| INTERIM PERFORMANCE REPORT FORM | August 6, 2024 | OMB CONTROL NUMBER = 2090-NEW, Expiration Date = mm/dd/yyyy | |||||||||||||||||||||
| OMB Burden Statement: | |||||||||||||||||||||||
| This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. OMB Control Number: 2090-NEW. Responses to this collection of information are mandatory [2 CFR Part 200]. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 20 hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates and any suggested methods for minimizing respondent burden to Director, Information Engagement Division; U.S. Environmental Protection Agency (2821T); 1200 Pennsylvania Ave., NW; Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. | |||||||||||||||||||||||
| Instructions for Grantees: | |||||||||||||||||||||||
| * This form requests performance information across five sheets: (1) Project Overview, (2) Activities, Dates, Locations, and Partners; (3) Outputs; (4) Outcomes; and (5) Financial Reporting. | |||||||||||||||||||||||
| * This form should be used during each discrete reporting period (e.g., quarterly, semi-annually, annually) up to the end of the project. | |||||||||||||||||||||||
| * Please refer to the supplemental instructions document for guidance on how to complete each section. | |||||||||||||||||||||||
| * Please speak to your EPA Project Officer to confirm that you understand all the reporting expectations for your program. | |||||||||||||||||||||||
| * The information you report should represent the actual implementation of the project activities. | |||||||||||||||||||||||
| * Use your Work Plan as a reference when completing this form, but do report any changes or additional unplanned activities. | |||||||||||||||||||||||
| * You can add information about outputs and outcomes for each activity at any time after you initially report the activity. Just be sure to indicate the date of data entry in Column A. | |||||||||||||||||||||||
| * You can use this spreadsheet to complete each new interim performance report, by adding new rows in each section. Just be sure to indicate the date of data entry in Column A. | |||||||||||||||||||||||
| * If you have any questions about how to complete this form, please contact your EPA Project Officer. | |||||||||||||||||||||||
| SECTION 1: PROJECT OVERVIEW | ||||||||
| Project Information | ||||||||
| Instructions: Please complete the information below. | ||||||||
| Project Lead Name | ||||||||
| Project Title | ||||||||
| EPA Grant # | ||||||||
| EPA Program (e.g., FIFRA) | ||||||||
| EPA Project Officer | ||||||||
| Project Start Date | ||||||||
| Expected Project End Date | ||||||||
| Project Objectives | ||||||||
| Instructions: List the specific objectives as outlined in the approved grant work plan. | ||||||||
| 1. 2. etc. |
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| Interim Performance Report Submission Schedule | ||||||||
| Instructions - start of project: Working with your Project Officer, please enter the expected dates in the submission schedule for the interim progress reports. Add or delete rows as needed to accurately represent the number and type of reports you are expected to submit for each year of the project. Instructions - when submitting each report: Enter the actual date that you submit that report. |
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| Project Year | Report Title | Deadline Date for Submission | Actual Date of Submission | |||||
| 1 | Interim Progress Report 1 | 6/30/2024 | ||||||
| 1 | Interim Progress Report 2 | 9/30/2024 | ||||||
| 1 | Interim Progress Report 3 | 12/31/2024 | ||||||
| 1 | Interim Progress Report 4 | 3/31/2025 | ||||||
| 2 | Interim Progress Report 5 | 6/30/2025 | ||||||
| 2 | Interim Progress Report 6 | 9/30/2025 | ||||||
| 2 | Interim Progress Report 7 | 12/31/2025 | ||||||
| 2 | Interim Progress Report 8 | 3/31/2026 | ||||||
| SECTION 2: ACTIVITIES & LOCATIONS | |||||||||||||||||||||||||||||||
| Instructions | |||||||||||||||||||||||||||||||
| Use this section to report your activities and associated information (e.g., locations, dates, partners, etc.). | |||||||||||||||||||||||||||||||
| Report each activity on a new (horizontal) row. | |||||||||||||||||||||||||||||||
| Insert additional rows in Part A if you have multiple items to report for an activity (e.g., locations). | |||||||||||||||||||||||||||||||
| Instructions for completing each column are provided below. | |||||||||||||||||||||||||||||||
| If you have any questions or need further assistance, please review the supplemental instructions for this form, and then speak to your EPA Project Officer. | |||||||||||||||||||||||||||||||
| Part A - Activity Log | Part B - Supplemental Information | ||||||||||||||||||||||||||||||
| A. Date of Data Entry | B. Project Year | C. Project Reporting Period | D. Activity | E. Dates of Activity | F. State, Territory, or Tribe/Alaska Native Village | G. Specific State, Territory, or Tribe/Alaska Native Village | H. Type of Location Data | I. Unique ID for location | J. Does the location include 1+ communities that are disadvantaged, marginalized, underserved, or overburdened by pollution? | K. Further Information for Answer in Column J | L. Source of Information for Answer in Column J | M. Partners and/or Collaborators | N. Partner Contributions | O. Comparison with Work Plan | P. Additional Information (Optional) | Provide any relevant information or updates about the activities that have not been captured in the standard reporting columns in this sheet. This may include unexpected challenges, innovative practices adopted, communications activities (e.g., social media posts, physical signs, media engagements, etc.) or any other pertinent developments. | |||||||||||||||
| Include the date(s) on which you are reporting the information in each row. | Select the project year for which you are providing information about the project activities. | Select the project reporting period (e.g., quarters, semiannual, annual) for which you are providing information about the project activities. | List each activity (i.e., specific tasks or actions) undertaken to achieve the objectives of the project (one per row). | Include a single date or start/end dates for the reported activity, as appropriate. If ongoing, list start date and state end date as "ongoing." | Indicate whether the activity took place in a state, territory, or Tribe/Alaska Native Village. | Select the specific state, U.S. territory, or Tribe/Alaska Native Village. Note that the drop-down menu options will change, dpeending on the answer provided in Column F. |
Select the location data type that is appropriate for your project activity. If you are not sure, please consult your EPA Project Officer. If you want to add multiple locations for an activity, use additional rows. |
Specify the unique ID that aligns with the location data type selected in Column H. If you want to add multiple locations for an activity, use additional rows. |
Select yes or no to indicate whether the location includes 1+ communities that are disadvantaged, marginalized, underserved, or overburdened by pollution. | If you answered "yes" to Column J, list the relevant communities in this column. | Indicate the screening tool or source (e.g., CEJST, EJScreen, etc.) used to make the determination in Column J. | List individuals, organizations or entities that either collaborated with you to conduct the activity, or contributed resources, expertise, or financial support to the activity. Indicate if no partners were involved. Please consult your EPA Project Officer for more information. |
Describe the roles and contributions (whether financial or non-financial) of each partner or collaborator listed in Column M. Write "not applicable" if no partners or collaborators participated in this activity. | Compare the completed activities with the planned activities described in the Work Plan. If any changes were made to the planned design or implementation, briefly explain the reason(s) for these changes. | Include additional information related to the activity that is requested by the program. Note that outputs and outcome will be reported on separate sheets/tabs (see list at the bottom of this window). |
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| 10/13/2023 | Year 1 | Q1 | Example A: Implemented nutrient reduction strategy in Metropolis River Basin and track water quality. |
July 15, 2023 – ongoing |
Territory | Connecticut | Latitude-Longitude | Metropolis County | No | CEJST | No partners | Not applicable | activity conducted in line with work plan | Not applicable | |||||||||||||||||
| 10/16/2024 | Year 2 | Q1 | Example B: Facilitated workshop with local stakeholders to discuss environmental concerns and inform project development |
6/1/2024 | State | Arizona | ZIP Code | 12345 | Yes | All CBOs were from zip code that has high prevalence (95th percentile) of nearby Superfund sites and a high rate of poverty (80th percentile) | EJ Screen | The Local Nonprofit Group (nonprofit) | The Local Nonprofit Group (subawardee) identified stakeholders and coordinated the meeting. | activity conducted in line with work plan | Not applicable | ||||||||||||||||
| 10/18/2025 | Year 2 | Q2 | Example C: Developed a database for a local government to aggregate data collected from a project funded with State Revolving Funds (SRF) |
9/6/2025 | State | Michigan | County | Generic County | Yes | Generic County has higher levels of polluted water bodies (70th percentile) | CEJST | Trusted Contractor LLC (contractor) | The grantee directly communicated with a Generic County government representative to ensure the new database met all the local government's requirements for collecting, storing, and extracting/exporting data in support of their SRF funded project. The grantee communicated these requirements to Trusted Contractor LLC, who then developed the database. The grantee kept the Generic County official updated on the status of the database development and communicated some minor database adjustments to Trusted Contractor LLC. | The workshop intended to have at least 3 community community-based organizations attend, but one CBO withdrew 24 hours before the workshop due to an unforseen scheduling conflict. | Database type & brief description (requested by program): The database is an an Excel document that automatically updates the relevant collected data every day in a new sheet, named after the day the data was collected (format XXMONXXXX, e.g., 11APR2024). Previous/historical data is not overwritten. | ||||||||||||||||
| SECTION 4: OUTCOMES - Results of the Activities | ||||||||||||||||||||||||||||
| Instructions | ||||||||||||||||||||||||||||
| Use this section to report the results you have documented for your activities (including timeframe and date that you recorded the result). | ||||||||||||||||||||||||||||
| For each activity in Part A, enter an outcome (result) that you wish to report (each activity can have multiple outcomes). | ||||||||||||||||||||||||||||
| Insert additional rows (horizontal) to Part A, if needed. | ||||||||||||||||||||||||||||
| Instructions for completing each column are provided below. | ||||||||||||||||||||||||||||
| If you have any questions or need further assistance, please review the supplemental instructions for this form, and then speak to your EPA Project Officer. | ||||||||||||||||||||||||||||
| Part A - Outcome Reporting | Part B - Supplemental Information | |||||||||||||||||||||||||||
| A. Date of Data Entry | B. Project Year | C. Project Reporting Period | D. Activity | E. Outcome Identification Number | F. Measured or Calculated Outcomes | G. Outcome Methodology | H. Outcome Time Frame | I. Communities or Groups | J. Results experienced by 1+ communities that are disadvantaged, marginalized, underserved, or overburdened by pollution | K. Further Information for Answer in Column I | L. Source of Information for Answer in Column I | M. Comparison with Work Plan | Provide any relevant information or updates about the outcomes that have not already captured in the standard reporting sections. This may include unexpected challenges, additional benefits realized, innovative measurement of outcomes, or any other pertinent developments. | |||||||||||||||
| Include the date(s) on which you are reporting the information in each row. | Select the project year for which you are providing information about the outcome. | Select the project reporting period (quarters, semiannual, annual) for which you are providing information about the outcome. Please speak to your EPA Project Officer to identify the reporting periods to be used. | List each activity undertaken to achieve the objectives of the project (one per row). You can copy this information from Column D in Section 2: Activities |
Assign a sequential identification number to each outcome for every activity. | List any results from the activity that you have measured or calculated (e.g., via modeling). Results should be aligned with your specific project objectives. The supplemental instructions for this form include a list of example outcome categories. | Indicate the methdology you used to measure or calculate your outcome. Example methodologies for different categories of outcomes are provided in the supplemental instructions. The supplemental instructions for this form include example methods to measure or calculate different types of outcomes. | Please indicate Please indicate whether this is a short-term outcome, an intermediate outcome, or a long-term outcome, based on the definitions provided by your EPA program: short-term outcome = documented within [A months and B months] after the activity intermediate outcome = documented within [C months/years and D months/years] after the activity long-term outcome = documented within [X months/years and Y months/years] after the activity |
List the communities or groups impacted by the outcome (result). | Select Yes or No to indicate whether whether the measured or calculated results affect one or more communities categorized as disadvantaged, marginalized, underserved, or overburdened by pollution. | If you answered "yes" to Column J, list the relevant communities in this column. | Indicate the screening tool or source (e.g., CEJST, EJScreen, etc.) used to make the determination in Column J. | Compare the recorded outcomes against any relevant indicators noted in your Work Plan (e.g., target results, target audience, timeline, etc.), briefly explaining any discrepancies. | ||||||||||||||||
| 10/13/2024 | Year 2 | Q3 | Example A: Implemented nutrient reduction strategy in Metropolis River Basin and track water quality. |
1 | Since July 15 2023 (1 year ago): * 95,000 pounds of total nitrogen load reduction * 16,000 pounds of total phosphorous load reduction * 85 tons of sediment load reduction |
scientific measurement |
Residents of Metropolis County | No | CEJST | * nitrogen load reduction was 5,000 pounds below the work plan target (100,000). * phosphorous load reduction was 4,000 pounds below the work plan target (20,000 pounds) * Sediment load reduction was 5 tons below work plan target (90 tons) Explanation for discrepancies: Inclement weather and equipment failure stopped work on the project for 2 months |
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| 10/13/2024 | Year 2 | Q3 | 2 | Since July 15, 2023 (1 year ago): * 100,000 recreation users recorded in visitor logs, an increase of 20,000 users compared to previous year (July 15 2022 to July 15, 2023) |
Document review (visitor logs) | Residents of Metropolis County | No | CEJST | No specific target set in Work Plan | |||||||||||||||||||
| 10/16/2024 | Year 2 | Q1 | Example B: Facilitated meeting with local stakeholders to discuss environmental concerns and inform project development |
1 | An intake survey and post workshop survey indicated an increased understanding of the CBO's role in identifying environmental concerns and developing projects to address these environmental concerns. | Intake survey and post workshop survey. | Community members in zip code 12345 | Yes | All members are from zip code that has high prevalence (95th percentile) of nearby Superfund sites and a high rate of poverty (80th percentile). | EJScreen | Outcome met the workplan performance indicator. | |||||||||||||||||
| 10/25/2025 | Year 3 | Q1 | 2 | Collaboration with local stakeholders in project proposal, implementation and/or future grant submission | Follow up survey one year after workshop |
Community members in zip code 12345 | Yes | All members are from zip code that has high prevalence (95th percentile) of nearby Superfund sites and a high rate of poverty (80th percentile). | EJScreen | A follow up survey indicated both CBOs utilized training from the workshop when they each drafted a grant application. No further training requests were noted in any survey. As of X date, both CBOs were waiting to hear about the results of their grant application submission. | ||||||||||||||||||
| 11/2/2026 | Year 3 | Q2 | Example C: Developed a database for a local government to aggregate data collected from a project funded with State Revolving Funds (SRF) |
1 | The Generic County government officials' self rated knowledge and understanding of post-award databases more than doubled from 3 to 7 out of 10 (10 being a theoretical perfect knowledge understanding). | Intake survey and follow up survey delivered one year after database implementation. | Community members in Generic County | Yes | Generic County has higher levels of polluted water bodies (70th percentile) | EJScreen | Not applicable | |||||||||||||||||
| 11/2/2026 | Year 3 | Q2 | 2 | 1st SRF recipient stated they can better collect, store, evaluate, and report data from their funded project. | Intake survey and follow up survey delivered one year after database implementation. | Community members in Generic County | Yes | Generic County has higher levels of polluted water bodies (70th percentile) | EJScreen | Expected results recorded: increase in user capability to collect, store, evaluate, and report data was demonstrated. | ||||||||||||||||||
| 11/2/2026 | Year 3 | Q2 | 3 | The Generic County government officials' self rated evaluation and reporting skills increased from 4 to 8 out of 10 (10 being a theoretical perfect understanding of evaluation and reporting). | Intake survey and follow up survey delivered one year after database implementation. | Community members in Generic County | Yes | Generic County has higher levels of polluted water bodies (70th percentile) | EJScreen | Expected results recorded: increase in evaluation and reporting skills for local government officials have been reported. | ||||||||||||||||||
| SECTION 5: PROJECT-LEVEL FINANCIAL REPORTING OPTIONAL: IF REQUESTED BY PROGRAM | |||||||||||
| Instructions | |||||||||||
| In Part A, report your budget utilization for each project reporting period by line item, including how funds were allocated and spent. Report each line item in a new row. | |||||||||||
| In Part B, report any financial challenges you have encountered and the strategies you used to address them. | |||||||||||
| Instructions for completing each column are provided below. | |||||||||||
| If you have any questions or need further assistance, please review the supplemental instructions for this form, and then speak to your EPA Project Officer. | |||||||||||
| Part A - Budget Utilization | Part B - Additional Information | ||||||||||
| A. Project Year | B. Project Reporting Period | C. Line Item | D. Approved Awarded Budget | E. Actual Expenses | F. Ending Balance | G. Expenses for Project Reporting Period (Optional) | H. Program-Specific Information (Optional) | Use this section to include any additional information you wish to provide about your budget and finances. This could include any changes to the budget or challenges encountered and the strategies used to address them. | |||
| Select the project year for which you are providing financial information. | Select the project reporting period (quarters, semiannual or annual) for which you are providing financial information. | Select the financial line item for which you are reporting information. | Specify the amount awarded for the selected line item for the project year. | Report the rolling expenses for the line item in the project year. For example, the Year 2 Q3 report should include cumulative actual expenses for Quarters 1 through 3 in Year 2. | Running balance that reflects prior and current expenses. NO DATA ENTRY REQUIRED |
Report expenses for the specific project reporting period, if requested by your program. | Include additional relevant information not captured in Columns A-G. This may include any specific information that is requested by your program. | ||||
| Personnel | $0.00 | ||||||||||
| Fringe Benefits | $0.00 | ||||||||||
| Travel | $0.00 | ||||||||||
| Equipment | $0.00 | ||||||||||
| Supplies | $0.00 | ||||||||||
| Contractual | $0.00 | ||||||||||
| Construction | $0.00 | ||||||||||
| Other | $0.00 | ||||||||||
| Indirect Charges | $0.00 | ||||||||||
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| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |