SUPPORTING STATEMENT

IDENTIFICATION OF THE INFORMATION COLLECTION

TITLE OF THE INFORMATION COLLECTION

Information Collection Request (ICR) 2207.02, Exchange Network Grants
Progress Reports, OMB Control Number 2025-0006, covers two forms to be
used by Exchange Network Grant recipients to report semi-annual progress
and quality assurance, a stipulation of their grant award. The current
ICR expires on July 31, 2006.

(b) SHORT CHARACTERIZATION

The Environmental Protection Agency (EPA) Office of Environmental
Information provides funding to EPA’s Exchange Network partners:
states; territories; and federally recognized Indian tribes to support
the development of the Environmental Information Exchange Network
(EIEN). 

As a stipulation of the award, recipients are required to submit
semi-annual and final progress reports.  Over the years, the reports
have come in several different formats making it burdensome to compare
grantee status.  The Progress Reporting Form is intended to provide a
uniform, simplified format for grantees to report goals, outputs, and
outcomes.  The form will serve as both the semi-annual and final
reporting form.

The Quality Assurance Reporting Form is intended to provide a simple
means for grant recipients to present how quality will be addressed
throughout their projects.  The Quality Assurance Reporting Form is
derived from guidelines provided in the EIEN’s fiscal year 2006 grant
solicitation notice.  As a stipulation of their award, grant recipients
are to submit tailored quality assurance information within ninety days
of grant award.

The EPA Office of Environmental Information understands that ICR 2207.01
was approved in January 2006, in advance of the government-wide effort
to standardize grantee performance reporting under Public Law 106-107.
As such, this information collection will adhere to the government-wide
grant reporting procedures as they become available.

2.	NEED FOR AND USE OF THE COLLECTION

AUTHORITY/NEED FOR THE COLLECTION

	The authority to gather progress performance and quality assurance
information for assistantship programs is derived from   SEQ CHAPTER \h
\r 1 40 CFR Part 31, “Uniform Administrative Requirements for Grants
and Cooperative Agreements to State and Local Governments.” 

	Section 31.40, Monitoring and reporting program performance, states:

“(1) Grantees shall submit annual performance reports unless the
awarding agency requires quarterly or semi-annual reports. However,
performance reports will not be required more frequently than quarterly.
 Annual reports shall be due 90 days after the grant year, quarterly or
semi-annual reports shall be due 30 days after the reporting period. The
final performance report will be due 90 days after the expiration or
termination of grant support. If a justified request is submitted by a
grantee, the Federal agency may extend the due date for any performance
report. Additionally, requirements for unnecessary performance reports
may be waived by the Federal agency.

    (2) Performance reports will contain, for each grant, brief
information on the following:

    	(i) A comparison of actual accomplishments to the objectives
established for the period. Where the output of the project can be
quantified, a computation of the cost per unit of output may be required
if that information will be useful.

    	(ii) The reasons for slippage if established objectives were not
met.

   	(iii) Additional pertinent information including, when appropriate,
analysis and explanation of cost overruns or high unit costs.”

    

Section 31.45 Quality Assurance, states:

“If the grantee's project involves environmentally related
measurements or data generation, the grantee shall develop and implement
quality assurance practices consisting of policies, procedures,
specifications, standards, and documentation sufficient to produce data
of quality adequate to meet project objectives and to minimize loss of
data due to out-of-control conditions or malfunctions.”

The need for the Office of Environmental Information (OEI) to create its
own progress report and quality assurance forms for which this ICR
covers is three-fold.  First, EPA does not currently have a standard
progress report or quality assurance form for electronic information
grants that can be disseminated to our grantees.  Second, the differing
formats of the semi-annual progress report over the years have made it
difficult to synthesize information for project evaluation.  Third, our
program’s Regional Grant Coordinators, who are responsible for
collecting progress reports from project officers in the states, tribes
and territories, have specifically requested this report format.

(b) USE/USERS OF THE DATA

The information provided on semi-annual forms will be used by the
Regional Grant Coordinators to monitor grant project development and
performance.  The reports will be attached to the applicable grantee’s
file in the Integrated Grants Management Database. The same reporting
form will also be used as the Final Progress Report, and will be used to
rate performance for future grant awards.

The Quality Assurance Report Form will be used to ensure grantees will
use quality assurance measures outlined in the EIEN Grant Solicitation
Notice Appendix D to pursue their project.

3.	NON DUPLICATION, CONSULTATIONS, AND OTHER COLLECTION CRITERIA

	(a) NONDUPLICATION

	The information a grantee provides in their Semi-annual Progress Report
is unique to each project.  Information concerning the status of goals,
outcomes and outputs for each project is not available from any other
source.  

PUBLIC NOTICE

The notice for this collection renewal was published was published on in
the Federal Register, Volume 71, No. 50, on March 16, 2006.  We have not
received any public comments from the notice.

CONSULTATIONS

For this ICR action, we consulted with the EIEN’s ten Regional Grant
Coordinators (RGC).  The RCGs are EPA employees, one in each of the
EPA’s ten regions, who specialize in Environmental Information.  For
most of the EIEN grants, the RGC is also the Project Officer and has
direct contact with the state, tribe or territory grantee. The RGC is
responsible for monitoring grant progress and collecting the Semi-annual
Progress Report Form.  It was the RGCs direct input that led to specific
changes in the form.

When the Emergency ICR was approved by OMB on January 31, 2006, the RGCs
requested that the form be simplified and organized in a format similar
to a “best practice” style that several grantees were already using.
 The RGCs also suggested that the form should be created in such a way
that grantees could continually update information and then use the
completed updates as the final report, thus lessening the repetitive
reporting methods of the past.  In conjunction with the RGCs, all of the
changes have been made.  The result is a streamlined  form familiar to
grantees that we are seeking ICR approval for.

The Quality Assurance Form was modeled in the same format as Appendix D
of the 2006 Grant Solicitation Notice. 

EFFECTS OF LESS FREQUENT COLLECTION

EIEN grants are usually awarded for two-year project periods.  The
Quality Assurance Form would be completed only once, no more than three
moths after the award is made.  As a stipulation of the EIEN grant
award, a progress report is completed every six months and a final
report is submitted no later than three months after project completion.
Less frequent reporting could result in project mismanagement.  For some
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.

GENERAL GUIDELINES

	Both the Semi-annual Progress Report Form and the Quality Assurance
Form covered in this ICR adhere to OMB general guidelines.

CONFIDENTIALITY

No pledge of confidentiality is given for grantee responses in either
the Semi-annual Progress Report Forms or Quality Assurance Forms.

SENSITIVE QUESTIONS

No sensitive questions are asked on either the Semi-annual Progress
Report Forms or Quality Assurance Forms.

4.	THE RESPONDENTS AND THE INFORMATION REQUESTED

RESPONDENTS/SIC CODES

Our respondents are generally employees of state, tribal, or territorial
environmental government offices.  For instance, the current grants
awarded to the state of North Carolina are managed by an employee of the
North Carolina Department of Natural Resources.

According to the 2002 NAICS 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 Administrations of Conservation Programs

INFORMATION REQUESTED

Please see attached forms for specific data elements (Exhibits B and C).

The data fields have changed since the OMB clearance in January, 2006. 
Specifically, the changes to the Semi-annual Progress Reporting form
are:

Page 1 – General Project Program Information

Reporting options were changed from Quarterly, Semi-Annual, Annual, and
Final to “Semi-Annual or Final” because Quarterly and Annual reports
are unnecessary.

“Before 2006 Exchange Network Grant Category” was added to identify
the type of grant for the Program Manager.

“Focus” was added to further identify the grant from other grants by
the same state agency for the Program Manager.

Page 2 – Project Goals

Section II and III of the previous format were combined into one section
in the new format.

The old format had columns titled:  Activities, Baseline, Outputs and
Outcomes, Target Date, and Completion Date.

The new format, one more familiar to grantees, has the columns:  Goals,
Outputs, Scheduled Date, Completion Date and Outcomes.

Page 3 – Comments

The wording was changed to phrases more familiar to grantees.

The old format included data fields for:  Problems, Impacts, Corrective
Actions Taken, Other Comments.

The new format includes data fields for:  Current Problems, Actions,
Request help from EPA, Other Comments.

RESPONDENT ACTIVITIES

	As previously stated, grantees are already required to report progress
semi-annually on their projects.  EIEN grantees have been submitting
Semi-annual Progress Reports and final reports to EPA Regional Offices
since the EIEN grant program began in 2002.  The Quality Assurance Form
is a new form for grantees to complete ninety days after award, but the
measures for Quality Assurance in a grantees’ project have been
explained in the EIEN Solicitation Notice since 2002.  

	According to the 1995 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.	INFORMATION COLLECTED

AGENCY ACTIVITIES

	Once the Semi-annual Reporting and Quality Assurance Forms are received
by the RGC, they are attached to the grant’s file in the Integrated
Grants Management System (IGMS) database.  It is simultaneously emailed
to the National Grant Coordinator at Headquarters who may use the
information to report grant status.

COLLECTION METHODOLOGY

	This information collection is form-related.  The Semi-annual Progress
Report Form has not been pre-tested but is based on a current format
voluntarily used by several states.  The format has worked well in the
past and is a “best practice” that we voluntarily chose to adopt. 
The Quality Assurance Form has not been pre-tested because 2006 awards
will not be issued until August, thus the form will be returned in
October, 2006.  However, the form is based on the information in
Appendix D of the 2006 Grant Solicitation Notice. 

	Respondents will enter data in Microsoft Word and email it to their
RGC.  The RGC will upload the forms in IGMS, a lotus based database that
has been used by the EPA since 2000.  To reduce burden, we ask 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 Progress Report from the previous six months. 

COLLECTION SCHEDULE

Table 1

FORM	SCHEDULE

Quality Assurance Report Form		Due to RGC 90 days after award of grant

Semi-Annual Progress Report Form	Due to RGC April 30 (Oct. 1- Mar. 31
period)

Due to RGC October 31 (Apr. 1 – Sept. 30 period)



6.	BURDEN ESTIMATE AND COST OF COLLECTION

ESTIMATING RESPONDENT BURDEN

The estimated hours for completing each form includes time for reviewing
instructions, completing information and transmitting through email.

Table 2

Form	Estimated Hours	Frequency per Year	Total Burden Hours

Semi-Annual Progress Reporting Form	1.5	2	3

Quality Assurance Reporting Form	1	1	1

Total	4



	(b) RESPONDENT UNIVERSE AND BURDEN

	

	At the beginning of fiscal year 2007, we estimate 225 grantees will be
responding to the Semi-annual Progress Report Form.  That number is
derived from our estimate of the rolling number of “Active Grants.”
The number of active grants fluctuates throughout the year as projects
are completed and grants are officially awarded and closed.  Every EIEN
grant is awarded for a two-year project period. Approximately half of
the grantees from any given year request extensions for their projects
for an additional year.  Using these exceptions and including the grants
that will be awarded in July 2006, we estimate 225 respondents at any
one time.

	The Quality Assurance Form will be completed only by award recipients
beginning in 2006.  These respondents are not unique; they are the same
respondents who will submit Semi-annual Progress Report Forms after the
first six months of their projects.

	Our burden estimate per year is based on the government’s fiscal
year.  In one fiscal year, a respondent who receives an award in 2006
will complete one Quality Assurance Form and two Semi-annual Progress
Report Forms.  Since this ICR will cover 2006-2009, we have included the
Quality Assurance burden hour estimate for each respondent, though
respondents for grant years 2003-2005 will not be required to respond. 
Please see Table 3.

Table 3

EIEN GRANT YEAR	Number of Grants

Semi-annual Progress Respondents	Number of 

Closed Grants no longer reporting	Number of Awards

γ

2004	67

0 γ

2005	59

0 γ

2006†	58

58

Total:	  =SUM(ABOVE)  251 

58

Total – Closed Grants	251-26 = 225	58

*As many as half of the 2003 grants projects have been completed, thus
no longer requiring reporting

† Awards for 2006 have yet to be awarded, thus the number of awards is
an estimate.

γ Grantees prior to 2006 will not respond to the Quality Assurance
Form, thus not all respondents complete every form every year.

					

Total Number of Responses:			

	Semi-annual Progress Forms:		225 Respondents x 2 per year = 	450

	Quality Assurance Report Form:	58 Respondents x 1 per year = 	 58

	Total =										508	

		

Total Burden:

	Semi-annual Progress Forms :	225 respondents x 3 hours = 		675

	Quality Assurance Report Form:	58 respondents x 1 = 			058

	Total = 									733

	(c) ESTIMATING RESPONDENT COST

	

Respondent Wage Rate:	  SEQ CHAPTER \h \r 1 $36.28 1 x 1.40 = $50.79

Quality Assurance Form:	58 Respondents x 1 hour x $50.79 = 2945.82

Progress Report Form:	225 Respondents x 1.5 hours x 2 per year x $50.79
= $34,283.25

	There are no capital, operating and maintenance, and annualizing
capital costs incurred by this information collection.  The respondent
cost is calculated in Table 4.

Table 4

Cost	Semi Annual	Quality Assurance

Labor Cost 	$34,283.25	$2,945.82

Capital/Start-up Cost	$0	$0

Operating and Maintenance	$0	$0

Annualizing Capital	$0	$0

Total Costs	$34,283.25	$2,945.82

	

	(d) ESTIMATING AGENCY BURDEN AND COST

	

	To estimate the cost and burden to EPA RGC’s, the estimated number of
“Active Grants,” 225, was used.  Since this ICR will cover
2006-2009, the number of forms per year was calculated at three, though
that number will not be in effect until grants prior to 2006 are closed.
 The total number of hours that all of EPA’s RGC’s review and submit
both forms is 337.50 hours per year.  The 337.50 hours per year cost the
agency $12,973.50 dollars.  Please see Table 5.

Table 5

Each RGC has approximately 22.5 Active Grants.					22.5

To Review and upload one form take .5 hours.			.5

Each grantee owes the RGC three forms per year			.5 x 3	          	 x
1.5

RGCs total hours									33.75

10 RGCs										x 10

Total RGS Hours for all Grants							337.50

RGC Hourly Rate, Fully Burdened*					$38.44		x 38.44

Total costs to 10 RGC for review and submit					$12,973.50

* The 2005 average hourly rate for General Schedule (GS) 11, Step 9
($27.46) was used to estimate burden costs for the EPA.  This was also
fully burdened (x 40 %), yielding a wage rate of $38.44.

(e) BOTTOM LINE BURDEN HOURS AND COSTS

Table 6

Total Annual Responses =			508		

Total burden hours for respondents = 	733* hours

Total burden hours for EPA = 		337.5 hours

Total respondent cost =			$0 dollars

Total EPA cost = 				$12,973.50 dollars

*Not all respondents complete every activity, every year.

(f) REASONS FOR CHANGE IN BURDEN

When we initially received OMB approval for ICR 2207.01 in January 2006,
annual response was calculated at 450, and burden hours were calculated
at 450.  These numbers did not account for responses for: extended grant
project periods (e.g. 2003 grants which remain open), grants awarded
this fiscal year (e.g. 2006 awards will be issued in July), and the
Quality Assurance Form.  

When the first Federal Register notice for ICR 2207.02 appeared on March
16, 2006, the burden statement accounted for these factors but assumed a
lower number of hours for the Semi-annual Progress Report Form. After
consulting with the RGCs, we raised the number of hours a respondent
completes the form from 1 hour to 1.5 hours. Thus the number of burden
hours for the Semi-annual Progress Report Form is adjusted from 450 (225
respondents x 2 responses x 1 hour) to 675 (225 respondents x 2
responses x 1.5 hours). This is the +225 adjustment in hours.

The program also changed because the Quality Assurance Form is now
included, and that adds an additional 58 responses.  The Quality
Assurance Form has a one hour burden, thus 58 hours will be added to the
675 hours for the progress form, totaling 733 burden hours.  The program
change is +58 hours.

Table 7

Burden	Responses	Burden Hours	Burden Costs

Previous	450	450	$0

New	508	733	$0

Difference	58	283	$0

Program Change	+58	0	$0

Adjustment	0	+225	$0



(g) BURDEN STATEMENT

The burden for Semi-annual Progress Reports is based on time for
reviewing instructions, completing information, and transmitting the
information via email. For the Semi-annual Progress Report Form, the
respondent burden is 1.5 hours.  Respondents complete the form twice a
year, thus the total annual burden is 3 hours.  For the Quality
Assurance Form, the annual respondent burden is 1 hour.  Only
respondents who receive grants this year, 2006, or later will complete
this form.  

The annual public reporting burden for the Semi-annual Progress Report
Form is estimated to average 1.5 hours per response.  The annual public
reporting burden for the Quality Assurance Reporting Form is estimate to
average 1 hour per response.  Burden means the total time, effort, or
financial resources expended by 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 systems for the purposes of
collecting, validating, and verifying information, processing and
maintaining information, and disclosing and providing information;
adjust the existing ways to comply 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
currently valid OMB control number.  The OMB control numbers for EPA's
regulations are listed in 40 CFR part 9 and 48 CFR chapter 15.     

	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 ICR under Docket ID Number
EPA-HQ-OEI-2006-0037 , which is available for online viewing at  
HYPERLINK "http://www.regulations.gov"  www.regulations.gov , or in
person viewing at the Office of Environmental Information Docket in the
EPA Docket Center (EPA/DC), EPA West, Room B102, 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 holidays.  The telephone number for the Reading Room is (202)
566-1744, and the telephone number for the Office of Environmental
Information 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 system,
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 EPA Docket ID Number EPA-HQ-OEI-2006-0037 and OMB Control Number
2025-0006 in any correspondence.

U.S. ENVIRONMENTAL PROTECTION AGENCY

Exchange Network Grant Program Progress Reporting 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
project 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:



Progress Report Instructions:

List major goals and each goal’s outputs as described in the work
plan.  

In the “Scheduled Date” column enter the dates from the grant work
plan

In the “Completion Date” column enter the date each output completed
as of the period covered by this report

In the Outcomes column, briefly outline how the goal or output will
enhance the recipient’s ability to carry out its mission or result in
other benefits.     

Use bold type for the outputs or outcomes you achieved during the
current reporting period.    

Insert more rows if you need them by using the tab key in the last cell
of the last row.  



EXAMPLE



Goals	Outputs	Scheduled Date	Completion date	List Outcomes for Each
Goal, and, if they differ, each Output 

1. Begin flowing ambient air quality data through the Exchange Network.
1. Develop XML schema by.	. mm/yyyy	mm/yyyy	 Enhanced environmental
decision-making due to more timely access to ambient air quality data.

	2. Initiate first test data flow by mm/yyyy	mm/yyyy





Goals	Outputs	Scheduled Date	Completion date	List Outcomes for Each
Goal, and, if they differ, each Output 



























































Comments

Instructions: If you have had any problems during the current period
please report them here.  In accordance with 40 C.F.R. §30.51(f) and 40
C.F.R. §31.40(d), a recipient of an EPA assistance agreement must
notify EPA of any problems, delays, or adverse conditions that will
materially impair the recipient’s ability to achieve the
outputs/outcomes specified in the assistance agreement work plan.



Current problems 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:





Definitions

Project/Program Goal:  A major objective or endpoint identified in the
assistance agreement work plan.  A work plan may include one or more
project/program goals. Use the goals as described in the assistance
agreement work plan.

Output:  A product, service, or implementation target that will be
produced or achieved during the project/program.  Outputs may be
qualitative or quantitative, but they must be measurable during the
assistance agreement funding period.  

Outcome:  Changes or benefits resulting from the successful achievement
of the project/program activities and outputs.  Outcomes may be
environmental, behavioral, health-related, or programmatic in nature,
but they must be quantitative.  Outcomes may not necessarily be
achievable within the assistance agreement funding period, and they can
be described as short-term, intermediate, or long-term:  

short-term – changes in learning, knowledge, attitudes, or skills; 

intermediate – changes in behavior, practices, or decisions; or 

long-term – changes in environmental, human health, or other
conditions.   



Paperwork Reduction Act (PRA) Burden Statement:  The public reporting
and recordkeeping burden for this collection of information is estimated
to average ninety 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 collection techniques to the
Director, Collection 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.



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, Analysis and Integration	

□ Planning, Mentoring, and Training

□ Challenge

Goal	Task	Output	Outcome	Quality Assurance Measures















Instructions:     - Please submit electronically to
exchangenetwork@epa.gov within 90 days of award.

                           - For Quality Assurance Measures, please
refer to Solicitation Notice Appendix D: Quality Assurance Guidelines.

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o 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 automated collection techniques to the Director, Collection
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.



	1  $36.28 represents the average wage rate of several occupations
expected to apply for grants or fellowships.  1.40 represents a 40% rate
for benefits.  This figure is derived from Table 1. Civilian Workers, by
Major Occupation Group; Management, Professional, and Related- found in
the Bureau of Labor Statistics New Release, “Employer Costs for
Employee Compensation - March 2005.”

 

 PAGE   

 PAGE   1 

OMB No. 2025-0006

Expires xx/xx/xxxx 

 PAGE   14 

EPA Form 5300-26

 PAGE   15 

EPA Form 5300-27

