United States 

ENVIRONMENTAL PROTECTION AGENCY 

Washington, DC 20460 

Form Approved 

OMB No. 2050-0192 

Expires 07-31-2009

JOB TRAINING REPORTING FORM 

Brownfields 

PART I – GRANT RECIPIENT INFORMATION 

1. Grant Recipient Name 

2. Grant Number 

Public reporting burden for this collection of information is 

estimated to average 5 hours per response, including the 

time for reviewing instructions, searching data sources, 

gathering and maintaining the data needed, and completing 

and reviewing the collection of information. Send comments 

regarding this burden estimate, or any other aspect of this 

collection of information, including suggestions for reducing 

this burden, to the Environmental Protection Agency, Office 

of Environmental Information, Code 2822T, Washington, DC 

20460 and to the Paperwork Reduction Project, Office of 

Management and Budget, Washington, DC 20503. DO NOT 

RETURN your form to either of these addresses. Send your 

completed form to the address provided by the issuing 

office.

PART II – PERFORMANCE MEASURES INFORMATION 

Table A – Mandatory Performance Measures

Measure (a) This Quarter (b) Cumulative 

3. Number of Participants Completing Training 

4. Number of Participants Obtaining Employment 

5. Average Hourly Wage of Participants Obtaining Employment 

6. Funds Leveraged (total) 

6-1. Funding Source Name 

6-2. Activity Funded 

6-1. Funding Source Name 

6-2. Activity Funded 

6-1. Funding Source Name 

6-2. Activity Funded 

7. Supplemental Performance Measures Information (optional) 

PART III – APPROVALS 

8. Grant Recipient Project Manager 

Name Signature Date 

9. US EPA Regional Representative 

Name Signature Date 

EPA Form 6200-04 (9-2006) 
 

EPA Form 6200-04 (9-2006) 

INSTRUCTIONS FOR COMPLETING 

JOB TRAINING REPORTING FORM - BROWNFIELDS 

GENERAL INSTRUCTIONS 

Overview:

As specified in your grant terms and conditions, all job training grant recipients must report to EPA on a 

regular basis. This OMB and EPA approved reporting form (OMB No. 2050 - 0192, EPA Form 6200-04), 

supplements your Quarterly Reports with information about specific activities and accomplishments that 

EPA deems necessary to adequately monitor and evaluate the performance of job training grants. Please 

contact your EPA Regional representative if you have any questions when completing this form. Please note 

that, in most instances, all reported information is accessible by 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.

 

Compared to the Quarterly Reports, the Brownfields Job Training Reporting Form (JT Reporting form) 

contains quantitative information relating to four specific measures of grant recipient performance. 

Reporting on these specific activities and accomplishments must be provided in the attached JT Reporting 

form rather than in the Quarterly Reports. Additional voluntary and/or narrative information may be 

provided in Part II of this form or in the Quarterly Report. 

When to Submit:

Original JT Reporting Forms. Grant recipients must develop the first JT Reporting form when the first 

specified accomplishment has occurred (e.g., when the first class of trainees “graduates” from the training 

program provided under the grant, or when leveraged funding is committed to supplement the grant 

activities). The form should be attached and delivered with the next required Quarterly Report. 

Updated JT Reporting Forms. JT Reporting forms should be updated and delivered as additional 

accomplishments occur, and should be attached to the next required Quarterly Report. In addition, an 

updated form should be provided when the grant is being closed-out. 

To Whom to Submit:

Grant recipients must submit JT Reporting Forms to their EPA Regional Representative identified in the 

terms and conditions of the cooperative agreement. The EPA Regional Representative may request the form 

also be submitted to the EPA Headquarters Data Manager. When online submission is available and JT 

Reporting Form information is entered online the data will automatically be delivered to the EPA Regional 

Representative. 

How to Submit: 

EPA is undertaking a two-phased process to facilitate electronic reporting and provide an information 

dissemination system to facilitate future grant recipient reporting. EPA will prepare electronic versions of 

this and other required reporting forms for the grant recipients to complete and submit via e-mail. When the 

Assessment, Cleanup, and Redevelopment Exchange System, (ACRES) is available on online to grant 

recipients, JT Reporting Form information may be entered electronically into the web-based database. 

Electronic reporting is optional; hard copy reports will always be acceptable. 
 

EPA Form 6200-04 (9-2006) 

DETAILED INSTRUCTIONS FOR COMPLETING EACH ITEM ON FORM

PART I - GRANT RECIPIENT INFORMATION 

1. Grant Recipient Name. Enter the grant name. Use the official name of the grant recipient as provided 

in the cooperative agreement, unless otherwise directed by the EPA Regional Representative. 

2. Grant Number. Enter the grant number. Use the number of the grant as provided in the cooperative 

agreement. 

PART II - PERFORMANCE MEASURES INFORMATION

This section contains two parts—one mandatory, for certain limited performance measures information 

(Table A); the other optional, for narrative information to supplement the quantitative information provided 

(section 7). 

Table A - Mandatory Performance Measures. In Table A, provide all quantitative information relating to 

each of the four (4) mandatory performance measures. For each measure, enter amounts in column (a) – 

This Quarter – to reflect the incremental accomplishments attained during the current reporting quarter and 

column (b) – Cumulative – to reflect the total accomplishments attained to date during the term of the grant. 

Note: Quantitative information relating to these performance measures should only be provided in the table 

(i.e., not in narrative reporting contained in the Quarterly Report). 

3. Number of Participants Completing Training. Enter the number of participants taking the grant 

funded training who have completed the training program. 

4. Number of Participants Obtaining Employment. Enter the number of graduates from the grant funded 

training program who have obtained employment of any kind. Self-employed graduates should be included 

in this count. The cumulative total number inserted in column (b) should only increase during the term of the 

grant; the grant recipients’ quantitative reporting of the cumulative total should not reflect any decreases for 

graduates who had obtained employment, but later report losing their jobs. If desired, provide a brief 

narrative description in section 7 for any reported job losses. 

5. Average Hourly Wage. Enter the average hourly wage of job training graduates in their initial posttraining employment. Provide the hourly wage for the first job that each employed graduate secures after 

completing the job training program. Anecdotal information about subsequent jobs and wages may also be 

narratively provided by the grant recipient. 

6. Funds Leveraged. Enter the total amount of funding leveraged as a result of grant activities. Capture the 

total number of non-grant dollars linked and leveraged to support additional, related activities of the grant 

recipient. To be reportable, there must be a demonstrable link or connection between the EPA funded 

activity and the leveraged funding. Funding can occur through direct financial assistance and/or through inkind services or supplies. Usually, leveraged funding that was committed prior to the award of the EPA 

grant should not be reported as leveraged since the activity predates the award. In addition, leveraged 

funding should not be reported in this section until the funding has been committed. These leveraged funds 

may be used to support activities that cannot be funded by the EPA grant (e.g., transportation or child care 

for job training students). 
 

EPA Form 6200-04 (9-2006) 

In addition to the total leveraged funds, also describe the source and amount of funding leveraged, and the 

types of activities it funded. For each funding source (6-1), also list the type of activity funded (6-2) and the 

amount of funding leveraged per source in columns (a) and (b). As necessary, add additional lines for 6-1 

and 6-2. 

6-1. Funding Source Name(s). For each funding source, enter the name of the organization 

providing the funds and/or in-kind services. Examples of sources of leveraged funding include other 

EPA programs, private organizations, state environmental, labor, or economic agencies, tribal 

governments, local governments (including community development corporations), and other federal 

agencies. 

6-2. Activity Funded. For each funding source listed under 6-1, provide the type of activity that 

was supported. Examples of leveraged activities include additional curricula development/training 

(e.g., environmental and non-environmental), supplies/equipment, transportation for students, and 

child care for students. 

7. Supplement Performance Measures Information (Optional). Provide a brief narrative description to 

supplement the required performance measures reporting, including, for example: demographic information 

(e.g., gender, age, ethnicity, education); description of the training curricula; information on the types of jobs 

obtained by the participants entering/completing the training; availability of photographs/video footage of 

the training/graduation/post-training employment; and/or specific milestones tracked by the grant recipient 

for its own management. 

PART III - APPROVALS

8. Grant Recipient Project Manager. Type or print the name of the grant recipient project manager. The 

project manager should also sign and date the completed JT Reporting form before submission. 

9. U.S. EPA Regional Representative. Type or print the name of the EPA Regional Representative. The 

EPA representative should also sign and date the reviewed JT Reporting form.