Form ED524B "Grant Performance Report Cover Sheet"

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U.S. Department of Education
OMB No. 1894-0003
Exp. 07/31/2024
Grant Performance Report Cover Sheet (ED 524B)
Check only one box per Program Office instructions.
[ ] Annual Performance Report [ ] Final Performance Report
General Information
1. PR/Award #:
2. Grantee NCES ID#:
(Block 5 of the Grant Award Notification - 11 characters.)
(See instructions. Up to 12 characters.)
3 Project Title:
(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:
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
Non-Federal Funds (Match/Cost Share)
a. Previous Budget Period
b. Current Budget Period
c. Entire Project Period
(For Final Performance Reports only)
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
If yes, please indicate which of the following applies to your grant?
b.
The grantee has an Indirect Cost Rate Agreement approved by the Federal Government:
The period covered by the Indirect Cost Rate Agreement is from:
/
/
to:
/
/
(mm/dd/yyyy)
The approving Federal agency is:
ED
Other (Please specify):
The Indirect Cost Rate is
%
The Type of Rate (For Final Performance Reports Only) is:
Provisional
Final
Other (Please specify):
c.
The grantee is not a State, local government, or Indian tribe, and is using the de minimus rate of 10% of modified total direct
costs (MTDC) in compliance with 2 CFR 200.414(f).
d.
The grantee is funded under a Restricted Rate Program and is you using a restricted indirect cost rate that either:
Is included in its approved Indirect Cost Rate Agreement; or
Complies with 34 CFR 76.564(c)(2).
e.
The grantee is funded under a Training Rate Program and:
Is recovering indirect cost using 8 percent of MTDC in compliance with 34 CFR 75.562(c)(2); or
Is recovering indirect costs using its actual negotiated indirect cost rate reflected in 9(b).
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
Data Privacy and Security Measures Certification (See instructions.)
11. Is a statement affirming that you are aware of federal and state data security and student privacy regulations included, with supporting
documentation attached?
Yes
No
N/A
Page 1 of 3
ED 524B
U.S. Department of Education
OMB No. 1894-0003
Exp. 07/31/2024
Grant Performance Report Cover Sheet (ED 524B)
Check only one box per Program Office instructions.
[ ] Annual Performance Report [ ] Final Performance Report
General Information
1. PR/Award #:
2. Grantee NCES ID#:
(Block 5 of the Grant Award Notification - 11 characters.)
(See instructions. Up to 12 characters.)
3 Project Title:
(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:
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
Non-Federal Funds (Match/Cost Share)
a. Previous Budget Period
b. Current Budget Period
c. Entire Project Period
(For Final Performance Reports only)
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
If yes, please indicate which of the following applies to your grant?
b.
The grantee has an Indirect Cost Rate Agreement approved by the Federal Government:
The period covered by the Indirect Cost Rate Agreement is from:
/
/
to:
/
/
(mm/dd/yyyy)
The approving Federal agency is:
ED
Other (Please specify):
The Indirect Cost Rate is
%
The Type of Rate (For Final Performance Reports Only) is:
Provisional
Final
Other (Please specify):
c.
The grantee is not a State, local government, or Indian tribe, and is using the de minimus rate of 10% of modified total direct
costs (MTDC) in compliance with 2 CFR 200.414(f).
d.
The grantee is funded under a Restricted Rate Program and is you using a restricted indirect cost rate that either:
Is included in its approved Indirect Cost Rate Agreement; or
Complies with 34 CFR 76.564(c)(2).
e.
The grantee is funded under a Training Rate Program and:
Is recovering indirect cost using 8 percent of MTDC in compliance with 34 CFR 75.562(c)(2); or
Is recovering indirect costs using its actual negotiated indirect cost rate reflected in 9(b).
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
Data Privacy and Security Measures Certification (See instructions.)
11. Is a statement affirming that you are aware of federal and state data security and student privacy regulations included, with supporting
documentation attached?
Yes
No
N/A
Page 1 of 3
ED 524B
Performance Measures Status and Certification (See instructions.)
12. 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)
13. By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate and the
expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal
award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to
criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and
Title 31, Sections 3729-3730 and 3801-33812).
Furthermore, to the best of my knowledge and belief, all data in this performance report are true, complete, and correct and the report
fully discloses all known weaknesses concerning the accuracy, reliability, and completeness of data reported.
Title:
Name of Authorized Representative:
Date:
/
/
Signature:
Page 2 of 3
ED 524B
U.S. Department of Education
OMB No. 1894-0003
Exp. 07/31/2024
Grant Performance Report Cover Sheet (ED 524B)
Check only one box per Program Office instructions.
[ ] Annual Performance Report [ ] Final Performance Report
PR/Award # (11 characters):
(See Instructions)
Page 3 of 3
ED 524B
Page of 3