Attachment
B:
Job
Training
Reporting
Form
 
Brownfields
The
public
reporting
and
recordkeeping
burden
for
this
collection
of
information
is
estimated
to
average
5
hours
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.

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
No.
SFUND­
2003­
0004,
which
is
available
for
public
viewing
at
the
OSWER
Docket
in
the
EPA
Docket
Center
(
EPA/
DC),
EPA
West,
Room
B102,
1301
Constitution
Ave.,
NW,
Washington,
DC.
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
OSWER
Docket
is
(
202)
566­
2426.
An
electronic
version
of
the
public
docket
is
available
through
EPA
Dockets
(
EDOCKET)
at
http://
www.
epa.
gov/
edocket.
Use
EDOCKET
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.
Once
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,
DC
20503,
Attention:
Desk
Office
for
EPA.
Please
include
the
EPA
Docket
ID
No.
SFUND­
2003­
0004
and
OMB
control
number
(
2050­
NEW)
in
any
correspondence.
EPA
Form
9310­
2
(
8­
2003)
United
States
ENVIRONMENTAL
PROTECTION
AGENCY
Washington,
DC
20460
Form
Approved.
OMB
No.
2050­
XXXX
Expires
XX­
XX­
XXXX
JOB
TRAINING
REPORTING
FORM
Brownfields
PART
I
 
GRANT
RECIPIENT
INFORMATION
1.
Grant
Recipient
Name
2.
Grant
Number
Public
reporting
burden
for
this
collection
of
information
is
estimated
to
average
5
hours
per
response,
including
the
time
for
reviewing
instructions,
searching
data
sources,
gathering
and
maintaining
the
data
needed,
and
completing
and
reviewing
the
collection
of
information.
Send
comments
regarding
this
burden
estimate,
or
any
other
aspect
of
this
collection
of
information,
including
suggestions
for
reducing
this
burden,
to
the
Environmental
Protection
Agency,
Office
of
Environmental
Information,
Code
2822T,
Washington,
DC
20460
and
to
the
Paperwork
Reduction
Project,
Office
of
Management
and
Budget,
Washington,
DC
20503.
DO
NOT
RETURN
your
form
to
either
of
these
addresses.
Send
your
completed
form
to
the
address
provided
by
the
issuing
office.
PART
II
 
PERFORMANCE
MEASURES
INFORMATION
Table
A
 
Mandatory
Performance
Measures
Measure
(
a)
This
Quarter
(
b)
Cumulative
3.
Number
of
Participants
Completing
Training
4.
Number
of
Participants
Obtaining
Employment
5.
Average
Hourly
Wage
of
Participants
Obtaining
Employment
6.
Funds
Leveraged
(
total)

6­
1.
Funding
Source
Name
6­
2.
Activity
Funded
6­
1.
Funding
Source
Name
6­
2.
Activity
Funded
6­
1.
Funding
Source
Name
6­
2.
Activity
Funded
7.
Supplemental
Performance
Measures
Information
(
optional)

PART
III
 
APPROVALS
8.
Grant
Recipient
Project
Manager
Name
Signature
Date
9.
US
EPA
Regional
Representative
Name
Signature
Date
EPA
Form
9310­
2
(
8­
2003)
INSTRUCTIONS
FOR
COMPLETING
JOB
TRAINING
REPORTING
FORM
­
BROWNFIELDS
GENERAL
INSTRUCTIONS
Overview:
As
specified
in
your
grant
terms
and
conditions,
all
job
training
grant
recipients
must
report
to
EPA
on
a
regular
basis.
This
OMB
and
EPA
approved
reporting
form
(
OMB
No.
2050
­
####,
EPA
Form
9310­
2),
supplements
your
Quarterly
Reports
with
information
about
specific
activities
and
accomplishments
that
EPA
deems
necessary
to
adequately
monitor
and
evaluate
the
performance
of
job
training
grants.
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
one
of
the
FOIA
exclusions
is
applicable.

Compared
to
the
Quarterly
Reports,
the
Brownfields
Job
Training
Reporting
Form
(
JT
Reporting
form)
contains
quantitative
information
relating
to
four
specific
measures
of
grant
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.
Grant
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
grant,
or
when
leveraged
funding
is
committed
to
supplement
the
grant
activities).
The
form
should
be
attached
and
delivered
with
the
next
required
Quarterly
Report.

Updated
JT
Reporting
Forms.
JT
Reporting
forms
should
be
updated
and
delivered
as
additional
accomplishments
occur,
and
should
be
attached
to
the
next
required
Quarterly
Report.
In
addition,
an
updated
form
should
be
provided
when
the
grant
is
being
closed­
out.

To
Whom
to
Submit:
Grant
recipients
should
submit
the
JT
Reporting
forms
to
their
EPA
Regional
Representative
identified
in
the
terms
and
conditions
of
the
cooperative
agreement
and
the
EPA
Headquarters
Data
Manager.

How
to
Submit:
EPA
is
undertaking
a
two­
phased
process
to
facilitate
electronic
reporting
and
information
dissemination
system
to
facilitate
future
grant
recipient
reporting.
In
the
first
phase,
EPA
will
prepare
electronic
versions
of
this
and
other
required
reporting
forms
for
the
grant
recipients
to
complete
and
submit
via
e­
mail.
In
the
second
phase,
EPA
will
develop
a
web­
based
database
that
will
allow
entry
of
the
information
directly
by
the
grant
recipient
or
the
Region.
As
needed,
EPA
will
continue
to
provide
contractor
data
entry
and
quality
assurance
support.
Electronic
reporting
is
optional,
hard
copy
reports
always
will
be
acceptable.
EPA
Form
9310­
2
(
8­
2003)
DETAILED
INSTRUCTIONS
FOR
COMPLETING
EACH
ITEM
ON
FORM
PART
I
­
GRANT
RECIPIENT
INFORMATION
1.
Grant
Recipient
Name.
Enter
the
grant
name.
Use
the
official
name
of
the
grant
recipient
as
provided
in
the
cooperative
agreement,
unless
otherwise
directed
by
the
EPA
Regional
Representative.

2.
Grant
Number.
Enter
the
grant
number.
Use
the
number
of
the
grant
as
provided
in
the
cooperative
agreement.

PART
II
­
PERFORMANCE
MEASURES
INFORMATION
This
section
contains
two
parts
 
one
mandatory,
for
certain
limited
performance
measures
information
(
Table
A);
the
other
optional,
for
narrative
information
to
supplement
the
quantitative
information
provided
(
section
7).

Table
A
­
Mandatory
Performance
Measures.
In
Table
A,
provide
all
quantitative
information
relating
to
each
of
the
four
(
4)
mandatory
performance
measures.
For
each
measure,
enter
amounts
in
column
(
a)
 
This
Quarter
 
to
reflect
the
incremental
accomplishments
attained
during
the
current
reporting
quarter
and
column
(
b)
 
Cumulative
 
to
reflect
the
total
accomplishments
attained
to
date
during
the
term
of
the
grant.
Note:
Quantitative
information
relating
to
these
performance
measures
should
only
be
provided
in
the
table
(
i.
e.,
not
in
narrative
reporting
contained
in
the
Quarterly
Report).

3.
Number
of
Participants
Completing
Training.
Enter
the
number
of
participants
taking
the
grant
funded
training
who
have
completed
the
training
program.

4.
Number
of
Participants
Obtaining
Employment.
Enter
the
number
of
graduates
from
the
grant
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
grant;
the
grant
recipients'
quantitative
reporting
of
the
cumulative
total
should
not
reflect
any
decreases
for
graduates
who
had
obtained
employment,
but
later
report
losing
their
jobs.
If
desired,
provide
a
brief
narrative
description
in
section
7
for
any
reported
job
losses.

5.
Average
Hourly
Wage.
Enter
the
average
hourly
wage
of
job
training
graduates
in
their
initial
posttraining
employment.
Provide
the
hourly
wage
for
the
first
job
that
each
employed
graduate
secures
after
completing
the
job
training
program.
Anecdotal
informa
tion
about
subsequent
jobs
and
wages
may
also
be
narratively
provided
by
the
grant
recipient.

6.
Funds
Leveraged.
Enter
the
total
amount
of
funding
leveraged
as
a
result
of
grant
activities.
Capture
the
total
number
of
non­
grant
dollars
linked
and
leve
raged
to
support
additional,
related
activities
of
the
grant
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
inkind
services
or
supplies.
Usually,
leveraged
funding
that
was
committed
prior
to
the
award
of
the
EPA
grant
should
not
be
reported
as
leveraged
since
the
activity
predates
the
award.
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
grant
(
e.
g.,
transportation
or
child
care
for
job
training
students).

In
addition
to
the
total
leveraged
funds,
also
describe
the
source
and
amount
of
funding
leveraged,
and
the
EPA
Form
9310­
2
(
8­
2003)
types
of
activities
it
funded.
For
each
funding
source
(
6­
1),
also
list
the
type
of
activity
funded
(
6­
2)
and
the
amount
of
funding
leveraged
per
source
in
columns
(
a)
and
(
b).
As
necessary,
add
additional
lines
for
6­
1
and
6­
2.

6­
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.

6­
2.
Activity
Funded.
For
each
funding
source
listed
under
6­
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.

7.
Supplement
Performance
Measures
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;
availability
of
photographs/
video
footage
of
the
training/
graduation/
post­
training
employment;
and/
or
specific
milestones
tracked
by
the
grant
recipient
for
its
own
management.

PART
III
­
APPROVALS
8.
Grant
Recipient
Project
Manager.
Type
or
print
the
name
of
the
grant
recipient
project
manager.
The
project
manager
must
also
sign
and
date
the
completed
JT
Reporting
form
before
submission.

9.
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.
