ED 524B 

### U.S. Department of Education **Grant Performance Report Cover Sheet (ED 524B) Check only one bo** 

**x per Program Office instructions .**  **[ ] Annual Performance Report [ ] Final Performance Report** 

### General Information 1 . PR /Award #: ___

_____ _______ _________________

__ _____ 2. Grantee NCES ID#: __________ _______________________ (Block 5 of the Grant Award Notification - 11 c haracters.) (See i nstructions . Up to 12 c haracters.) 3 Project Title: ____

___________________________ _ _____________________ ____________________________________ __ _______ (Enter the same title as on the approved application.) 4. Grantee Name (Block 1 of the Grant Award Notific a tion . ): ______ _______________________________________________ _ ________ 5. Grantee Address (See i nstruct ions.) 6. Project Director (See i nstructions . ) Nam e: _________________ ___________

__ _________ T itle: _______ _ ________________

_ ______ Ph #: ( ) __

__ __ __ - _ __ ___ ____ Ext: ( ) Fax #: ( ) __ __ __ __ - __ __ __ ___ _ Email Address: ______

________________________________________ ____ 

### Reporting Period Information **( See**  **i nstructions**  **.)** 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 Funds Non**  **- Federal 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 ): _______ __ _______________________________________ _ _ _ Ty pe 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 (Annual Institutional Review Board**  **(IRB) Certification)**  **(See i**  **nstructions.)** 10. Is the a nnual c ertification of Institutional Review Board (IRB) a pproval attached? ___Yes ___ No ___ N/A 

### Performance Measures Status and Certification **(See i**  **nstructions.)** 11. Performance Measures Status a. Are complete data on performance measures for the current budget period included in the Pr oject 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: _____ __________________________ ________ Nam e of Authorized Repr e sentative:

____ _________________________________________________ Date: __ ___/ __ ___/__ __ __ _ Signature: OMB No. 189 4 - 000 3 Exp.ED 524B 

### U.S. Department of Education **Grant Performance Report (ED 524B) Executive Summary** 

PR/Award # (11 characters) : ____ __________________

__ **(See Instructions)**

**Public Burden Statem ent:**  According to the Paperw ork Reduction Act of 1995, no persons are required to respond to a collection of information unless su ch colle ction displays a valid OMB control number. Public report ing burden for this collection of information is estimated to average 22 hours per response for annual performance reports and 23 hours per response for final performance reports including time for reviewing instru ctions, searching existing data sources, g athering and maintaining the data needed, and completing and reviewing the collection of info rmation. The obligation to respond to this collection is required to obtain or retain benefit. Send comments regarding the bu rden estimate or any other aspect of this colle c tion of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210 - 4537 or email ICDoc k etMgr@ed.gov and reference the O MB Control Number 1894 - 0003. OMB No. 1894 - 0003 Exp.