Information Collected on PR

Information to be Submitted in the Health Care and
Other Facilities Progress Report

Equipment-Only

Design-Only

New Construction/Renovation

Estimated or actual date for the
project start

Estimated or actual date for the
project start

Estimated or actual date for the
project start

Estimated or actual date for the
completed project/date the
equipment is installed

Estimated or actual date for the
completed project

Estimated or actual date for the
completed project

Current project completion
percentage

Current project completion
percentage

Current project completion
percentage

Current percentage of funds
drawn down

Current percentage of funds
drawn down

Current percentage of funds
drawn down

Description of project status,
including major problems, delays,
etc.

Description of project status,
including major problems, delays,
etc.

Description of project status,
including major problems, delays,
etc.

Change of scope

Change of scope

Change of scope
Photos of project progress.
Photos submitted should include
a brief description. It is
recommended that photos be
taken of exterior shots (front, rear
of building) and major rooms. If
your project has not started,
please upload a document
stating: “The project has not
been started.”

Public Burden Statement: 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 OMB control
number for this project is 0915-0309. Public reporting burden for this collection of information is estimated
to average 0.5 hours per response, including the time for reviewing instructions, searching existing data
sources, and completing and reviewing the collection of information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

OMB Number (0915-0309)
Epiration Date XX/XX/201X