Form B Progress Report

OMB Number 0915-0061

Expiration date XX/XX/201X

Public Burden Statement:  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 number for this project is 0915-0061.  Public reporting burden for this collection of information is estimated to average .25 hours per response, including the time for reviewing instructions, searching existing data sources, 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 HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, Maryland, 20857.

APPENDIX B

Revised Progress Report

FORM NAME: PROGRESS REPORT

TYPE OF RESPONDENT: Grantees of Infrastructure Programs

Grantees of Direct Financial Support Programs

Grantees of Multipurpose or Hybrid Programs

SECTION I. PROJECT OBJECTIVES AND ACCOMPLISHMENTS¹

Objective A

Description of Objective

Accomplishments

Objective B

Description of Objective

Accomplishments

Objective C

Description of Objective

Accomplishments

SECTION II. BARRIERS & RESOLUTIONS²

Barrier A

Description

Activities Taken to Resolve

Barrier B

Description

Activities Taken to Resolve

SECTION III. TECHNICAL ASSISTANCE NEEDS

Please identify any technical assistance needs that will assist your organization in meeting project objectives and/or improve performance.

1 Note: grantees will have the ability to list up to 9 objectives and related accomplishments.

2 Note: grantees will have the ability to list up to 9 barriers and related solutions.

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