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FINANCIAL STATUS REPORT
<br /> Lon Form
<br /> Public reporting burden fdr this collection of Information is estimated to average 30 minutes per response, incuding time for reviewing instructions,
<br /> searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
<br /> regaNing fhe burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of
<br /> Management and Budget, Paperwork Reduction Project (0346-0039), Washington, DC 20503.
<br /> PLEASE p0 NOT RETURN YOUR COMPLETED. FORM TO THE OFFICE OF MANAGEMENT AND
<br /> BUDGET.
<br /> Please type or print legibly. The following general instructions explain how to use the form itself. You may need additional
<br /> information to complete certain Rems correctly, or to decide whether a specific Rem is applicable to this award. Usually,
<br /> such information will be found in the' Federal agency's grant regulations or n the terms and conditions of the award (e.g.,
<br /> how to calculate the Federal share, the permissible uses of program income, the value of in-kind contributions, etc.). You
<br /> may also contact the Federal agency directly.
<br /> . Item Entry Item Entry
<br /> 1, 2 and 3. Self-explanatory. 10b. Enter any receipts related .to outlays reported on the
<br /> form that are being treated as a reduction of expenditure
<br /> 4. Enter the Employer Ident~cation Number (EIN) rather than income, and were not already netted out o_f
<br /> assigned by the U.S. Internal Revenue Service. the amount shown as outlays on line 10a.
<br /> 5. Space reserved for an account number or other 10c. Enter the amount of program income that was used in
<br /> identifying number assigned by the recipient. accordance with the deduction alternative. ~ •
<br /> 6. Check yes onlyrf this is the last report for the Note: Program inrrome used in accordance with other
<br /> period shown in item 8. affematives is entered on lines q; t, and. s. Recipients
<br /> reporting on a cash basis should enter the amount of
<br /> 7. Self-explanatory. cash income received; on an accrual basis, enter the
<br /> program income earned: Program income mayor may
<br /> 8. Unless you have received other instructions from not have been included in an application budget and/or
<br /> the awarding agency, enter the beginning and a budget on the award document ff actual income is
<br /> ending dates of the current funding period. ff this is from a different source or is significantly different in
<br /> a multi-year program, the Federal agency might amount, attach an explanation or use the remarks
<br /> require cumulative reporting through consecutive section.
<br /> funding periods. in that case, enter the beginning
<br /> and ending dates of the grant period, and in the rest 10d, e, f, g,. h, i and j. Self-explanatory.
<br /> of these instructions, substitute the term "grant
<br />
<br /> • period"for "funding period." 10k. Enter the total amount of unliquidated obligations,
<br /> including unfiquidated obligations to subgrantees and
<br /> 9. Self-explanatory. contractors.
<br /> 10. The purpose of columns, I, II, and III is to show the Unliquidated obligations on a cash basis are obligations.
<br /> effect of this reporting period's transactions on incurred, but not yet paid. On an accrual basis, they are.
<br /> cumulative financial status. The amounts entered in obligations incu"rred, but for which an outlay has not yet
<br /> column (will normally be the same as those in been recorded.
<br /> column III of the previous report in the same
<br /> funding period. If this is the first or only report of Do not include any amounts on line 10k that have been
<br /> the funding period, leave columns I and M blank. ff included on lines 10a and 10j.
<br /> you need to adjust amounts entered on previous
<br /> reports, footnote the column I entry on this report On the final report, line 10k must be zero.
<br /> and attach an explanatioh,. 101. Self-explanatory.
<br /> 10a. Enter total gross program outlays. Include
<br /> disbursements of cash realized as program income 10m. On the final report, line 10m must also be zero.
<br /> if that income will also be shown on I(nea 10c or
<br /> 10g. Do not include program Income that will be 10n, o, p, q, r, s and t. Self-explanatory. '
<br /> shown on lines 10r or 10s.
<br /> 11a. Self-explanatory.
<br /> For reports prepared on a cash basis, outlays are
<br /> the sum of actual cash disbursements for direct 11b.. Enter the indirect cost rate In effect during the reporting
<br /> costs for goods and services, the amount of indirect period.
<br /> expense charged, the value of in-kind contributions
<br /> applied, and the amount of cash advances and 19 c. Enter the amount of the base against which the rate
<br /> payments made to subrecipients. For reports was applied.
<br /> prepared on an accrual basis, outlays are the sum
<br /> of actual cash disbursements for direct charges for 11d. Enter the total amount of indirect costs charged during
<br /> goods and services, the amount of indirect expense the report period.
<br /> incurred, the value of in-kind contributions applied,
<br /> and the net increase or decrease in the amounts 11e. Enter the Federal share of the amount in 11d.
<br /> owed by the recipient for goods and other property
<br /> received, for services pertormed by employees, Note: ff more than one rate was in effect during he period
<br /> contractors, subgrentees and other payees, and shown in item 8, attach a schedule showing the bases
<br /> other amounts becoming owed under programs for against which the different rates were applied, the
<br /> which no current ,services or pertormances are respective rates, the calendar periods they were in
<br /> required, such as annuities, insurance claims, and effect, amounts of indirect expense charged to the .
<br /> other benefit payments. project, and the Federal share of indirect expense
<br /> charged to the project to date..
<br /> SF-289 Back (Rev.7-97)
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