, and
who was discharged or released therefrom under conditions other than dishonorable,
as specified in 38 U.S.C. 101(2).
2. Is a person who is (a) the spouse of any person who died of a service-connected
disability, (b) the spouse of any member of the Armed Forces serving on active duty
who at the time of application for assistance under this part, is listed, pursuant to 38
U.S.C 101 and the regulations issued thereunder, by the Secretary concerned, in one
or more of the following categories and has been so listed for more than 90 days: (i)
missing in action; (ii) captured in the line of duty by a hostile force; or (iii) forcibly
detained or interned in the line of duty by a foreign government or power; or (c) the
spouse of any person who has a total disability, permanent in nature resulting from
a service-connected disability or the spouse of a veteran who died while a disability
so evaluated was in existence.
C.6
Participant Age (Mean) - Enter the mean age in years of the new participants. Mean
age is defined as the sum of the ages of all of new participants/enrollees divided by the
number of new participants/enrollees.
C.7
Persons with a Disability - Enter the total number of new participants, where known, or
who self-identify that they have any "disability," as defined in Section 3(2)(a) of the
Americans with Disabilities Act of 1990 (42 U.S.C. 12102). Under that definition, a
"disability" is a physical or mental impairment that substantially limits one or more of
the person's major life activities. (For definitions and examples of "physical or mental
impairment" and "major life activities," see paragraphs (1) and (2) of the definition of
the term "disability" in 29 CFR 37.4, the definition section of the WIA non-discrimination
regulations.)
C.8
Pell-Grant Eligible – Enter the number of participants who are eligible to receive federal
Pell Grant assistance.
C.9
TAA Eligible – Enter the number of participants who are eligible to receive Trade
Adjustment Assistance (TAA) benefits.
Other Demographic Measures – This optional field allows grantees to enter and report
on additional characteristics as needed or desired.
C.10
Section D. Achievements and Successes
This field will be used by grantees to provide a brief narrative description of their most
innovative achievement or greatest success story from the previous year.
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Section F. Services and Outcomes for TAA Eligible Individuals
This field will be used by grantees to provide a description of how the program(s) have served
TAA eligible individuals. Specifically, grantees should address: 1) the number of TAA Eligible
individuals who participated in TAACCCT funded programs; 2) how many TAA Eligible
individuals enrolled and obtained credentials, certificates or degrees; 3) how many TAA Eligible
Individuals enrolled and did not attain credentials, certificates or degrees; and 4) the average
duration (provided in weeks) and whether the duration of education and training was longer or
shorter for these individuals than for other non-TAA eligible participants. Grantees can use
observations or participant records to compile and summarize this information
Section G. Report Certification/Additional Comments
G.1
Report Comments/Narrative – Grantees should provide any additional information on
annual outcomes in this section.
G.2
Name of Grantee Certifying Official/Title – Enter the name and title of the grantee
official that is certifying submission of the report to the Department.
G.3
Telephone Number – Enter the area code (999) and telephone number (999-9999) of the
authorized official.
G.4
Email Address – Enter the email address of the authorized official.
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File Type | application/pdf |
File Title | OMB Control Number 1205-0420 |
Author | Kristen |
File Modified | 2018-07-17 |
File Created | 2018-07-17 |