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Tags: cash accrual, employer identification number, federal grant, financial status report, number 6, omb approval, organization name, organizational element, outlays, recipient organization, reported period, zip code,Pages: 2
Language: english
Created: Wed Aug 6 10:13:02 1997
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FINANCIAL STATUS REPORT
(Short Form)
(Follow instructions on the back)
1. Federal Agency and Organizational Element 2. Federal Grant or Other Identifying Number Assigned OMB Approval Page of
to Which Report is Submitted By Federal Agency No.
0348-0038
pages
3. Recipient Organization (Name and complete address, including ZIP code)
4. Employer Identification Number 5. Recipient Account Number or Identifying Number 6. Final Report 7. Basis
Yes No Cash Accrual
8. Funding/Grant Period (See instructions) 9. Period Covered by this Report
From: (Month, Day, Year) To: (Month, Day, Year) From: (Month, Day, Year) To: (Month, Day, Year)
10. Transactions: I II III
Previously This Cumulative
Reported Period
a. Total outlays
b. Recipient share of outlays
c. Federal share of outlays
d. Total unliquidated obligations
e. Recipient share of unliquidated obligations
f. Federal share of unliquidated obligations
g. Total Federal share(Sum of lines c and f)
h. Total Federal funds authorized for this funding period
i. (Line h minus line g)
Unobligated balance of Federal funds
a. Type of Rate(Place "X" in appropriate box)
11. Indirect Provisional Predetermined Final Fixed
Expense b. Rate c. Base d. Total Amount e. Federal Share
12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing
legislation.
13. Certification: I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and
unliquidated obligations are for the purposes set forth in the award documents.
Typed or Printed Name and Title Telephone (Area code, number and extension)
Signature of Authorized Certifying Official Date Report Submitted
NSN 7540-01-218-4387 269-202 Standard Form 269A (Rev. 7-97)
Prescribed by OMB Circulars A-102 and A-110
FINANCIAL STATUS REPORT
(Short Form)
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget,
Paperwork Reduction Project (0348-0038), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
Please type or print legibly. The following general instructions explain how to use the form itself. You may need additional information to
complete certain items correctly, or to decide whether a specific item is applicable to this award. Usually, such information will be found in
the Federal agency's grant regulations or in the terms and conditions of the award. You may also contact the Federal agency directly.
Item Entry Item Entry
1, 2 and 3. Self-explanatory. the value of in-kind contributions applied, and the net
increase or decrease in the amounts owed by the recipient
4. Enter the Employer Identification Number (EIN) for goods and other property received, for services
assigned by the U.S. Internal Revenue Service. performed by employees, contractors, subgrantees and
other payees, and other amounts becoming owed under
5. Space reserved for an account number or other programs for which no current services or performances are
identifying number assigned by the recipient. required, such as annuities, insurance claims, and other
benefit payments.
6. Check yes only if this is the last report for the
period shown in item 8. 10b. Self-explanatory.
7. Self-explanatory. 10c. Self-explanatory.
8. Unless you have received other instructions from 10d. Enter the total amount of unliquidated obligations,
the awarding agency, enter the beginning and including unliquidated obligations to subgrantees and
ending dates of the current funding period. If this is contractors.
a multi-year program, the Federal agency might
require cumulative reporting through consecutive Unliquidated obligations on a cash basis are obligations
funding periods. In that case, enter the beginning incurred, but not yet paid. On an accrual basis, they are
and ending dates of the grant period, and in the rest obligations incurred, but for which an outlay has not yet
of these instructions, substitute the term "grant been recorded.
period" for "funding period."
Do not include any amounts on line 10d that have been
9. Self-explanatory. included on lines 10a, b, or c.
10. The purpose of columns I, II, and III is to show the On the final report, line 10d must be zero.
effect of this reporting period's transactions on
cumulative financial status. The amounts entered in 10e. f, g, h, h and i. Self-explanatory.
column I will normally be the same as those in
column III of the previous report in the same 11a. Self-explanatory.
funding period . If this is the first or only report of the
funding period, leave columns I and II blank. If you 11b. Enter the indirect cost rate in effect during the reporting
need to adjust amounts entered on previous reports, period.
footnote the column I entry on this report and attach
an explanation. 11c. Enter the amount of the base against which the rate was
applied.
10a. Enter total program outlays less any rebates,
refunds, or other credits. For reports prepared on a 11d. Enter the total amount of indirect costs charged during the
cash basis, outlays are the sum of actual cash report period.
disbursements for direct costs for goods and
services, the amount of indirect expense charged, 11e. Enter the Federal share of the amount in 11d.
the value of in-kind contributions applied, and the
amount of cash advances and payments made to Note: If more than one rate was in effect during the period shown
subrecipients. For reports prepared on an accrual in item 8, attach a schedule showing the bases against
basis, outlays are the sum of actual cash which the different rates were applied, the respective rates,
disbursements for direct charges for goods and the calendar periods they were in effect, amounts of indirect
services, the amount of indirect expense incurred, expense charged to the project, and the Federal share of
indirect expense charged to the project to date.
*U. S. Government Printing Office: 1993 - 342-197/81289 SF-269A (Rev. 7-97) Back