EPA Form 6200

- 04 

### United States

ENVIRONMENTAL PROTECTION AGENCY

Washington, DC 20460

JOB TRAINING REPORTING FORM

Public repo rting burden for this co llectio n of info rmation is estimated to average 4 hours per response, including the time for reviewing instructions,

searching data so urces, gathering and maintaining the data needed, and completing and reviewing the co llectio n of info rmatio n. Send comments

regarding this burden estimate

— o r any other aspect of this c o ll ectio n of info rmatio n, including suggestio ns for reducing this burden

— to the

Environmental Protection Agency, Office of Environmental Information, Code 2822T, Washington, DC 20460 and to the P aperwork Reductio n Pro j ect,

Office of Management and B udget, Washington, DC 20503. DO NOT RETURN yo ur fo rm to either of these addresses. Send yo ur co mpleted f o rm to the

address pro v

ided by the issuing o ffice.

1. Cooperative Agreement Recipient Name: 2. Cooperative Agreement Number:

PART II

- PERFORMANCE MEASURES INFORMATION

This Federal

Fiscal

QUARTER CUMULATIVE

3. Number of Participants Entering Training

3a. Number of Veterans Entering Training

4. Number of Participants Completing Training

5a. Number of Participants Obtaining Employment

5b. Number of Individuals that did not Obtain Employment but are

Pursuing Education (e.g., GED, college courses, etc.)

6. Average Hourly Wage of Participants Obtaining Employment

7. Funds Leveraged (total)

7

- 1. Funding Source Name:

7

- 2. A c t i v

i t y Funded:

7

- 1. Funding Source Name:

7

- 2. A c t i v

i t y Funded:

7

- 1. Funding Source Name:

7

- 2. A c t i v

i t y Funded:

8. Supplemental Performance Measures Information (optional) :

PART III

- APPROVALS

9. Cooperative Agreement Recipient Project Manager:

Name (please print) Signature: Date:

10. U.S. EPA Regional Representative:

Name (please print) Signature: Date PART I

- COOPERATIVE AGREEMEMENT RECIPIENT INFORMATION Form Approved

OMB No. 2050

- 0192

Expires: xx

- xx

- xxxxEPA Form 6200

- 04 INSTRUCTIONS FOR COMPLETING

JOB TRAINING REPORTING FORM

GENERAL INSTRUCTIONS

Overview:

As specified in your cooperative agreement terms and conditions, all Job Training cooperative agreement

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 progress

toward goals defined in cooperative agreements. 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 an FOIA exclusion is applicable.

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

contains quantitative information on four specific measures of 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. Cooperative agreement 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 cooperative agreement, or when leveraged funding is committed to

supplement the cooperative agreement activities).

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

accomplishments occur. In addition, an updated form should be provided when the cooperative agreement is

being closed out. Cooperative agreement recipients should provide ample time to report job placement

activities prior to the closeout of the project period. If you have data to report after the closeout of the

cooperative agreement, please contact the ACRES Help desk a t acres_help@epa.gov.

To Whom to Submit:

Cooperative agreement recipients must submit JT Reporting Forms to their EPA Regional Representative

identified in the terms and conditions of the cooperative agreement. If data is entered online it will

automatically be delivered to the EPA Regional Representative.

How to Submit:

The Assessment, Cleanup, and Redevelopment Exchange System (ACRES) is available online and is the

preferred method for Job Training cooperative agreement recipients to enter and submit the JT Reporting

Form. Electronic reporting is optional. The JT Reporting Form may also be submitted in hard copy with the

next required Quarterly Report or via e

- mail to the EPA Regional Representative.EPA Form 6200

- 04

DETAILED INSTRUCTIONS FOR COMPLETING EACH ITEM ON FORM

PART I

– COOPERATIVE AGREEMENT RECIPIENT INFORMATION

1. Cooperative Agreement Recipient Name. Enter the cooperative agreement recipient name. Use the

official name provided in the cooperative agreement, unless otherwise directed by the EPA Regional

Representative.

2. Cooperative Agreement Number. Enter the cooperative agreement number. Use the number as provided

in the cooperative agreement.

PART II

- PERFORMANCE MEASURES INFORMATION

This section contains two parts

— one mandatory, for performance measures information; the other optional,

for narrative information to supplement the quantitative information provided (Field 8).

Mandatory Performance Measures.

Provide all quantitative information relating to each of the mandatory performance measures. For each

measure, enter amounts in column (a)

— This Federal Fiscal Quarter

— to reflect the incremental

accomplishments attained during the current federal fiscal reporting quarter and column (b)

— Cumulative

— to reflect the total accomplishments attained to date during the term of the cooperative agreement. Note:

quantitative information relating to these performance measures should only be provided in the JT Form (i.e.,

not in narrative reporting contained in the Quarterly Report).

3. Number of Participants Entering Training. Enter the number of participants who entered a cooperative

agreement funded training program.

3a. Number of Veterans Entering Training. Enter the number of participants who entered a cooperative

agreement funded training program that are Veterans.

4. Number of Participants Completing Training. Enter the number of participants taking the cooperative

agreement funded training who have completed the training program.

5a. Number of Participants Obtaining Employment. Enter the number of graduates from the cooperative

agreement 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 cooperative agreement ; the recipients’ reporting of the cumulative total should not

reflect any decreases for graduates who had obtained employment but later reported losing their jobs. If

desired, provide a brief narrative description in section 8 for any reported job losses.

5b. Number of Individuals that did not Obtain Employment but are Pursuing Education (e.g., GED,

college courses, etc.). Enter the number of graduates from the cooperative agreement funded training

program who have not obtained employment but are pursuing an education. Education can include GED

classes, college courses, vocational training, etc.

6. Average Hourly Wage. Enter the average hourly wage of job training graduates in their initial post

training 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.EPA Form 6200

- 04 7. Funds Leveraged. Enter the total amount of funding leveraged as a result of cooperative agreement

activities. Capture the total number of non

- cooperative agreement dollars linked and leveraged to s upport

additional, related activities of the 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 in

- kind services or supplies. Usually, leveraged funding that was

committed prior to the award of the EPA recipient should not be reported as leveraged. 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 cooperative agreement (e.g.,

transportation or child care for job training students).

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

types of activities it funded. For each funding source (7

- 1), also list the type of activity funded (7

- 2) and the

amount of funding leveraged per source in columns (a) and (b). As necessary, add additional lines for 7

- 1

and 7

- 2.

7

- 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.

7

- 2. Activity Funded. For each funding source listed under 7

- 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.

8. Supplement Performance Measu res 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; names of employers; names of brownfield sites

graduates are placed at; availability of photographs/video footage of the training/graduation/post

- training

employment; and/or other milestones tracked by the recipient for its own management.

PART III

- APPROVALS

9. Cooperative Agreement Recipient Project Manager. Type or print the name of the cooperative

agreement recipient project manager. The project manager should also sign and date the completed JT

Reporting Form before submission.

10. 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.