General Program Report 2023.xlsx

Standardized Reporting Forms for Federally Funded Public Health Projects and Agreements

General Program Report 2023.xlsx

OMB: 0910-0909

Document [xlsx]
Download: xlsx | pdf

Overview

Coversheet
ProgressNarrative (Format 1)
ProgressNarrative (Format 2)
FOAReqs
AddlQuestions
Personnel
Budget
Performance Elements

Sheet 1: Coversheet






OMB Number: 0910-0909 Exp Date: XX/XX/XXXX See bottom of page for PRA statement




























Recipient Name



Federal Award Identification Number






Report
Initial Report Mid-Year Report Annual Report


Date Completed






















Project Period Start Date






Project End Date






Budget Period Start Date






Budget Period End Date






















Principal Investigator (PI)



PI Email



PI Phone















Sheet 2: ProgressNarrative (Format 1)



































































































































































































































































Fiscal Year:
FY23
































































































































































































































































































































































































































































































































































































































































































































































































































































































































































Initial Report Response
Mid-Year Report Response
Annual Report Response
Performance Elements Column1 Column2 Column3 Column4 Column5 Column6 Column7 Column8 Column9 Column10 Column11 Column12 Column13 Column14 Column15 Column16 Column17 Column18












IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.







IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.





















Action Item 1:


Action Item 1:






Action Item 1:






Action Item 1: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 2:


Action Item 2:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 2:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 2: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 3:


Action Item 3:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 3:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 3: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 4:


Action Item 4:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 4:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 4: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 5:


Action Item 5:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 5:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 5: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 6:


Action Item 6:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 6:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 6: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 7:


Action Item 7:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 7:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 7: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 8:


Action Item 8:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 8:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 8: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 9:


Action Item 9:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 9:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 9: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 10:


Action Item 10:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 10:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 10: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 11:


Action Item 11:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 11:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 11: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 12:


Action Item 12:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 12:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 12: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 13:


Action Item 13:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 13:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 13: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 14:


Action Item 14:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 14:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 14: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 15:


Action Item 15:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 15:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 15: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 16:


Action Item 16:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 16:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 16: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 17:


Action Item 17:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 17:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 17: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]





Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 18:


Action Item 18:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 18:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 18: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 19:


Action Item 19:





IF changes are made to the performance element impacts for this action item (in the table to the right) please explain below. Otherwise leave blank.
Action Item 19:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 19: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]



































Initial Report Response
Mid-Year Report Response
Annual Report Response





















Action Item 20:


Action Item 20:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 20:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 20: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Planned Start Date


Actual Start Date
Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Initial Report



















Planned End Date


Actual End Date
Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Planned Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]
















































































































Action Item 21:









































New Action Approved by (Enter FDA Approver)

Date Approved
Did new action require a budget change? Select If yes, was the change JAG approved? Select Enter JAG Approver















































































































At time of Approval
Mid-Year Report Response
Annual Report Response





















Action Item 21:


Action Item 21:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 21:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 21: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Start Date





Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Approval



















Planned End Date





Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]














































































Action Item 22:









































New Action Approved by (Enter FDA Approver)

Date Approved
Did new action require a budget change? Select If yes, was the change JAG approved? Select Enter JAG Approver














































































































At time of Approval
Mid-Year Report Response
Annual Report Response





















Action Item 22:


Action Item 22:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 22:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 22: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Start Date





Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Approval



















Planned End Date





Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]














































































Action Item 23:









































New Action Approved by (Enter FDA Approver)

Date Approved
Did new action require a budget change? Select If yes, was the change JAG approved? Select Enter JAG Approver














































































































At time of Approval
Mid-Year Report Response
Annual Report Response





















Action Item 23:


Action Item 23:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 23:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 23: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Start Date





Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Approval



















Planned End Date





Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]














































































Action Item 24:









































New Action Approved by (Enter FDA Approver)

Date Approved
Did new action require a budget change? Select If yes, was the change JAG approved? Select Enter JAG Approver














































































































At time of Approval
Mid-Year Report Response
Annual Report Response





















Action Item 24:


Action Item 24:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 24:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 24: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Start Date





Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Approval



















Planned End Date





Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]














































































Action Item 25:









































New Action Approved by (Enter FDA Approver)

Date Approved
Did new action require a budget change? Select If yes, was the change JAG approved? Select Enter JAG Approver














































































































At time of Approval
Mid-Year Report Response
Annual Report Response





















Action Item 25:


Action Item 25:





IF changes are made to the performance element impacts for this action item (in the table to the far right) please explain below. Otherwise leave blank.
Action Item 25:





IF changes are made to the performance element impacts (in the table to the right) for this action item please explain below. Otherwise leave blank.
Action Item 25: Objective 1 Objective 2 Objective 3 Objective 4 Objective 5 Activity 1 Activity 2 Activity 3 Activity 4 Activity 5 Activity 6 Activity 7 Activity 8 Activity 9 Activity 10 Activity 11 Activity 12 Activity 13

Start Date





Action Item Status Select
Actual Start Date
Action Item Status Select
Impacts at Approval



















Planned End Date





Action Item Percent Complete Select
Actual End Date
Action Item Percent Complete Select
Impacts at Mid-Year Report



















Action Item Short Description
Mid-Year Progress Report (Use Alt+Enter for new line if desired)






Annual Progress Report (Use Alt+Enter for Actual line if desired)






Impacts at Annual Report
























[If this Plan of Action was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response Section. Otherwise, complete the Annual Report Response section and replace this bracketed text with your Progress Report]


























Objective Descriptions Objective 1. Develop and implement a system to administer financial assistance to State, local, territorial and tribal retail regulatory food programs based on the FDA Retail Flexible Funding Model (RFFM). Objective 2. Develop and implement a standardized method to assess training needs of retail food regulatory jurisdictions and facilitate meetings those needs. Objective 3. Develop and implement a tracking system that quantifies the extent of Standardization of regulatory food safety inspections personnel within, and among, regulatory retail food jurisdictions.






































































































































































































































































































Sheet 3: ProgressNarrative (Format 2)























































































































































































































































































































































































Grant Track (select):























Budget Period (select):






















Mid-Year and Annual Reports























Detailed Progress Report on the Recipient meeting the project objectives/activities/milestones/outcomes detailed in the cooperative agreement, proposal, strategic plan, conditions of the award, etc. Enter your Mid-Year information for each performance element on the yellow rows. Provide any updates for your Annual Report in the light blue fields on the brown marked rows provided.
Note: This form is intended to capture your progress narrative. You do not need to include details that will be documented with your other Mid-Year submissions e.g. a required Stategic Improvement Plan. Please include a reference to the applicable document when appropriate.		 Select Yes in the table below if this narrative includes progress for one or more of the regulatory program standards if applicable:














Performance Elements
 Recipient Self-Reported Status (Select) Recipient Estimated Percent Complete
(Select)		 Progress Narrative
(Use Alt+Enter for new line if desired)		 Deliverables
(Use Alt+Enter for new line if desired)		 Meetings/Activities
(Use Alt+Enter for new line if desired)		 Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Standard 9 Standard 10





Objective 1
Select Select


















Objective 1 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Objective 2
Select Select


















Objective 2 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Objective 3
Select Select


















Objective 3 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Objective 4
Select Select


















Objective 4 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Objective 5
Select Select


















Objective 5 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 1
Select Select


















Activity 1 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 2
Select Select


















Activity 2 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 3
Select Select


















Activity 3 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 4
Select Select


















Activity 4 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 5
Select Select


















Activity 5 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 6
Select Select


















Activity 6 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 7
Select Select


















Activity 7 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 8
Select Select


















Activity 8 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 9
Select Select


















Activity 9 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 10
Select Select


















Activity 10 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 11
Select Select


















Activity 11 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 12
Select Select


















Activity 12 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















Activity 13
Select Select


















Activity 13 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]




























Mid-Year and Annual Reports























Provide at least one goal for your program for this budget period. Your Mid-Year Report rows are marked with yellow and any updates for your Annual Report in the light blue fields on the rows marked with brown provided. Select Yes in the table below if this narrative includes progress for one or more of the regulatory program standards if applicable:















State Programmatic Goals for this track Recipient Self-Reported Status
(Select)		 Recipient Estimated Percent Complete
(Select)		 Progress Narrative
(Use Alt+Enter for new line if desired)		 Deliverables
(Use Alt+Enter for new line if desired)		 Meetings/Activities
(Use Alt+Enter for new line if desired)		 Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Standard 9 Standard 10





State Goal 1 [Replace bracketed text with your response] Select Select


















State Goal 1 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 2 [Replace bracketed text with your response] Select Select


















State Goal 2 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 3 [Replace bracketed text with your response] Select Select


















State Goal 3 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 4 [Replace bracketed text with your response] Select Select


















State Goal 4 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 5 [Replace bracketed text with your response] Select Select


















State Goal 5 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 6 [Replace bracketed text with your response] Select Select


















State Goal 6 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 7 [Replace bracketed text with your response] Select Select


















State Goal 7 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 8 [Replace bracketed text with your response] Select Select


















State Goal 8 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 9 [Replace bracketed text with your response] Select Select


















State Goal 9 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]

















State Goal 10 [Replace bracketed text with your response] Select Select


















State Goal 10 Annual Report Updates: Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]


























Mid-Year and Annual Reports























Special Project Report (DO NOT complete this section if a Special Project was not included as part of your award) Note: the end of project report requires additional information, as described in the NOA, to be attached as a supplemental narrative to your submission. Select Yes in the table below if this narrative includes progress for one or more of the regulatory program standards if applicable:















Special Project Goals Recipient Self-Reported Status
(Select)		 Recipient Estimated Percent Complete
(Select)		 Progress Narrative
(Use Alt+Enter for new line if desired)		 Deliverables
(Use Alt+Enter for new line if desired)		 Meetings/Activities
(Use Alt+Enter for new line if desired)		 Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Standard 9 Standard 10





Special Project [Replace bracketed text with your response] Select Select


















Annual Report Updates (If Applicable) [Replace bracketed text with your response] Select Select [If this Performance Element was reported as complete at your Mid-Year Report and no additional updates are needed please skip the Annual Report Response row. Otherwise, complete the Annual Report Response rowand replace this bracketed text with your Progress Report]




















































































































Sheet 4: FOAReqs






































































































































































































































































































































Mid-Year Program Response











Annual Program Response





























































Agreement Specific Requirements - Provide a reference to the applicable action item(s) from the progress narrative page or accompanying data file that addresses the requirement OR enter the requested information in the field(s) provided below.





Agreement Specific Requirements - Provide a reference to the applicable action item(s) from the progress narrative page or accompanying data file that addresses the requirement OR enter the requested information in the field(s) provided below.






























Estimated total of in-kind budget contributions toward accomplishing the goals of the cooperative agreement during the reporting period: $0.00






Estimated total of in-kind budget contributions toward accomplishing the goals of the cooperative agreement during the reporting period: $0.00







Estimated in-kind budget contribution narrative:







Estimated in-kind budget contribution narrative:


























































Status Report on the purchasing, development, and operational readiness of any equipment, computers, or software purchased.






Status Report on the purchasing, development, and operational readiness of any equipment, computers, or software purchased.

















































How many Full Time Employees (or FTE Equivalent) are currently employed in your state program to routinely conduct manufactured food inspections and related operations?







How many Full Time Employees (or FTE Equivalent) are currently employed in your state program to routinely conduct manufactured food inspections and related operations?








Comments on FTEs currently employed in your state program to routinely conduct manufactured food inspectors and related operations:







Comments on FTEs currently employed in your state program to routinely conduct manufactured food inspectors and related operations:








Provide a status report on the hiring and training of cooperative agreement funded personnel and other manufactured food program personnel:







Provide a status report on the hiring and training of cooperative agreement funded personnel and other manufactured food program personnel:








Key personnel (minimum of two) must attend an annual face-to-face meeting (as determined by the FDA OP) as a condition of the award.

Select Yes or No if this requirement has been met as of the date of this report and provide a narrative, if desired, below.		 Select






Key personnel (minimum of two) must attend an annual face-to-face meeting (as determined by the FDA OP) as a condition of the award.

Select Yes or No if this requirement has been met as of the date of this report and provide a narrative, if desired, below.		 Select

















































Pending issues or concerns that may affect accomplishing the objectives and goals of the cooperative agreement, and proposed solutions:



Pending issues or concerns that may affect accomplishing the objectives and goals of the cooperative agreement, and proposed solutions:









































Meetings











Meetings




































List meetings held, participants, summaries of issues discussed, decisions made, action items, and responsible parties.










List meetings held, participants, summaries of issues discussed, decisions made, action items, and responsible parties.

Note: it is only necessary to report activities that have occurred since the previous report submission.





Meeting title or short description Date (M/D/YYYY) Agenda Filename Reference Meeting Outcomes Evaluation Results How will the feedback received be used to improve future meetings? Meeting title or short description Date (M/D/YYYY) Agenda Filename Reference Meeting Outcomes Evaluation Results How will the feedback received be used to improve future meetings?
1











2











3











4











5











6











7











8











9











10











11











12











13











14











15











16











17











18











19











20






























































Training Received Mid-Year











Training Received Annual)











Note: it is only necessary to report activities that have occurred since the previous report submission.











Note: it is only necessary to report activities that have occurred since the previous report submission.





































Training Title Training Provider Number of People Trained Track(s) this Training Supported








Training Title Training Provider Number of People Trained Track(s) this Training Supported




































































































































































































































































































































































































































































































































































































(Optional) Anything else you would like to report related to your project that is not reported elsewhere on this form:




(Optional) Anything else you would like to report related to your project that is not reported elsewhere on this form:















Sheet 5: AddlQuestions





































































































































































Mid-Year Progress Response






Annual Progress Response























Public Heath Impacts





Public Heath Impacts



















Please describe the public health impact of your activities under this cooperative agreement. Please describe the public health impact of your activities under this cooperative agreement.























Please describe how your activities have facilitated long-term improvements to the national food safety system under this cooperative agreement. Please describe how your activities have facilitated long-term improvements to the national food safety system under this cooperative agreement.











Please describe any other relevant outcomes not reported elsewhere (e.g. your interpretation of project results). Please describe any other relevant outcomes not reported elsewhere (e.g. your interpretation of project results).








































Sheet 6: Personnel



























































































































































































































































































Mid-Year Personnel Report



Annual Personnel Report

















Select appropriate response: Select
Name Title Project Role Months Funded Personnel Changes Explanation OPEI Entity Name Standard Name FY


Name
(last name, first name)		 Title Project Role Months Funded
(# calendar mos)		 Personnel Changes? Personnel Changes Response










1



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

2



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

3



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

4



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

5



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

6



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

7



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

8



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

9



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

10



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

11



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

12



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

13



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

14



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

15



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

16



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

17



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

18



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

19



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

20



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

21



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

22



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

23



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

24



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

25



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

26



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

27



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

28



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

29



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

30



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

31



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

32



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

33



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

34



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23

35



Select

0 0 0 0.00 Select 0 76 NEHA NEHA FY23






*If adding or removing personnel please update their name, title, project role, and months funded as applicable.











Sheet 7: Budget






































































































































































































































































































































































































































































































































































































































Mid-Year and Annual Budget Report


























































*Note: Annual Total Budgeted is pre-set equal to Mid-Year Total budgeted and Mid-Year and Annual Projected expenses are pre-set as calculated using the Total Budgeted minus Expended. These formulas should be cleared and actual numbers entered if different.






















Expenses Mid-Year Total Budgeted Annual Total Budgeted* Mid-Year Expended to Date Annual Expended to Date Mid-Year Projected Expenses* Annual Projected Expenses*




Budget Questions MY Budget Numerical Responses Annual Budget Numerical Responses MY Budget Text Responses Annual Budget Text Responses Expenses MY Total Budgeted Annual Total Budgeted MY Expended to Date Annual Expended to Date My Projected Expenses Annual Projected Expenses Standard Name FY OPEI Entity Name

1 Total Salary, Wages, and Fringe Benefits $0.00 $0.00 $0.00 $0.00 $0.00 $0.00





















2 Equipment $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Total Budget: Total Budgeted $0.00 $0.00

Total Salary, Wages, and Fringe Benefits $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

3 Travel $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Total Budget: Expended to Date $0.00 $0.00

Equipment $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

4 Materials and Supplies $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Total Budget: Total Projected Expenses $0.00 $0.00

Travel $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

5 Publication Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Estimated current obligated funds $0.00 $0.00

Materials and Supplies $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

6 Consultant Services $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Carryover I will be requesting $0.00 $0.00

Publication Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

7 ADP/Computer Services $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




New funding request $0.00 $0.00

Consultant Services $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

8 Subawards/Contractual Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Total Requested for next budget period $0.00 $0.00

ADP/Computer Services $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

9 Equipment/Facility Rental/User Fees $0.00 $0.00 $0.00 $0.00 $0.00 $0.00




Additional Budget Comments:

0 0 Subawards/Contractual Costs $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

10 Federal F&A (Indirect Costs) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00









Equipment/Facility Rental/User Fees $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

11 Other 1 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00









Federal F&A (Indirect Costs) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

12 Other 2 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00









Other 1 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

13 Other 3 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00









Other 2 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

14 Other 4 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00









Other 3 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

15 Total Budget $0.00 $0.00 $0.00 $0.00 $0.00 $0.00









Other 4 [Replace only bracketed text] $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 NEHA FY23 76 NEHA

16 Estimated current obligated funds $0.00 $0.00

























17 Carryover I will be requesting $0.00 $0.00

























18 New funding request $0.00 $0.00

























19 Total Requested for next budget period $0.00 $0.00



























Mid-Year Report Comments Annual Report Comments





















20 Additional Budget Comments:























Sheet 8: Performance Elements
















Primary Outcomes - Objectives

Objective 1.

Objective 2.

Objective 3.

Objective 4.

Objective 5.

Secondary Sub-Outcomes - Activities

Activity 1.

Activity 2.

Activity 3.

Activity 4.

Activity 5.

Activity 6.

Activity 7.

Activity 8.

Activity 9.

Activity 10.

Activity 11.

Activity 12.

Activity 13.
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