Northern Border Regional Commission Investment Reporting
Government Performance & Results Act (GPRA) Data Collection Form
Grant Recipient Name:
Grant Agreement Number:
Authorized Contact Person:
Telephone #:
Award Date: ! ! Award Amount:
Data in this report is for the time period:
Project Close-out! 3 years after project close out
Signature: ____________________________________________
Date: ___________________
Total Project Costs
NBRC Investment
Any Other Federal Funds
All Other Funds
Total Project Costs
Results of the Investment
Peformance Measure
Outlined in Grant
At Project Close Out
Three Years After Project Close Out
Jobs Created
Jobs Retained
Private Investment
Project Specific
Performance Measure #1
Project Specific
Performance Measure #2
Project Specific
Performance Measure #3
NBRC Form 1003
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GPRA Data Collection Instructions
If there is not sufficient space on the data collection form, you may use additional pages only when the NBRC Grant
Agreement number, date of award, and reporting period are at the top of each page.
Recipient Name: Legal name of the Recipient/Organization/Entity.
Grant Agreement Number: You must put the Grant Agreement Number from your Grant Agreement on this form.
Authorized Contact: Person to contact regarding this report. Include the telephone number, if different from Recipient.
Telephone: Please provide a direct number where the person responsible for this project can be reached.
E-mail Address: Internet address of authorized contact using the following format, (
Award Date: The date that is on original your Grant Agreement.
Award Amount: The amount of funds originally awarded and as found on your Grant Agreement.
Investment Program: Check to indicate appropriate NBRC investment program.
Other Federal dollars: Federal sources, such as HUD, Agriculture, or Transportation funds not reported in Applicant dollars
All Other Funds: Include local and state funds. Local public sources such as city or county appropriations, general
obligation/revenue bond issues, and economic development sales taxes. CDBG funds are authorized for use as local shares.
State sources are state appropriations or CDBG funds to the state. Private sector dollars invested in project construction or
loan fund capitalization, including donations, foundation grants, contributions from local financial institutions, and private
Results of the Investment
Jobs Created and/or Retained: Total of jobs created and retained at the time of this report. Jobs Generally: Only
permanent and direct jobs may be counted. Part-time jobs should be converted to full-time equivalents (sum the total part-
time hours worked per week and divide by the hourly work week for full-time employees, normally 35-40 hours). Jobs
Created: Private sector jobs created by businesses and other project beneficiaries as a result of this NBRC investment. Jobs
Retained: Private sector jobs retained as a result of this NBRC investment. Direct Jobs: Include those created or retained by
employers located at the project site or by firms that require services of the NBRC-funded facility in order to locate, expand or
operate in the project area. Recipients should report other direct or directly related jobs, including subsequent employers that
locate or expand in the project area as a result of the project. For some projects (e.g., roads, water and sewer lines), direct
jobs may include those created by firms that were not originally anticipated as part of the project; however the firms required
the facility or service provided by the NBRC investment in order to locate or expand in the area. For RLF reporting: Actual
Created Jobs are the result of and attributable to the RLF loan, and have been verified by the borrower. A created job must be
removed if the job fails to last 18 months. For loans paid in full, borrowers may use the job data on file provided there is
confidence in the reliability of the data. If there is a question on reliability, the data should be verified by the next reporting
period. Retained Jobs are existing jobs where it can be documented that without the RLF assistance, the jobs would have
been lost. Job creation and retention numbers are actual jobs, not estimates or based on studies of similar projects.
Private Investment: Generated as a result of the NBRC investment. The total private sector investment made because of
the NBRC investment, including investments in new plant and equipment. Do not report private sector contributions to project
construction or loan fund capitalization reported above in this section.
If the above does not apply to your project put N/A in the box for the reporting period.
Project Specific Performance Measures: List the Peformance Measures found in your Grant Agreement in the first column
labeled ‘Peformance Measure Outlined in Grant Agreement’ then provide the numerical results in the appropriate reporting
field (at close out or 3 years after close out). If there are more than three Performance Measures you may use additional
paper, but only if the Grant Agreement is list at the top of each page.
Record retention: Recipients must retain supporting performance documentation for a minimum of three years.