1 SUPPORTING STATEMENT 1. ID ENTIFICATION OF THE INFORMATION COLLECTION (a) TI TL E OF THE INFORMATION COLLECTION Exchange Network Grants Progress Report s (Renewal) EPA IC R Number 2207.0 6 , OMB Control Number 2025
- 0006 (b) SHORT CHARACTERIZATION The Environmental Protection Agency ’s (EPA) Office of Environmental Information (OEI) provides funding to EPA’s Exchange Network partners ( states , territories , and federally recognized Indian tribes ) to support the development of the National Environmental Information E xchange Network ( Exchange Network, or EN)
. As a stipulation of the award, recipients are required to submit semi
- annual and final progress reports. EPA also requires recipients to sub mit a quality assurance report within 90 day s of award. Since 2006, EPA has used standard forms for these reports (EPA Form 5300
- 26: Semi
- Annual Progress Report Form and EPA Form 5300
- 27: Quality Assurance Reporting Form)
. 2. NEED FOR AND USE OF THE COLL ECTI ON (a) AUTHORITY/NEED FOR THE COLLECTION The authority to gather progress performance for assistantship programs is derived from 2 CFR Part 200, “Uniform Administrative Requirements , C ost Principles , and Audit Requirements for Federal Awards
. ” Section 200.328 “ Monitoring and reporting program performance, ” paragraphs (b)(1) and (b)(2) state : “ (1) The non
- Federal entity must submit performance reports at the interval required by the Federal awarding agency or pass through entity

to best inform improvements in program outcomes and productivity . Intervals must be no less frequent than annually nor more frequent than quarterl y except in unusual circumstances, for example where more frequent reporting is necessary for the effective monitoring of the Federal award or could significantl y affect program outcomes. Annual reports must be due 90 calendar d ay s after the reporting period; quarterl y or semiannual reports must be due 30 calendar day s after the reporting period. Alternativel y, the Federal awarding agency or pass
- through entity may require annual reports before the anniversary dates of multiple year Federal awards. The final performance report will be due 90 calendar day s after the period of performance end date. If a2 justified request is submitted by a non - Federal entity , the Federal agency may extend the due date for any performance report. (2) The non
- Federal entity must submit performance reports using OMB
- approved governmentwide standard information collections when providing performance information. As appropriate in accordance with above mentioned information collections, these reports will contain, for each Federal award, brief information on the following unless other collections are approved by OMB: (i) A comparison of actual accomplishments to the objectives of the Federal award established for the period. Where the accomplishments of the Federal award can be quantified, a computation of the cost (for example, related to units of accomplishment) may

be required if that information will be useful. Where performance trend data and anal ys is would be informative to the Federal awarding agency program, the Federal awarding agency

should include this as a performance reporting requirement. (ii) The reasons wh y established goals were not met, if appropriate. (iii) Additional pertinent information including, when appropriate, analy sis and explanation of cost overruns or high unit costs. ” The authority to gather quality assurance information for assistantship programs is derived from 2 CFR Part 1500, “Uniform Administrative Requirements , C ost Principles , and Audit Requirement s for Federal Awards
. ” Section 1500.11 “Quality Assurance , ” paragraphs (a) through (d), state :

“(a) Quality

assurance applies to all assistance agreements that involve environmentally

related data operations, including environmental data collection, production or use. (b) Recipients shall develop a written quality assurance s ys tem commensurate with the degree of confidence needed for the environmentally

related data operations. (c) If the recipient complies with EPA's quality policy , the sy stem will be presumed to be in compliance with the quality assurance s ys tem requirement. The recipient may also comply

with the quality

assurance s ys tem requirement by complying with American National Standard ANSI/ASQ E4:2014: Quality management s ys tems for enviro nmental information and technology

programs. (d) The recipient shall submit the written quality assurance sy stem for EPA review. Upon EPA's written approval, the recipient shall implement the EPA
- approved quality assurance sy stem.”3

OEI needs these report s to ensure that grants are making progress consistent with their work plans and that grantees have the policies, procedures, specifications , standards, and documentation to produce data of sufficient quality to meet project objectives
. (b) PRACTI CAL UTI LITY/USERS OF THE DATA The information provided on Semi
- Annual Progress Report F orms wi ll be used by the Regional Exchange Network Coordinators to monitor grant project development and performance. The reports will be attached to the applicable grantee’s file in the Integrated Grants Management Sy stem (IGMS) . The same reporting form will also be used for the final progress r eport, and will be used to rate performance for future grant awards. The Quality

Assurance Report ing Form will be used to ensure grantees will use quality assurance measures outlined in the grant’s administrative terms and conditions. 3. NON DUPLICATION, CONSUL TAT IONS, AND OTHER COLLECTION CRI TERIA (a) NONDUPLICATION The informati on a grantee provides in their semi
- annual progress r eport is unique to each project. Information concernin g the status of goals and outputs for each project is not available from any other source. (b) PUBLIC NOTICE The notice for this collection renewal was published in the Federal Register on January 15, 2015 ( 80 FR 2099 ). No comments were received
. (c) CONSUL TAT IONS For this I CR action, we consulted with the EN’s ten Regional Exchange Network Coordinators (REN C s ) , as well as OEI staff . The REN C’ s are EPA employees, one in each of the EPA’s ten regions, who s pecialize in environmental i nformation , and serve as project officers for EN grants
. The RENCs and OEI staff suggested several changes to the form, which we have incorporated into Exhibit A. (d) EFFECTS OF LESS FREQUENT COLLECTION EN grants are usuall y awarded for three
- ye ar project periods. The Quality Assurance Reporting Form is completed only once, no more than 90 day s after the award is m ade. As a stipulation of the EN grant award, a progress report is completed every six months and a final report is submitted no later than 90 day s after the expiration or termination of the approved project period
. Less frequent reporting could result in project mismanagement. For s ome Project Officers with many grants to manage, the semi
- annual progress report is the best opportunity

to ensure the project is on schedule to meet its goals.4

(e) GENERAL GUIDELINES Both the Semi
- Annual Progress Report Form and the Quality Assurance Reporting Form covered in this ICR adhere to OMB general guidelines. (f) CONFIDENTIALITY No pledge of confidentiality is given for grantee responses in either the Semi
- Annual Progress Report Form or the Quality Assurance Reporting Form
. (g) SENSI TIVE QUESTIONS No sensitive question s are asked on either the Semi
- Annual Progress Report Form or Quality Assurance Reporting Form
. 4. THE RESPONDENTS AND THE INFORMATION REQUESTED (a) RESPONDENTS/SI C CODES Our respondents are generally employees of state, tribal, or territorial environmental government offices. For instance, the current grants awarded to the state of Maryland are managed b y an employee of the Maryland Department of the Environment
. Accordi ng to the 2002 NAI CS codes available at www.naics.com , our respondents would fall into one of three categories: 921150 American Indian and Alaska Native Tribal Governments 921190 Other General Government Support 924120 Administration of Conservation Programs (b) IN FORMAT ION REQUESTED Please see attachments for sp ecific data elements (Exhibits A and B ). FY 201 5 guidance for quality

assurance p lans are described in the FY 201 5 Exchange Networ k Solicitation Notice, Section VI
- B, which requires each recipient to “submit a tailored Quality Assurance Project Plan (QAPP) to the EPA Regional Project Officer within 90 day s of the award issuance date” as a condition of each grant. (c) RESPONDENT ACTIVITIES As previously

stated, grantees are already required to report progress semi
- annuall y on their projects. EN grantees have been submitting semi
- annual progress report s and final reports to EPA Regional Offices since the National Environmental Information Exchange Network grant program began in 2002. EPA implemented the requirement to submit the Quality Assurance Reporting Form for new EN grants beginning in 2006, but the measures for quality a ssurance in a grantees’ pro

ject have been explained in the EN Solicitation Notice since 2002.5

According to the 1995 Paperwork Reduction Act ( PRA ) definition of burden §3502, the only time and effort that the forms required from grantees are: (A) Reviewing instructions; (E) Completing and reviewing the collection of information; and (F) Transmitting through email. 5. IN FORMAT ION COLLECTED (a) AGENCY ACTIVITIES Once the semi
- annual report and quality a ssurance report are received b y the RENC , they are attached to the grant’s file in the IGMS database. Semi
- annual reports are also entered into EPA’s Central Data Exchange, which Headquarters Exchange Network staff and management may use to track and report grant status
. (b) COLLECTION METHODOLOGY This information collection is form
- related. Th e Semi
- Annual P rogress Report Form is changing and is attached in Exhibit A. The Quality Assurance Reporting Form is changing to clarify the instructions and is attached in Exhibit B. Beginning with grants awarded in FY 2008, EPA requires, through the administrative terms and conditions, the recipients to submit semi
- annual and final progress reports on line via EPA’s Central Data Exchange (CDX) s ys tem, which replaced the former paper report s. For those grant s awarde d prior to FY 2008 , the award recipient has the option of submitting semi
annual progress reports to the EPA Regional Project Officer electronically (i.e., through CDX) or in Microsoft Word , email ed to their RENC
. These progress reports must be submitted w ithin one month of the end of the each reporting period. The first reporting period is from the award issuance date to March 31, 2015 , and the first report will be due to the EPA Regional Project Officer on Apri l 30, 2015 . Subsequent reports will be due every six months thereafter, until the project is completed , and the reporting periods will be as follows: April 1 through September 30 (report due October 31) and October 1 through March 31 (report due April 30)
. The RENC will upload the forms in IGMS, a L otus Notes database that has been used by the EPA since 2000. To reduce burden, EPA ask s that grantees not re
- write their entire semi
- annual progress report , but simply

add their recent outcomes, outputs and modified dates into their semi
- annual progres s report from the previous six months. Recipients of all new grants must submit the Quality Assurance R eport ing Form to their RENC via email within 90 d ay s of receiving the award. (c) SMALL ENT ITY FLEXIBILITY There are no small entities affected because the respondents are states.6

(d) COLLECTION SCHEDULE **Table 1** FORM SCHEDULE Q uality Assurance R eport ing Form Due to RENC 90 days after award of grant Semi
- Annual Progress Report Form • Due to RENC April 30 (Oct. 1
- Mar. 31 period)
• Due to RENC October 31 (Apr. 1

– Sept. 30 period)
• Final Due to the RENC 90 day s after expiration/termination 6. BURDEN ESTIMATE AND COST OF COLLECTI ON (a) ESTIMATING RESPONDENT BURDEN The estimated hours for completing each form includes time for reviewing instructions, completing information and transmitting through email or via CDX
. **Table 2** Form Estimated Hours Frequency per

Year Total Burden

Hours Semi
- Annual Progress Report Form 0.75 2 1.5 Quality Assurance R eport ing Form 1 1 1 (b ) RESPONDENT UNIVERSE AND BURDEN At the beginning of fiscal year 201 5 , EPA estimate s 2 00 grantees will be responding to the Semi
- Annual Progress Report Form. That number is derived from an esti mate of the rolling number of “active grants.” The number of active grants fluctuates throughout the year as projects are completed and grants are officiall y awarded and closed. Starting in FY 2013, e very EN grant is awarded for a three
- ye ar project period (increased from two ye ars)
. In cludin g the grants that EPA awarded in FY 2014 , open grants that have been extended, and grants still awaiting the submission or approval of technical reports , EPA estimate s 2 00 Semi
- Annual Progress Report Form respondents during any one given fiscal year . The Quality

Assurance Reporting Form will be completed once for each award by award recipients . These respondents are not unique; they are the same re spondents who will submit Semi
- Annual Progress Report Forms after the first six months of their projects. Of the 200 respondents, it is anticipated that 40 of them will complete the quality assurance reporting form in addition to the semi
- annual progress report forms. Assuming 40 new EN grant awards per ye ar, EPA estimates 40 Quality Assurance Reporting Form res pondents per fiscal ye ar. EPA’s burden estimate per year is based on the government’s fiscal year. In one fiscal ye ar, a respond e nt who receives an award in 2014 will complete one quality a ssurance report and two semi
- annual progress report s for that grant .7

Total Number of Responses : Semi
- Annual Progress Report F orms : 2 00 Respondents x 2 per year = 4 00 Quality Assurance Report ing Form: 40 Respondents x 1 per year = 40 Total = 440 Total Burden: Semi
- Annual Progress Report F orms: 2 00 R espondents x 1.5 hours = 3 00 Quality Assurance Report ing Form: 40 R espondents x 1 hour = 40 Total = 340 Table 3 summarizes respondent burden. **Table 3**
**– Respondent Burden** 

**Respondents Calculation**  **Semi -**  **Annual Progress**  **Report Form**  **Quality**

**Assurance Reporting**  **Form Total** 
**a** Estimated Hours per Form 0.75 1 **b** Frequency per Year 2 1 **c** Annual Burden Hours per Form Type (a) x (b) 1.5 1 **d** Respondents per Year 200 40 **e** Responses per Year (b) x (d) 400 40 440 **f Total Annual Burden Hours**  **(c) x (d) 300**  **40 340**  (c) ESTIMAT ING RESPONDENT COST Respondent costs consist only of labor. There are no capital, operating and maintenance, or annualizing capital costs incurred b y this information collection. Respondent Wage Rate: $35.26 1 x 1.50 = $52.88 Quality Assurance Report ing Form: 40 Total Annual Burden H ours x $52.88 = $2,115 Semi
- Annual Progress Report Form: 300 Total Annual Burden Hours x $52.88 = $15,864

1 $35.26 represents the average wage rate of several occupations expected to apply for grants or fellowships. 1.50 represents a 50% rate for benefits. $52.88 represents the average fully burdened wage rate, including benefits. These figures are derived f rom Table 3. State and local government, by major occupational and industry group: Management, Professional, and Related, found in the Bureau of Labor Statistics Economic News Release, “Employer Costs for Employee Compensation

– September 2014.”8

Table 4 summarizes respondent costs. **Table 4**
**– Respondent Costs**  Respondent Cost

s Semi
- Annual Quality

Assurance Total Labor Cost $15,864 $2,115 $17,979 Capital/Start
- up Cost $0 $0 $0 Operating and Maintenance $0 $0 $0 Annualizing Capital $0 $0 $0 **Total Costs $15,864**  **$2,115 $17,979**  (d) ESTIMATING AGENCY BURDEN AND COST To estimate the cost and burden to the RENC s, EPA assumes that each recipient will submit two Semi
- Annual Progress Report Forms each ye ar, and that each new grant recipient will submit one Quality

Assurance Report ing Form each ye ar. EPA assumes that th ere are 2 00 active grants in any single fiscal ye ar, that 40 new grants are awarded each year, and that there is an even distribution for each (active and new grants) across all 10 regions. EPA estimates that it should take an RENC 0.5 hours to review/upload a Quality Assurance Report ing Form and 0. 2 5 hours to review/upload a Semi
- Annual Progress Report Form. EPA estimates that e a ch RENC will review ( 200/10 ) x 2 = 40 s emi
- annual forms and (40/10) x 1 = 4 quality a ssurance f

orms each ye ar. Each RENC will spend 40 x 0. 25 = 1 0 hours reviewing/uploading semi
- annual forms and 4 x 0.5 = 2 hours reviewing quality assurance forms. The total number of hours that all of EPA’s RENC s review/upload forms is 10 x 10 = 1 00 hours for the Semi
- Annual Progress Report Form and 2 x 10 = 2 0 hours for the Quality Assurance Reporting Forms, for a total of 12 0 hours each ye ar . Assuming a fully burdened hourl y rate of $55.99 2 for each RENC, the cost to review/upload form s is 1 00 x $55.99 = $5,599 fo r Semi
- Annual Progress Report Forms and 2 0 x $55.99 = $1,120 for Quality Assurance Reporting Forms, for a total of $ 6,719 each ye ar.

2 The 2015 average hourly rate for a General Schedule (GS) 13, Step 1 with Rest of U.S. Locality Pay ($39.99) was used to estimate burden costs for EPA’s RENCs. This rate was also fully burdened (x 40 %), yielding a wage rate of $55.99.9

Ta ble 5 summarizes Agency burden
. **Table 5**
**– Agency Burden** 

**EPA RENCs Calculation**  **Semi -**  **Annual Progress**  **Report Form**  **Quality**

**Assurance Reporting**  **Form Total** 

**a** Estimated Hours per Form (R eview/Upload) 0.2 5 0.5 **b** Frequency per Year 2 1 **c** Annual Burden Hours per Form Type (a) x (b) 0.5 0.5 **d** Grants Subject to EPA Review /Upload per Year 200 40 **e** EPA R eviews/Uploads per Year (b) x (d) 400 40 440 **f Total Annual Burden Hours**  **: EPA**  **(c) x (d) 1**  **00 2**  **0 12**  **0** Table 6 summarizes Agency cost. **Table 6**
**– Agency Costs**  EPA Cost s Semi
- Annual Quality

Assurance Total Labor Cost $5,599 $1,120 $6,719 Capital/Start
- up Cost $0 $0 $0 Operating and Maintenance $0 $0 $0 Annualizing Capital $0 $0 $0 **Total Costs $**  **5,599 $1,120**  **$6,719** (e) BOTTOM LINE BURDEN HOURS AND COSTS **Table 7**
**– Summary Burden Hours and Costs**  Semi
- Annual Quality

Assurance Total Total Annual Responses 400 40 440 * Total Burden H ours for R espondents 300 hours 40 hours 340 hours Total Burden Hours for EPA 100 hours 20 hours 120 hours Total Respondent Cost $15,864 $2,115 $17,979 Total EPA Cost $5,599 $1,120 $6,719 **Total Costs $**  **21,463 $3,235**  **$24,698** *Not all respondents complete every activity, every year.10

(f) REASONS FOR CHANGE IN BURDEN There is a decrease of 5 hours in the total estimated respondent burden compared with the ICR currentl y approved by OMB. This decrease is due to a decrease in the number of grants that are awarded annually
. There is no change in respondent burden per res ponse . Total estimated respondent cost has increased as a result of inflationary increases and updated meth odologies for estimating respondent salaries
. Additionally , there is a decrease of 2.5 hours in the total estimated EPA burden
. This decrease is d

ue to a decrease in the number of grants that are awarded annually
. There is no change in EPA burden per response
. Total estimated EPA cost has increased as a result of inflationary

increases and updated meth odologies for estimating EPA RENC salaries
. ( g) BURDEN STATEMENT The annual public reporting and recordkeeping burden for this collection of information is estimated to average .77 hours per response. Specificall y, the estimate is 0.75 hours per response for the Semi
- Annual Progress Report Form (total of 1.5 hours) and 1 hour per response for the Quality Assurance Reporting Form. Burden means the total time, effort, or financial resources expended b y persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and s ys tems for the purposes of collecting, validating, and verifying information, pr ocessing and maintaining information, and disclosing and providing information; adjust the existing way s to compl y with any previously

applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currentl y valid OMB control number. The OMB control numbers for EPA's regulations are listed in 40 CFR part 9 and 48 CFR chapter 15. The burden for the Semi
- Annual Progress R eport Form is based on time for reviewing instructi ons, collecting the information and entering it into the form, and transmitting on - line (via CDX) or through email. For each Semi
- Annual Progress Report Fo rm, the respondent burden is 0.75 hours. Respondents complete the form twice a year; thus the total annual burden is 1.5 hours. For the Quality

Assurance Report ing Form, the annual respondent burden is 1 hour for each new EN grant awarded
. To comment on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including the use of automated collection techniques, EPA has established a public docket for this I CR under Docket ID Number EPA
- HQ
- OEI
- 2006
- 0037 , which is available for online viewing at www.regulations.gov , or in person viewing at the Office of Environmental Information Docket in the EPA Docket Center (EPA/DC), EPA West, Room 3334 , 1301 Constitution Avenue, NW, Washington, D.C. The EPA Docket Center Public Reading Room is open from 8:30 a.m. to 4:30 p.m., Monday

through Friday , excluding legal holiday s. The telephone number for the Reading Room is (202) 566
- 1744, and the telephone number for the Office of Environmental Information11

Docket is (202) 566
- 1752. An electronic version of the public docket is available at www.regulations.gov . This site can be used to submit or view public comments, access the index listing of the contents of the public docket, and to access those documents in the public docket that are available electronically . When in the sy stem, select “search,” then key in the Docket ID Number identified above. Also, you can send comments to the Office of Information and Regulatory

Affairs, Office of Management and Budget, 725 17th Street, NW, Washington, D.C. 20503, Attention: Desk Officer for EPA. Please include the E PA Docket ID Number EPA
HQ
- OEI
- 2006
- 0037 and OMB Control Number 2025
- 0006 in any correspondence.Exhibit A OMB No. 2025
- 0006 Expires xx/xx/xxxx

EPA Form 5300
- 26 1 

### U.S. EN**VIRONMENTAL PROTECTION AGENCY Exchange Network Grant Program**  **Progress Report Form**  **for Use by Recipients of Assistance Agreements** Please Check: 

## □ Semi
- annual report 

## □ Final Report **Instructions: This form is for Exchange Network Grant recipients to report their progress. Recipients** 

**should send these to their regional grant project officer for spring reports by April 30 for the period**  **October 1**  **- March 31**  **. Fall reports**  **are due to the regional projec t officer by**  **October 31 for the period April 1**  **- September 30**  **. Recipient Information:**  **Agency Name: EPA Grant Number** 

**– Program Code, Number, and Amendment Number (e.g.,**  **OS**
**– 12345678** 
**– 0):**  **For grants awarded before 2006 Exchange Network Grant Category (i.e., One Stop, Readiness, Implementation, or Challenge):**  **Project Manager: Name:**  **Phone: Email:**  **Funding Year: Award Amount:**  **Expenditures during this reporting period:**  **Funds Remaining: Reporting Period (starting and**  **ending dates, mm/dd/yyyy): Date Report Submitted**  **(mm/dd/yyyy): EPA Project Officer to Whom Report is Submitted:**  **Name: EPA Region/Program:**  **Focus:**OMB No. 2025
- 0006 Expires xx/xx/xxxx

EPA Form 5300
- 26 2 **Progress Report Instructions:** 1. List major goals and each goal’s outputs as described in the work plan (Note for recipients submitting through CDX: After you have submitted your first online progress report for a grant, any chan ges to goals or outputs that are needed must be made by your EPA Regional Project Officer. You should submit your change request di rectly to your Regional Project Officer.) 2. In the “Scheduled Completion Date” column, enter the dates from the grant work plan 3. In the “Actual Completion Date” column, enter the date each output completed as of the period covered by this report **4.** In the “Prog ress and Status” field below each output, enter any factor that has or will affect the recipient’s ability to complete that o utput; also indicated whether a resource listed in RCS or ENDS was used or, if a resource was created, it was registered in ENDS or RCS. **EXAMPLE Goals**  **Tasks/ Outputs**  **Scheduled Completion**  **Date Actual** 

**Completion date**  1 . Flow ambient air quality data through the Exchange Network. 1. Develop XML schema mm/yyyy mm/yyyy **Progress and Status** 2. Initiate first test data flow mm/yyyy **Progress and Status Goals**  **Tasks/ Outputs**  **Scheduled Completion**  **Date Actual** 

**Completion date**  **Progress and Status :** OMB No. 2025
- 0006 Expires xx/xx/xxxx

EPA Form 5300
- 26 3 **Goals Tasks/**  **Outputs Scheduled**  **Completion Date**  **Actual**

**Completion date**  **Progress and Status: Progress and Status:**  **Comments** Instructions: If you have had any problems during the current period please report them here. In accordance with 2 C.F.R. § 200.328(d) , a recipient of an EPA assistance agreement must notify EPA of any problems, delays, or adverse conditions
. If you have had any project
- level problems or delays in spending grant funds during the current period , please report them in this section
. **P roblems during this reporting period:**  **Describe any actions your organization has taken or plans to take to resolve the problem: If**  **you need help from EPA you may request it here: Other comments:**  **Paperwork Reduction Act (PRA) Burden Statement:** The public reporting and recordkeeping burden for this collection of information is estimated to average forty

- five minutes per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collecti on techniques to the Director, Col lection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460
. Include the OMB control number in any correspondence. Do not send the completed form to this address.Exhibit B OMB No. 2025
- 0006 Expires xx/xx/xxxx

EPA Form 5300
- 27 1 **U.S. ENVIRONMENTAL PROTECTION AGENCY Quality Assurance Reporting Form**  **for Use by Recipients of Assistance Agreements Recipient Organization:**  **Name: Address:**  **EPA Award Number: Project/Program Period(starting and ending dates, mm/dd/yyyy):** 
**Activity Group:** (check all that apply) □ Infrastructure Development

□ Data Exchange, Anal ysis and Integration □ Planning, Mentoring, and Training □ Challenge **Goal Task**  **Output Outcome**  **Quality Assurance Measures**

**Instructions: -**  **Please submit electronically to your**  **EPA Regional Project Officer**  **within 90 days of award.** 

**- For Quality Assurance Measures, please refer to**  **mo st recent**  **Solicitation Notice for**  **Quality Assurance Guidelines.**

**- For Goals, please refer to goals outlined in your assistance agreement wor**  **k plan.**  **Paperwork**

**Reduction Act (PRA) Burden Statement:** The public reporting and recordkeeping burden for this collection of information is estimated to average one hour per response. Send comments on the Agency's need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of au tomated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. I nclude the OMB control number in any correspondence. Do not send the completed form to this address.