ITEM

ENTRY

ITEM

ENTRY

1.

Enter legal name of the grantee.

10.

Enter the title of the ANA project, the name of the individual that prepared the report, and the date the report was prepared.

2.

Enter the grant number assigned by DHHS/ACF/ANA.

11.

If attachments are being included with the report list each of the attachments.

3.a.

Enter the organization’s DUNS number (received from Dun and Bradstreet).

12.

Self-explanatory.

3.b.

Enter the Employer Identification Number of the organization assigned by the Internal Revenue Service.

13.a.

Enter the name and title of the Authorized Representative of the tribe or organization.

4.

Enter the organization’s name and complete address, including the zip code.

13.b.

Enter the signature of the Authorized Representative of the tribe or organization.

5.

Select yes if the Standard Form 269 is attached to the Objective Progress Report.  Select no if the Standard Form 269 is not attached.

13.c.

Enter the telephone number including the area code and extension number of the Authorized Representative certifying the report.

6.

Enter the month, day, and year of the project start date and the month, day, and year of the project end date.

13.d.

Enter the email address of the Authorized Representative certifying the report.

7.

Enter the month, day, and year of the last day covered by the report (e.g. December 31, March 31, June 30, or September 29).

13.e.

Enter the month, day, and year the report is being submitted.

8.

Select yes if this is the last report for the project and no if the project is not ending on the last day covered by the report.

14.

Leave blank.

9.

Select quarterly for report frequency and indicate 1st, 2nd, 3rd, or 4th quarter.  Select other if the report does not cover a three month period and provide information on the period covered by the report.

Item

Entry

Item

Entry

1.

Objective Work Plan Update.  Select yes if changes have been made to the Objective Work Plan (OWP) approved at grant award and no if there have not been any changes to the OWP.  If yes, provide an explanation of the changes.  Select yes if the changes were approved by ANA and no if the changes were not approved by ANA.

5.

Leveraged Resources.  A leveraged resource is any cash or in kind goods/services received by the grantee to support the ANA project that are over and above the non-federal share match for the reporting period only.   In column one enter the source of the leveraged resources (e.g. donated legal services).  In column two enter if the source was federal or non-federal.  In column three enter the dollar value of the leveraged resource.

2.

Objective Work Plan.  Enter the goal of the project.  List each objective for that project year and all the activities for the objectives in the approved OWP.  Describe how each activity was accomplished from the beginning date of the grant award to the last day of the reporting period.  If an activity is not completed state the reason(s) it was not completed and the percent of completion to date.  Check the status of each activity; completed, ongoing, N/A this quarter, or not completed.  If the activity was not completed enter the expected day, month, and year that the activity is expected to be completed.  If checking ongoing, include specific progress (i.e.: 6 of 10 meetings held or 10 of 20 people trained).  Copy and add objective space as needed.

6.

Native American Youth and Elder Opportunities.  Select yes if the ANA project provided opportunities or activities for Native American youth or elders.  Select no if the ANA project did not provide opportunities for Native American youth or elders.  Select NA (not applicable) if Native American youth or elders are not a component of the ANA project.   If yes complete the following five columns.  In column one enter each activity for the reporting period only.  In column two enter the number of youth participating in the specific activity.  In column three enter the number of elders that participated in the specific activity.  In column four enter a description of the activity.  In column five enter yes if it was an inter-generational activity (youth and elders participating together) or no if it was not an inter-generational activity.

3.

Impact/Performance Indicators.  In column one enter each of the impact/performance indicators included in the approved grant application.  In column two enter the target number or dollar amount detailed in the approved grant application (e.g. leveraged resources $75,000).  In column three enter the number or dollar amount secured for the reporting period only (e.g. leveraged resources $12,300).  In column four enter the total number or total dollar amount from the beginning of the grant to the last day of the reporting period.

7.

Jobs.  A job is classified as an individual that received a salary or consultant fee as a result of the ANA project whether paid through ANA funding or in kind services.  In column one enter the position title for each job created for the reporting period only.  In column two enter the name of the individual filling the position.  In column three enter if the position is full time or part time.  In column four enter the number of hours worked by the position per month during the reporting period.  In column five enter if the position was paid with federal funds or in kind.

4.

Partnerships.  In column one enter the name of the agency, organization, or tribe that the grantee established a partnership with to support the ANA project for the reporting period only.  In column two select the category that best represents the partnership entity: local, regional, state, national, federal, international, faith-based, philanthropic, tribal, or other.  If other, describe the entity.  In column three provide a brief description for each partner on how the partnership is benefiting the ANA project.

8.

Jobs.  Select yes if any jobs were created in the community as a result of the ANA project (e.g. leveraged resources or businesses created or expanded).  Select no if there were no jobs created in the community as a result of the ANA project.  In column one enter the position title for each job created for the reporting period only.  In column two enter if the position is full time or part time.  In column three enter the number of hours worked by the position per month during the reporting period.

Item

Entry

Item

Entry

9.

Project Personnel.  Select yes if all key personnel identified in the approved grant application have been hired.  Select no if all key personnel have not been hired.  If no is selected list the vacant positions that have not been hired and provide an explanation as to why each position has not been hired.

14.

Financial.  Select yes if the organization secured the non-federal share of the project costs forecasted on the SF 424A during the reporting period.  Select no if the organization did not secure the non-federal share of the project costs forecasted on the SF 424A during the reporting period or if grantee is not required to provide match.  If no is selected provide an explanation as to why the organization did not secure the non-federal share of the project costs.

10.

Project Personnel.  Select yes if there has been a change in key personnel, consultants or contractors during the reporting period.  Select no if there has not been a change in key personnel, consultants or contractors.  If yes is selected list each position, consultant, or contractor that has changed and provide an explanation for the change.

15.

Other.  List each challenge encountered during the reporting period.  For each challenge listed provide an explanation and how the organization overcame the challenge or plans to overcome the challenge.

11.

Financial.  Enter the federal and non-federal forecasted cash needs from the Standard Form 424A of the approved grant application for the reporting period.  Enter the actual cash needs (expenditures) for the reporting period, which should align with what is on the SF 269.  The information provided in prior reports will be maintained on the current report.

16.

Other.  Select yes if the organization needs training or technical assistance (T/TA) to complete the ANA project objectives.  Select no if the organization does not need T/TA to complete the ANA project objectives.  If yes, select the method of training and technical assistance that would benefit the project.  Electronic – T/TA through email, fax, and/or telephone.  On-site – ANA sending a consultant to the project site to work with the staff.  Other – grantee determined method.  Explain the reason and needs for T/TA that are being requested from ANA.

12.

Financial.  Select yes if the organization accessed (drew down) funds from the Division of Payment Management (DPM) during the reporting period.  Select no if the organization did not access funds during the reporting period.  If no is selected explain why the organization did not access funds from DPM during the reporting period.

17.

Other.  Select yes if the organization plans to complete all ANA project objectives by the end date of the grant.  Select no if the organization will not be able to complete all ANA project objectives by the end date of the grant.  If no is selected, provide an explanation as to why the ANA project objectives will not be completed.

13.

Financial.  Select yes if a revision was made to the budget during the reporting period.  A budget revision is a change in the dollar amount of a line item.  Select no if there was not a budget revision during the reporting period.  Select yes if the budget revision was approved by ANA or no if the budget revision was not approved by ANA.   If a budget revision was made during the reporting period, provide an explanation of the reason for the budget modification. (Please note- this does not take the place of submitting a formal request.  All standard procedures for requesting a budget modification must still be followed.)

18.

Other.  Provide any information that the organization wants to share with ANA about the project.  Examples might be copy of curriculum or codes developed by the project, detailed description and/or pictures of a project activity, or changes in the community as a result of project activities.