OMB Number: 1855-0016 Approval Expires 2/28/2015

 Form Submission:

 4665 Lampson Ave.

 Los Alamitos, CA 90720

Please be sure to make a copy of the completed form for your own records.

 Paperwork Burden Statement:

According to the Paperwork reduction Act of 1995, no persons are required to respond to a collection of information unless 

such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1855-

0016. The time required to complete this information collection is estimated to average 127 hours per response, including the 

time to review instructions, search existing data resources, gather the data needed and complete and review the information 

collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, 

please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding 

the status of your individual submission of this form, write directly to: U.S. Department of Education, Office of Innovation and 

Improvement 400 Maryland Avenue, S.W., LBJ-4W227, Washington D.C. 20202-2800.

 Attn: CSP Data Collection

 WestEd

If an electronic copy cannot be sent, please send a paper copy of the completed CSP Data Collection 

Form to the following address:

The completed CSP Data Collection Form should be sent to CSPdatacollection@wested.org. In the 

subject heading please include "CSP Data Collection" followed by your state name. Please be sure to 

save a copy of the completed form for your own records.

 Contact Information:

If you have any questions or concerns regarding the completion of the CSP Data Collection Form, 

please contact WestEd. You can email us at CSPdatacollection@Wested.org, or call toll-free 866-902-

4887.

Charter Schools Program (CSP)

Office of Innovation and Improvement

U.S. Department of Education

CSP Data Collection Form - State Education Agency (SEA) Grantees

Part B asks for CSP subgrant award information. Beginning in 2011, we are asking grantees to indicate 

if the subgrant is operated by a management organization, and to provide the name of the authorized 

public chartering agency. Charter developer information is no longer required. In all, grantees will 

provide the following information for each active subgrant within the State's 36 month project period: 1) 

the name and contact information for the charter school and LEA; 2) the charter school's management 

organization (CMO, EMO or freestanding); 3) the authorized public chartering agency; 4) the total 

amount of funding an applicant received to start a charter school, along with the beginning and end date 

of the grant project period and budget periods; and 5) other charter school information (e.g., enrollment) 

as needed. 

Instructions

 Purpose of Data Collection:

The new data collection will collect CSP grant award information from SEA grantees to create a new 

database of subgrant award data. The CSP Data Collection Form will allow the U.S Department of 

Education (ED) to monitor CSP grant performance and analyze data related to accountability for 

academic performance and financial integrity. The data collection will assist in carrying out the purpose 

of the Charter School Program Section 5201 of the ESEA, which is to expand the number of high quality 

charter schools and increase the national understanding of the charter school model.

Part A asks for CSP SEA grantee award information. The state name, the state contact person, and the 

contact person's department has already been entered in the form. If this information is incorrect, please 

contact the data collection administrators (see "Contact Information" below). In the gray boxes, please 

enter the number of CSP subgrantees for each Federal Fiscal Year that still receive CSP funds within 

the State's 36 month project period. Keep in mind that your Grant Award Notification (GAN) provides 

the beginning and end date for your current project period.

 For SEAs: The CSP Data Collection Form has two parts:
Data Collection Form: Part A: SEA CSP Grant Award Information

State:

State Contact Person:

Department of Contact Person:

PR/Award #:

Project Period Begin Date:

Project Period End Date:

Total Award Amount Obligated:

The award amount includes the total amount obligated to 

your state - both the original Grant Awards and any 

Supplemental Grant Awards - during the current project 

period. See the breakdown of funds across years below. 

Please list the number of subgrants for each Fiscal Year 

that are still receiving CSP funds within the State's 

project period. On the following worksheets, you will 

provide grant award information for each of these 

subgrantees. 

Breakdown of Obligated Funds 

per Fiscal Year:

Grant Award 

Amount

Supplemental 

Award Amount

Administrative 

Expenditures Number of new subgrant awards per Fiscal Year

FY 2010

FY 2011

FY 2012

FY 2013

FY 2014

Total Number of Current Active Subgrants: 0

Please turn to Part B to provide data for each subgrant

OMB Number: 1855-0016 Approval Expires 2/28/2015

Comments? If any of the above information is incorrect, or if you need to provide any additional information regarding your CSP grant, 

please use the box below. You may also direct comments to us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887. 
Total award amount obligated from ED (from Part A)--> $0 $0 <--Total FY 2014 award amount from ED (from Part A) $0 <--Total FY 2013 award amount from ED (from Part A)

Total administrative expenditures (from Parrt A)--> $0 $0 <--Total FY 2014 administrative expenditures (from Part A) $0 <--Total FY 2013 administrative expenditures (from Part A)

Total subgrant award amount (sum of column AI)--> $0 Grant Payments $0 <--Total FY 2014 dollars allocated (sum of column AL) $0 <--Total FY 2013 dollars allocated (sum of column AL)

Total award amount remaining from ED (from Part A)--> $0 $0 $0 $0 <--Total remaining $0 <--Total remaining

Minimum total award amount (mininum of column AI)--> $0 $0 <--Minimum FY 2014 award amount $0 <--Minimum FY 2013 award amount

Maximum total award amount (maximum of column AI)--> $0 $0 <--Maximumt FY 2014 award amount $0 <--Maximumt FY 2013 award amount

Average total award amount (average of column AI)--> #DIV/0! #DIV/0! <--Average FY 2014 award amount #DIV/0! <--Average FY 2013 award amount

Number of subgrantees (count of column AI)--> 0 0 <--Number of total subgrants FY 2014 0 <--Number of total subgrants FY 2013

F Y 2 0 1 4 F U N D S (8/1/14-7/31/15) F Y 2 0 1 3 F U N D S (8/1/13-7/31/14)

Project Period Begin Date Project Period End Date

Total Subgrant Award Amount 

Obligated (calculated from 

amounts provided in each FY) Total Subgrant Payments

Total Projected Subgrant 

Commitments

Dollar amount of 

subgrant award 

Beginning date 

of subgrant 

budget period 

End date of 

subgrant budget 

period

Type of subgrant (choose 

one)

Dollar amount of 

subgrant award 

Beginning date 

of subgrant 

budget period 

End date of 

subgrant budget 

period

Type of subgrant (choose 

one)

Projected Grant 

Commitments

4) Subgrant Award Information. Please provide the breakdown of funds obligated to subgrantees within each Federal Fiscal Year. The total amount 

obligated across one or more years will equal the Total Subgrant Award Amount Obligated (column AI) for that subgrantee. The Total Subgrant Payments 

(column AJ) should equal the total amount dispersed to each subgrantee to date. Projected Subgrant Commitments (column AK) are future obligations and 

payments anticipated over the grant project period. In addition to providing the breakdown of funds obligated, please list the budget period for the time the 

funds were obligated, and whether the awards were used for preplanning, planning, implementation or dissemination purposes.
 Check your data:

State: 0

State Contact Person: 0

Department of Contact Person: 0

PR/Award #: 0

Project Period Begin Date: 1/1/1904

Project Period End Date: 1/1/1904

Total Award Amount Obligated: $0

Breakdown of Obligated Funds 

per Fiscal Year:

Grant Award 

Amount

Obligated Award 

Amount

Unobligated 

Award Amount

Number of new 

subgrant awards

Total number of 

subgrant awards 

per fiscal year

Minimum Award 

Amount per fiscal 

year

Maximum Award 

Amount per fiscal 

year

Average Award 

Amount per fiscal 

year

FY 2010 $0 $0 $0 0 0 $0 $0 #DIV/0!

FY 2011 $0 $0 $0 0 0 $0 $0 #DIV/0!

FY 2012 $0 $0 $0 0 0 $0 $0 #DIV/0!

FY 2013 $0 $0 $0 0 0 $0 $0 #DIV/0!

FY 2014 $0 $0 $0 0 0 $0 $0 #DIV/0!

$0 $0 $0 0 0 $0 $0 #DIV/0!

This sheet summarizes the CSP Grant Award Data already provided in Part A and the CSP Subgrant Award data you 

entered in Part B. If there are discrepancies in the amount of funds obligated and awarded in each Federal Fiscal Year, 

please use the gray space below to explain. 

Comments or questions? Please contact us at CSPdatacollection@Wested.org, or call toll-free 866-902-4887. 

OMB Number: 1855-0016 Approval Expires 2/28/2015