HomeMy WebLinkAboutSS4A Quarterly Performance Progress Report FormSAFE STREETS AND ROADS FOR ALL (SS4A) DISCRETIONARY GRANT PROGRAM
Quarterly Project Progress Report
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Project Information
NAME
STATE SUBMISSION DATE AWARD NUMBER
FHWA
NAME OF GRANT RECIPIENT QUARTER NOFO FUNDING YEAR
Project Overall Status
Scope
Schedule
Budget
Project Significant Activities and Issues
Action Items/Outstanding Issues
SAFE STREETS AND ROADS FOR ALL (SS4A) DISCRETIONARY GRANT PROGRAM
Quarterly Project Progress Report
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Action Plan Project Milestones
Milestone Actual/Expected Date
Planned Draft Action Plan
Completion Date:
Completion Date:
Date:
Submission Date:
Supplemental Planning Activity Project Milestones
Milestone Baseline Date
(Grant Agreement)
Latest Amended Date
(If applicable) Actual/Expected Date
Planned Draft [insert type of
project/resulting deliverable]
project/resulting deliverable]
Adoption Date [insert type of
Submission Date:
Demonstration Activity Project Milestones
Milestone Baseline Date (Grant
Agreement)
Last Amended Date (If
applicable) Actual/Expected Date
Planned NEPA Completion
Date:
Planned Construction Start
Date:
Substantial Completion and
Planned SS4A Final Report
Submission Date:
SAFE STREETS AND ROADS FOR ALL (SS4A) DISCRETIONARY GRANT PROGRAM
Quarterly Project Progress Report
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Implementation (Construction) Project Milestones
Milestone Actual/Expected Date
Date:
Date:
Substantial Completion and
Submission Date:
Implementation (Non-Construction) Project Milestones
Milestone Baseline Date
(Grant Agreement)
Latest Amended Date
(If applicable) Actual/Expected Date
Date:
Date:
Submission Date:
Certification: 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 3801-3812).
Name of Authorized Certifying Official:
Title of Authorized Certifying Official:
Signature of Authorized Certifying Official: Telephone (Area code, number and extension):
Email Address: