![](media/image1.wmf)

#########  U.S. Department of Education

#########  Grant Performance Report Cover Sheet (ED 524B)

***Check only one box per Program Office instruction.***

**\[ \] Annual Performance Report \[ \] Final Performance Report**

**General Information**

1\. PR/ Number #: \_\_\_\_\_\_\_\_\_\_ 2. NCES ID#: \_\_\_\_\_\_\_\_\_\_

*(Block 5 of the Grant Award Notification - 11 Characters.)* *(See
Instructions - Up to 12 Characters.)*

3 Project Title: \_\_\_\_\_\_\_\_\_

*(Enter the same title as on the approved application.)*

4\. Grantee Name *(Block 1 of the Grant Award Notification):*
\_\_\_\_\_\_\_\_

5\. Grantee Address *(See Instructions.)*

6\. Project Director Name: \_\_\_\_\_\_\_\_\_\_ Title:
\_\_\_\_\_\_\_\_\_\_

Ph #: ( ) \_\_\_\_ - \_\_\_\_\_ Ext: ( ) Fax \# : ( ) \_\_\_\_\_ -
\_\_\_\_\_

Email Address: \_\_\_\_\_\_\_\_\_\_

**Reporting Period Information *(See Instructions.)***

7\. Reporting Period: From: \_\_\_/\_\_\_/\_\_\_ To:
\_\_\_/\_\_\_/\_\_\_ (mm/dd/yyyy)

**Budget Expenditures *(To be completed by your Business Office. See
instructions. Also see Section B.)***

8\. Budget Expenditures

+-----------------------+----------------------+-----------------------+
|                       | **Federal Grant      | **Non-Federal Funds   |
|                       | Funds**              | *(Match/Cost          |
|                       |                      | Share)***             |
+-----------------------+----------------------+-----------------------+
| a\. Previous Budget   |                      |                       |
| Period                |                      |                       |
+-----------------------+----------------------+-----------------------+
| b\. Current Budget    |                      |                       |
| Period                |                      |                       |
+-----------------------+----------------------+-----------------------+
| c\. Entire Project    |                      |                       |
| Period                |                      |                       |
|                       |                      |                       |
| *(For Final           |                      |                       |
| Performance Reports   |                      |                       |
| only)*                |                      |                       |
+-----------------------+----------------------+-----------------------+

**Indirect Cost Information *(To be completed by your Business Office.
See instructions.)***

9\. Indirect Costs

a\. Are you claiming indirect costs under this grant? \_\_\_Yes \_\_\_No

b\. If yes, do you have an Indirect Cost Rate Agreement approved by the
Federal Government? \_\_\_Yes \_\_\_No

c\. If yes, provide the following information:

Period Covered by the Indirect Cost Rate Agreement: From: \_\_\_/
\_\_\_/\_\_\_ To: \_\_\_/\_\_\_/\_\_\_ (mm/dd/yyyy)

Approving Federal agency: \_\_\_ED \_\_\_Other *(Please specify*):
\_\_\_\_\_\_\_\_\_\_

Type of Rate *(For Final Performance Reports Only*): \_\_\_ Provisional
\_\_\_ Final \_\_\_ Other *(Please specify)* \_\_\_\_

d\. For Restricted Rate Programs (check one) \-- Are you using a
restricted indirect cost rate that:

\_\_\_ Is included in your approved Indirect Cost Rate Agreement?

\_\_\_ Complies with 34 CFR 76.564(c)(2)?

**Human Subjects *(See Instructions.)***

10\. Annual Certification of Institutional Review Board (IRB) Approval?
­\_\_\_Yes \_\_\_No \_\_\_N/A

**Performance Measures Status and Certification *(See Instructions.)***

11\. Performance Measures Status

a\. Are complete data on performance measures for the current budget
period included in the Project Status Chart? \_\_\_Yes \_\_\_No

b\. If no, when will the data be available and submitted to the
Department? \_\_\_/\_\_\_/\_\_\_\_ (mm/dd/yyyy)

12\. To the best of my knowledge and belief, all data in this
performance report are true and correct and the report fully discloses
all known weaknesses concerning the accuracy, reliability, and
completeness of the data.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Title:
\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Authorized Representative:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Date: \_\_\_/\_\_\_/\_\_\_\_

Signature:

####### ![](media/image1.wmf) 

#######  U.S. Department of Education

#######  Grant Performance Report (ED 524B)

#######  Executive Summary

PR/ Number \# (11 characters)\_\_\_\_\_\_\_

**(See Instructions)**