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FINANCIAL STATUS REPORT
<br /> (Short Form) '
<br /> Public reporting burden for this collection of information is estimated to average90 minutes per response, including time for reviewing instructions, searching
<br /> existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
<br /> burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, tb the Office of Management and Budget;
<br /> Paperwork Reduction Project (0348-0038), Washington, DC 20503.
<br /> PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
<br /> SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.
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<br /> Please type or print legibly. The following general instructions explain how to use the form itself. You may need additional-information to
<br /> complete certain items correctly, or to decide whether a specific item is applicable to this award. Usually, such information will be found in
<br /> the Federal agency's grant regulations or in the terms and conditions of the award. You may also contact the Federal agency directly.
<br /> Item Entry Item Entry
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<br /> 1, 2 and 3. Self-explanatory. the value of in-kind contributions applied, and the net
<br /> increase or decrease in the amounts owed by the recipient
<br /> 4. Enter the Employer Identification Number (EIN) for goods and other property received, for services
<br /> assigned by the U.S. l:aern?! RevQn_?e •S?rvice. performed by employees, contractors, subgrantees and
<br /> other payees, and other amounts becoming owed under
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<br /> ' 5. Space reserved for an account number. or other programs for which no current services or performances are
<br /> identifying number assigned by the recipient. required, such as annuities, insurance claims, and other
<br /> benefit payments.
<br /> 6. Check yes only if this is the last report for the
<br /> period shown in item 8. 10b. Self-explanatory.
<br /> 7. Self-explanatory. 100, Self-explanatory.
<br /> 8. Unless you have received other instructions from 10d. Enter the total amount of unliquidated obligations,
<br /> the awarding agency, enter the beginning and including unliquidated obligations to subgrantees and
<br /> ending dates of the ctarrentfiunding period.`If this is contractors.
<br /> a multi-year program, the Federal agency might
<br /> require cumu ative reporting through consecutive n iqui a e o iga ions on a cas asis are o igations
<br /> _ _ funding periods. _In_that case
<br /> --enter the beginning--- incurred,- but -not yet paid. On an accrual basis, the_y__are_____
<br /> and ending dates. of the grant. period,. and in the rest.... obligations incurred, but for which an outlay has not yet
<br /> of these instructions, ...substitute the errn "grant been recorded.
<br /> _ _ _
<br /> period" for"funding period."
<br /> Do not include any amounts on line 10d that have been
<br /> 9. Self-explanatory. included on lines 10a, b, or c.
<br /> 10. The purpose of columns I, II, and III is to show the On the final report, line 10d must be zero.
<br /> effect of this reporting period's transactions on
<br /> cumulative financial s.atus. Tile amounts aritered in 10e. f, g, h, h and is Self-explanatoi~~. -
<br /> column I will normally be the same as those in
<br /> column IIt of the previous report in the same 11 a. Self-explanatory.
<br /> funding period. If this is the first or only report of the
<br /> funding period, leave columns I and II blank. If you 11 b. Enter the indirect cost rate in effect during the reporting
<br /> need to adjust amounts entered on previous reports, period.
<br /> footnote the column I entry on this report and attach
<br /> an explanation. 11c. Enter the amount. of the base against which the rate was
<br /> applied.
<br /> 10a. Enter total program outlays less any rebates,
<br /> refunds, or other credits. For reports prepared on a 11 d. Enter the total amount of indirect costs charged during the
<br /> cash basis, outlays are the sum of actual cash report period.
<br /> disbursements for direct costs for goods and
<br /> services, .the amount of indirect expense charged, 11 e. Enter the Federal share of the amount in 11 d.
<br /> .the value of in-kind contributions applied, and the
<br /> amount .of cash advances and payments made to Note: If more than one rate was in effect during the period shown
<br /> subrecipients. For reports prepared on an accrual in item 8, attach a schedule showing the bases against
<br /> basis, outlays are the sum of actual cash which the different rates were applied, the respective rates,
<br /> disbursements for direct charges for goods and the calendar periods they were in effect, amounts of indirect
<br /> services, the amount of indirect expense incurred, expense charged to the project, and the •Federal share of
<br /> indirect expense charged to the project to date.
<br /> "U. S. Government Printing Office: 1993 - 342-197/81289 SF-269A (Rev. 7-97) Back
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