Grant Performance Report Cover Sheet (Part 1 Cover Sheet And Summary) {ED 524B}

U.S. Department of Education Grant Performance Report Cover Sheet (ED 524B) Check only one box per Program Office instructions. [ ] Annual Performance Report [ ] Final Performance Report OMB No. 1894-0003 Exp. 06/30/2017 General Information 1. PR/Award #: _______________________________________ (Block 5 of the Grant Award Notification - 11 characters.) (Enter the same title as on the approved application.) 4. Grantee Name (Block 1 of the Grant Award Notification.):______________________________________________________________ 5. Grantee Address (See instructions.) 6. Project Director (See instructions.) Name:_______________________________________Title: _______________________________ Ph #: ( ) ________ - __________ Ext: ( ) Fax #: ( ) ________ - __________ Email Address: __________________________________________________ 2. Grantee NCES ID#: _________________________________ (See instructions. Up to 12 characters.) 3 Project Title: __________________________________________________________________________________________________ Reporting Period Information (See instructions.) 7. Reporting Period: From: _____/_____/_______ To: _____/_____/_______ (mm/dd/yyyy) Budget Expenditures (To be completed by your Business Office. See instructions. Also see Section B.) 8. Budget Expenditures Federal Grant Funds a. Previous Budget Period b. Current Budget Period c. Entire Project Period (For Final Performance Reports only) Non-Federal Funds (Match/Cost Share) Indirect Cost Information (To be completed by your Business Office. See instructions.) 9. Indirect Costs a. Are you claiming indirect costs under this grant? ___Yes ___No b. If yes, do you have an Indirect Cost Rate Agreement approved by the Federal Government? ___Yes ___No c. If yes, provide the following information: Period Covered by the Indirect Cost Rate Agreement: From: _____/ _____/_______ To: _____/_____/_______ (mm/dd/yyyy) Approving Federal agency: ___ED ___Other (Please specify): ___________________________________________________ Type of Rate (For Final Performance Reports Only): ___ Provisional ___ Final ___ Other (Please specify): _______________ d. For Restricted Rate Programs (check one) -- Are you using a restricted indirect cost rate that: ___ Is included in your approved Indirect Cost Rate Agreement? ___ Complies with 34 CFR 76.564(c)(2)? Human Subjects (Annual Institutional Review Board (IRB) Certification) (See instructions.) 10. Is the annual certification of Institutional Review Board (IRB) approval attached? ___Yes ___ No ___ N/A Performance Measures Status and Certification (See instructions.) 11. Performance Measures Status a. Are complete data on performance measures for the current budget period included in the Project Status Chart? ___Yes ___ No b. If no, when will the data be available and submitted to the Department? _____/_____/______ (mm/dd/yyyy) 12. To the best of my knowledge and belief, all data in this performance report are true and correct and the report fully discloses all known weaknesses concerning the accuracy, reliability, and completeness of the data. _____________________________________________________ Name of Authorized Representative: _____________________________________________________ Signature: ED 524B Title: _______________________________________ Date: _____/_____/_______ Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com U.S. Department of Education Grant Performance Report (ED 524B) Executive Summary OMB No. 1894-0003 Exp. 06/30/2017 PR/Award # (11 characters): ________________________ (See Instructions) ED 524B Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com