DRAFT EPA Form XXXXX 1 - 8 - 16

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**INSTRUCTI ONS FOR COMPLETING BROWNFIELDS AREA**  **- WIDE PLANNING** 

**COOPERATIVE AGREEMENT REPORTING FORM Overview**  As specified in the cooperative agreement terms and conditions, all Brownfields Area
- Wide Planning (BF AWP) cooperative agreement recipients (CARs) must report to EPA no later than 30 day s after the end of each reporting quarter.

 All CARs must complete and regularly maintain a BF AWP Cooperative Agreement Reporting Form.

 The CAR must use the Brownfields Program on
- line reporting s ys tem, known as Assessment, Cleanup and Redevelopment Exchange S ys tem (ACRES), to associate to the BF AWP grant all relevant property records (such as site assessments and cleanups) that are al ready in ACRES. o The CAR will not cr eate any new propert y records under the BF AWP grant. o If the CAR is also a recipient of an EPA Brownfields assessment, cleanup or revolving loan fund (RLF) grant for a property within the BF AWP project area, then the CAR must first create property record(s) in ACRES and complete a Brownfields Property Profile Form as required under their assessment, cleanup or RLF grant, and then associate the appropriate property record(s) to the BF AWP grant. o If EPA provides a Targeted Brownfields Assessment (TBA) within the BF AWP project area, the CAR will work with EPA to associate this TBA to the BF AWP grant.

 The CAR must also track and report all leveraging information (resources) and accomplishments for the BF AWP project area. CAR will ensure that an y l everaging that is already otherwise associated to a particular property in ACRES is not double counted (e.g., the same leveraging resource and amount should not be captured for both the BF AWP grant and the assessment, cleanup or revolving loan fund grant).

 When to submit: o The original BF AWP Cooperative Agreement Reporting Form must be submitted when the cooperative agreement recipient starts using EPA funds to pay for eligible BF AWP activities. o The CAR will update this form and ACRES as new activities, accomplishments, resources, changes, and other information pertaining to revitalizing the BF AWP project area is available. o The CAR will update this form upon completion of th e brownfields area
- wi de plan as well as when the cooperative agreement is being closed out. o The CAR should continue to update the form as plan i mplementation actions are taken and new investments occur within the BF AWP project area. If you have project area updates to report after the closeout of the cooperative agreement, please contact the ACRES Help desk at acres_help@epa.gov
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 To whom to submit: CARs must submit their BF AWP Cooperative Agreement Reporting Form to their EPA Regional Representative identified in the terms and conditions of the cooperative agreement. If data is entered online it will automatically be delivered to the EPA Regional Representative.

 How to submit: ACRES is available online and is the preferred method fo r all CARs to enter and electronically

submit the BF AWP Cooperative Agreement Reporting Form. The form may

a lso be submitted in hard copy with the next required quarterly p rogress r eport or submitted via e
- mail to the EPA Regional Representative. A dditi onal reporting requirements may be included in the terms and conditions of the cooperative agreement. This Office of Management and Budget (OMB) and Environmental Protection Agency (EPA) approved reporting form (OMB Form XXXX , EPA Form XXXX ), supplements the required quarterl y p rogress r eports . Please note that in most instances, all reported information is accessible to the public under the Freedom of Information Act (FOIA) and may be distributed by EPA to the public unless one of the FOIA exclusions is applicable.DRAFT EPA Form XXXXX 1 - 8 - 16

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**Detailed Instructions for Completing Each Item on the Form**  The BF AWP Cooperative Agreement Reporting Form is divided into five parts. Unless otherwise indicated, reporting in each section is mandatory for all CARs . Some questions need only be answered once; other questions should be updated when conditions change within the BF AWP project area. Additional instructions and definitions for completing this form are provided below. Please contact yo ur EPA Regional Representative if you have an y questions when completing this form. **Co operative Agreement Recipient Information**  **1. Cooperative Agreement Recipient Name.**  Enter the CAR name. Use the official name of the CAR as written in the cooperative agreement documentation, unless otherwise directed b y the EPA Regional Representative. **2 a**  **- d. City, County, State and Zip Code**  . Enter the city , county, state and zip code for the CAR. **3. Cooperative Agreement Number.** Enter the number of the cooperative agreement as provided in the cooperative agreement documentation (e.g., BF 00000000). **4 .**  **In dicate if this form is the initial**  **or u**  **pdated f**  **orm.** Indicate if this is the first BF AWP Cooperative Agreement Reporting Form being submitted or an updated version of a previousl y submitted f

orm. **P art**  **I**
**– BF** **AWP Project Area Information 5. Name of BF AWP Project Area.**  If the project area has a specific name, enter it here. **6 a**  **. Boundaries of the BF AWP Project Area**  **.** Enter geographic boundaries of your BF AWP project area. Use street names and/or natural or constructed boundaries (such as a river or railroad). Be specific as these boundaries will be used for mapping and other anal ys is
. **6b. Insert map of project area within broader context of the city or larger community**  **.** C opy and paste a map **w** ith clear scale and street
- level detail, which precisely delineates your BF AWP project area boundaries within the context of the city or larger community
. **7. Project area size (in acres).**  Enter approximate acreage of your project area. **8. Project area description.** Provide a brief description of the project area, highlighting a few key identifying features, area characteristics, ty pical land uses and general population. ACRES
- Associated Brownfields Properties **9. Number of brownfields properties within the BF AWP project area that have an A CRES**  **ID.** Enter the number of properties within the project area that already have an ACRES ID because they

have received EPA brownfields resources for assessment and/or cleanup. If you answered one or more to question 9, answer items pertaining to questio n 10 as neededDRAFT EPA Form XXXXX 1 - 8 - 16

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**10a. Associated brownfields s**  **ite 1.** Enter the ACRES ID for the first associated brownfields site. If needed, add information for additional associated properties **10b . Associated**  **brownfields s ite**  **2 (or 3, 4, 5, etc).**  Enter the ACRES ID for the an y additional associated brownfields site(s). Catalyst Site(s) **11. Number of catalyst/high priority brownfield site(s) within BF AWP project area**  . Enter the number of properties within the project area that are considered to be the catal ys t/high priority sites within the BF AWP project area, as identified in the grant workplan. Please note that a catal ys t/ high priority brownfield site may

or may not already

have an ACRES ID. If you answered one or more to question 11, answer items pertaining to question 12 as needed For each site that is considered a catal ys t/high priority brownfield within the BF AWP project area, specify

whether the site has an ACRES ID. If a site does not have an ACRES ID, provide the site nam e, address and size (in acres). **12a. Catalyst/high priority site**  **1.** Enter the ACRES ID, or if the site does not have an ACRES ID enter the site name, ad dress and site size (in acres). If needed, add information for additional sites **12b. Catalys**  **t/high priority s ite 2 (or 3, 4, 5, etc).**  Enter the ACRES ID, or if the site does not have an ACRES ID enter the site name, address and site size (in acres). **Part II: Leveraged Resources** The table in this section collects information pertaining to resources that have been or are being leveraged to support revitalization outcomes within the BF AWP project area that are consistent with the goals of the brownfields area
- wide plan. Resources reported here as leveragin g must be used to support outputs related to the BF AWP cooperative agreement
- funded and/or outcomes related to the broader project area revitalization efforts. Le veraged resources includes funds (private or public investment, grant funds, etc), related t echnical assistance, and other resources provided in
- kind. Lev eraged funds may be used to support allowable activities (e.g., inventory , assessment, cleanup) and activities that cannot be funded b y the EPA cooperative agreement (e.g., demolition, property preparation, redevelopment construction, transportation improvements, marketing, etc) that should be reported in this section. To be reportable, there must be a demonstrable link or connection between the EPA
- funded activity and the leveraged resource. T he leveraged resource shoul d be reported only when awarded and manifested . Given that in many cases the BF AWP effort happened as a result of or alongside other project area revitalization efforts, leveraged resources reported here may pre
- date the award o f the BF AWP cooperative agreement. Therefore it is imperative that the CAR report the year the resources were awarded
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CARs should take great care to ensure that leveraged resources are not double
- counted. An y leveraged resource that is already reported in ACRES as part of a specific propert y record (e.g., reported as part of an assessment or cleanup site and is associated to the BF AWP grant) must not be reported in this section
. Site
- specific leveraging that is already reported in ACRES as part of a sp ecific property

record w ill be captured as part of the property record’s association to the BF AWP grant. The table in this section collects the Source of Resources, nam e of the entity(ies) providing resources , the ye ar resources awarded, how the resource s are used, and the amount of resources leveraged to support the BF AWP project or BF AWP project area revitalization. Please use a separate line for each resource listed. The categories of funding include:  **Other Federal.** Select if any other federal resource s were leveraged beyond the BF AWP grant and an y associated brownfields listed under item 10. Other federal resources include, for example, U.S. Department of Housing and Urban Development Community Development Block Grant, U.S. Economic Development Adm inistration Public Works grant , EPA technical assistance project , U.S. Department of Transportation Transportation Investment Generating Economic Recovery (TIGER), etc.  **State/Tribal Funding.** Select if an y state and tribal resources (exclusive of state and tribal property - specific 128(a) cooperative agreement funds) were leveraged (e.g., state brownfields grant, state economic development grant).  **Local Government.** Select if an y local resources were leveraged (e.g., local bond/tax in crement financing).  **Private/Other.** Select if any private resource s were leveraged (e.g., company X, developer Y, non
- profit Z). **Name of Entity Providing Resources**  **.** Indicate the name of the entity that provided resources . **Year Resources Awarded.** Use the dropdown boxes to select the year the leveraged resources were awarded
. **Resources used for.** Select one of the dropdown categories for items that were not paid under the BF AWP grant :  In frastructure improvement: e.g. transportation, utility , broa dband improvements  Supporting study : e.g. a market or renewable energy study of the project area  C ommunity

outreach/education: e.g., d onated meeting space or events used for BF AWP community

sessions; free advertising to the community of BF AWP events; co mmunity survey s  R ecr eation/greenspace improvements: e.g., development of park or recreation space within the BF AWP project area  B uilding (new/rehab ): e.g, development of new or rehabilitated buildings within the BF AWP project area  Other Also p rovide a specific yet brief description of how the resource s were used in support of the BF AWP project outputs and/or BF AWP project area revitalization outcomes .DRAFT EPA Form XXXXX 1 - 8 - 16

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**Am ount of Resources Leveraged to Support BF AWP Project or BF AWP Project Area**  **Revitalizat ion**  **.** Enter the amount of resources that were used in support of BF AWP project outputs or BF AWP project area revitalization outcomes
. Onl y the amount that is specific to the BF AWP project area should be captured here
. If the leveraged resources is designated for an area larger than the BF AWP project area (e.g. if the resources was provided for a city- wide improvement), include here onl y the amount used within the BF AWP project area. Estimates are accepted but the m ethodology for apportionment of funds must be documented in the grant f

ile
. **Part III: Brownfields Area -**  **Wide Planning Documents 13. Provide weblink to final brownfields area**  **- wide plan document(s**  ). Enter the weblink where the final BF AWP documents can be accessed. **14. Provide weblink for project photographs.** Enter the weblink where photographs from the project can be accessed. **15. Share highlights from the final brownfields area**  **- wide plan**  . Include a brief summary that highlights the community and project area goals identified in the final brownfields area
- wide plan, including the overall BF AWP project approach
. **16. Describe past uses and planned future uses within the BF AWP project area.**  Indicate within the tables the ty

pe and amount (select acres or square footage ) for:  Past/existing land uses within the BF AWP project area, and  Planned future land uses within the BF AWP project area (as described with in the brownfields area
- wide plan) Land u se c ategories include:  Greenspace: agricultural site, field, forest, nature trails, park, playing fields, playground, pond, recreational area, stormwater management areas, green roof, urban forest canop y, wetland, wildlife refuge;  Residential: housing;  In dustrial: chemical plant, foundry , machine shop, incineration, landfill, manufacturing (general), mill (general), mining, petroleum (distribution/storage), power generating plant, utility , warehouse, water treatment/sewage plant, wood products site; and  Commercial: automotive (dealership), dry cleaning facility , bank, museum, office, laundry , recycling, retail, service station, storage, public services, places of worship, schools, transportation center (bus, rail, etc.).  Other: include other land use ty pes not already described in the above categories , and further describe the specific ty pe of land use  For properties with more than one future use (i.e., mixed use), check all categories that apply and indicate the proportional acreage of each use.DRAFT EPA Form XXXXX 1 - 8 - 16

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**Part IV: Implementation Activities**  **17. Which of these plan implementation activities relate to your BF AWP project area?**  Check all that appl y . Select Completed, Underway , N ot Yet Started & Not Applicable from the dropdown menu. In the space next to each selection, provide one or more specific examples of how you are working on or completed the BF AWP plan implementation activity
. Add a new line to list any

activity not listed.

**18 .**  **Have an y**  **catalyst/high priority sites and/or other associated brownfield properties within the BF AWP project area been redeveloped or reused consistent with the goals of**  **the brownfields area -**  **wide plan?** Select Yes, No or Underway from the dropdown boxes to i ndicate whether an y cataly st/high priority sites or other associated brownfields properties within the BF AWP project area have been or are being redeveloped/reused consistent with the goals of  Conducting brownfield site assessments, cleanup or other site preparation activities within the project area  Continuing to reach out to community members and project partners, and create opportunities to be involved with plan implementation  Working with local property owners, developers, and/or securing parcels as needed, to prepare brownfields for reuse  Targeting infrastructure and housing improvements (including design/construction/abatement activities) to the project area  Tying the BF AWP implementation efforts to other city or regional planning efforts  Changing/updating policy : e.g., local zoning, c reating tax increment (or similar) financing or business improvement districts, adopting the brownfields area
- wide plan, making other changes  Leveraging infrastructure investments that enable revitalization  Securing grants or technical assistance opportunities to help further implementation  Securing nonprofit or private funds to help further implementation  Working with developers to help further implementation  Strengthening relationships with federal, state, tribal, regional and local partners to continue support for the BF AWP revitalization goals  List other implementation activitiesDRAFT EPA Form XXXXX 1 - 8 - 16

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the brownfields area
- wide plan. If yes within the tables the ty pe and amount of acres or square footage within the BF AWP project area that have actuall y been reused or redeveloped. If you answered Yes or Underway question 18 , answer items pertaining to question 1 9 as needed **19 a**  **- 1**  **. Catalyst/high pr**  **iority site 1.** The information from item 12a will automatically appear. Select how this property has been redeveloped/reused using the dropdown land use categories
. If needed, information from the additional catalyst/high priority sites will appear as 19a
- 2 (or 3,4,5, etc). **19a -**  **2 .**  **Catalyst/high priority site 2.** The information from item 12b will automatically appear. Select how this property has been redeveloped/reused using the dropdown land use categories
. **19b -**  **1 .**  **Associated brownfields site 1.** The information from item 10 a will automatically appear. Select how this property has been redeveloped/reused using the dropdown land use categories
. If needed, information from the additional associated brownfield sites will appear as 19b
- 2 (or 3,4,5, etc). **19b -**  **2 .**  **Associated brownfields site 2.** The information from item 10b will automatically appear. Select how this property has been redeveloped/reused using the dropdown land use categories
. Land use categories include:  Greenspace: agricultural site, field, forest, nature trails, park, playing fields, playground, pond, recreational area, stormwater management areas, green roof, urban forest canop y, wetland, wildlife refuge;  Residential: housing ;  Industrial: chemical plant, foundry , machine shop, incineration, landfill, manufacturing (general), mill (general), mining, petroleum (distribution/storage), power generating plant, utility , warehouse, water treatment/sewage plant, wood products site; and  Commercial: automotive (dealership), dry cleaning facility , bank, museum, office, laundry , recycling, retail, service station, storage, public services, places of worship, schools, transportation center (bus, rail, etc.).  Other: include other land use ty pes not already describe d in the above categories, and further describe the specific ty pe of land use  For properties with more than one future use (i.e., mixed use), check all categories that apply and indicate the proportional acreage of each use. **Part V: Successes, Challenges and Lessons Learned**  **20 . Share one or more activities and/or approaches that worked well for your BF AWP**  **project.** Provide one or more “best practice” activity or approach that contributed to the success of your project. **2 1**  **. Share one or more ma jor challenges and/or barriers identified during the BF AWP**  **project.** Provide one or more challenge/barrier/obstacle you faced during your BF AWP project. Also include if/how you were able to work throu gh each challenge/barrier/obstacle.DRAFT EPA Form XXXXX 1 - 8 - 16

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**22 . Share key**  **lessons learned and/or any advice you would give to future BF AWP cooperative agreement recipients**  . Provide a short summary of lessons learned during your BF AWP project. Also include some words of advice to future CARs that will help them learn from yo ur BF AWP grantee experience. **23 . Describe how the cooperative agreement term & condition for considering changing**  **climate conditions was met during the BF AWP process.** Include a brief statement describing how you met the term & condition for considering changing climate conditions.  CARs need to document in their BF AWP cooperative agreement file how they met this term & condition.  CARs are encouraged to use and include in their BF AWP cooperative agreement file the BF AWP GRANTEE CHECKLIST **:** How to Address C

hanging Climate Concerns in Your Brownfields Area
- Wide Planning Project found at http://www.epa.gov/brownfields/brownfields
- bf
- awp - climate
- adaptation
- checklist
.  The term & condition for considering changing climate conditions states: “ As recipients develop the brownfields area
- wide plan and implementation strategy , they must consider whether the proposed reuses for brownfield site(s) and other land in the project area are appropriate, given local changing climate conditions (e.g., sea level rise, site proximity to a flood plain, likelihood of increased major storm events, drought conditions, etc.). Recipients may

additionally

consider the degree to which the propo sed reuses in the project area can be designed to reduce greenhouse gas discharges, reduce energy use or employ alternative energy

sources, reduce volume of wastewater generated/disposed, reduce volume of materials taken to landfills, reduce stormwater run
- off, improve air quality , and recycle and re
- use materials generated during the cleanup and reuse process, to the maximum extent practicable. ” A pprovals **24 . Cooperative Agreement Recipient Project Manager.**  Ty pe or print the name of the cooperative agre ement recipient project manager. The project manager should also **sign and date**  the completed f

orm before submission. **25 . U.S. EPA Regional Representative.**  Ty pe or print the name of the EPA Regional representative. The EPA representative should also **sign and date**  the reviewed f orm.