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AC 150/5900-1B Appendix 1 1/31/79 INSTRUCTIONS FOR PREPARING THE FINANCIAL STATUS REPORT Item 1 — Enter the name of the Federal grantor agency and organizational element to which this report is submitted. Item 2 — Enter the grant number or other identifying num- ber assigned by the Federal grantor agency. Item 3 — Enter the name and complete mailing address, including the ZIP code for the grantee organization. Item 4 — Enter the employer identification number as- signed by the U.S. Internal Revenue Service. Item 5 — This space is reserved for an account number or other identifying numbers which may be assigned by the grantee. Items 6 and 7 — Mark the appropriate boxes. Item 8 — Enter the month, day, and year of the beginning and ending of this project period. For formula grants which are not awarded on a project basis, show the grant period. Item 9 — Enter the month, day. and year of the beginning and ending dates of the period for which this report is prepared. The frequency of the report will be established by the Federal grantor agency. PLEASE READ BEFORE COMPLETING ITEM 10 — The purpose of vertical Columns 11) through (6) is to provide financial data for each program, function, and activity in the budget as approved by the Federal grantor agency. If additional columns are needed, use as many additional forms as needed and mark "continuation" on each form; however, the summary totals of all programs, functions or activities should be shown in the "total' Column of the first page. For grants pertaining to a single Federal grant program (cat- alog number) or several grant programs which do not re- quire a functional or activity classification, enter under Columns (1) through (6) the title of the program(s). For grants pertaining to multiple programs where one or more • programs require a further breakdown by function or activ- ity, use a separate form for each program showing the appli- cable functions or activities in separate columns. For grants containing several functions or activities which are funded from several programs, prepare a separate form for each activity or function when requested by the Federal grantor agency. Item 10 — STATUS OF FUNDS Line a. Enter the total outlays reported on line foe of the last report. Show zero, if this is the initial report. Line b. Enter the total gross program outlays for this report period, including disbursements of cash realized as program income For reports which are prepared on a cash basis, outlays are the sum of actual cash disburse- ments for goods and services, the amount of indirect ex- pense charged, the value of in -kind contributions applied, and the amount of cash advances and payments made to contractors and subgrantees For reports prepared on an accrued expenditure basis, outlays are the sum of actual cash disbursements, the amount of indirect expense incurred, the value of in -kind contributions applied, and the net increase (or decrease) in the amounts owed by the grantee for goods and other property received and for services performeJ by employees, contractors, sub - grantees, and other payees. Line c. Enter the amount of all program income realized in this period which is to be used in the project or program in accordance with the terms of the grant. For reports prepared on a cash basis, enter the amount of cash 26 income received during the reporting period. For reports prepared on an accrual basis, enter the amount of the net increase (or decrease) in the amount of accrued income since the beginning of the report period. Line d. This amount should be the difference between amounts shown on Lines b and c. Line e. Enter the sum of amounts shown on Lines a and d above. Line f. Enter the amount pertaining to the non -Federal share of program outlays included in the amount on Line e. Line g. Enter the Federal share of program outlays. The amount should be the difference between Linese and f. Line h. When the report is prepared on a cash basis, enter the total amount of unpaid obligations for this projector program including unpaid obligations to subgrantees. If the report is prepared on an accrued expenditure basis, enter the amount of undelivered orders and other out- standing obligations. Do not include any amounts that have been included on Lines a through g. On the final report, Line h should have a zero balance. Line i. Enter the non -Federal share of unpaid obligations shown on Line h. Line j. Enter the Federal share of unpaid obligations shown on Line h. The amount shown on this line should be the difference between the amounts on Lines h and i. Line k. Enter the sum of the amounts shown on Lines g and j. If the report is final, the report should not contain any unpaid obligations Item I — Enter the total cumulative amount of Federal funds authorized. Line m. Enter the unobligated balance of Federal funds, This amount should be the difference between Lines k and I. Item 11 — INDIRECT EXPENSE a. Type of rate — Mark the appropriate box. b. Rate — Enter the rate in effect during the reporting period. c. Base — Enter the amount of the base to which the rate was applied. d. Total Amount — Enter the total amount of indirect cost charged during the report period. e. Federal Share — Enter the amount of the Federal share charged during the report period. If more than one rate was applied during the project period, include a separate schedule which shows the bases against which the indirect cost rates were applied, the respective indirect rates, the month, day, and year the indirect rates were in effect, amounts of indirect expense charged to the project, and the Federal share of indirect expense charged to the project to date. (See Office of Management and Bud- get Circular No. A-87 which contains principles for deter- mining allowable costs of grants and contracts with State and local governments.) Item 12 — Space is provided for any explanation deemed necessary by the grantee or for the provision of information required by the Federal grantor agencies in compliance with the governing legislation. Item 13 — Complete the certification before submitting this report.