Action
Plan / Techinal Assistance Request
<Grantee
Name>
<Grantee Mailing Address>
EIN - <#> |
<Principal
Grantee Contact >
<Month/Day/Year> |
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Part
I: Action Plan |
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Action Item: |
Target Completion
Date: |
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Expected Outcome: |
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Key
Steps |
Timeframe |
Responsible
Party |
Status |
Bureau |
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Transition Date to Grant Application:
Additional Comments:
Action Plan / Techinal Assistance Request
<Grantee
Name>
<Grantee Mailing Address>
EIN - <#> |
<Principal
Grantee Contact >
<Month/Day/Year> |
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Part II: Technical Assistance Request
Section I: To be Completed by Grantee:
Summary of TA Request:
Expected Outcome:
Estimated Number of Days:
Section II: To be Completed by OPR:
Region:
Team Lead:
Grant #:
Bureau/Office Funded:
Project Officer:
OPR Review Team Concurrence with Request:
OPR Comments:
Project Officer Comments:
Recommendation Bureau/Office to Lead TA: