**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, W ashington, 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-4W 227, W ashington D.C. 20202-2800. 

### Attn: CSP Data Collection W estEd 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 W estEd. 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 organiz ation (CMO, EMO or freestanding); 3) the authoriz ed 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 A**

**ward 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 summariz

es 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@W ested.org, or call toll-free 866-902-4887.

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