Federal financial report




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FEDERAL FINANCIAL REPORT

(Follow form instructions)



1. Federal Agency and Organizational Element

to Which Report is Submitted



2. Federal Grant or Other Identifying Number Assigned by Federal Agency

(To report multiple grants, use FFR Attachment)



Page

of







1




 

pages

3. Recipient Organization (Name and complete address including Zip code)




4a. DUNS Number

4b. EIN

5. Recipient Account Number or Identifying Number

(To report multiple grants, use FFR Attachment)



6. Report Type

 Quarterly

 Semi-Annual

 Annual


 Final

7. Basis of Accounting

Cash  Accrual



8. Project/Grant Period

From: (Month, Day, Year)



To: (Month, Day, Year)

9. Reporting Period End Date

(Month, Day, Year)












10. Transactions

Cumulative

(Use lines a-c for single or multiple grant reporting)

Federal Cash (To report multiple grants, also use FFR Attachment):

a. Cash Receipts




b. Cash Disbursements




c. Cash on Hand (line a minus b)




(Use lines d-o for single grant reporting)

Federal Expenditures and Unobligated Balance:

d. Total Federal funds authorized




e. Federal share of expenditures




f. Federal share of unliquidated obligations




g. Total Federal share (sum of lines e and f)




h. Unobligated balance of Federal funds (line d minus g)




Recipient Share:

i. Total recipient share required




j. Recipient share of expenditures




k. Remaining recipient share to be provided (line i minus j)




Program Income:

l. Total Federal program income earned




m. Program income expended in accordance with the deduction alternative




n. Program income expended in accordance with the addition alternative




o. Unexpended program income (line l minus line m or line n)



11. Indirect



Expense

a. Type

b. Rate

c. Period From

Period To

d. Base

e. Amount Charged

f. Federal Share











































 

g. Totals:










12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:

13. Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001)

a. Typed or Printed Name and Title of Authorized Certifying Official

c. Telephone (Area code, number and extension)







d. Email address




b. Signature of Authorized Certifying Official

e. Date Report Submitted (Month, Day, Year)









14. Agency use only:


Standard Form 425

OMB Approval Number: 0348-0061

Expiration Date: 10/31/2011


Paperwork Burden Statement

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection is 0348-0061. Public reporting burden for this collection of information is estimated to average 1.5 hours 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 ( 0348-0060), Washington, DC 20503.




Federal Financial Report Instructions
Report Submissions

1) Recipients will be instructed by Federal agencies to submit the Federal Financial Report (FFR) to a single location, except when an automated payment management reporting system is utilized. In this case, a second submission location may be required by the agency.


2) If recipients need more space to support their FFRs, or FFR Attachments, they should provide supplemental pages. These additional pages must indicate the following information at the top of each page: Federal grant or other identifying number (if reporting on a single award), recipient organization, Data Universal Numbering System (DUNS) number, Employer Identification Number (EIN), and period covered by the report.
Reporting Requirements

1) The submission of interim FFRs will be on a quarterly, semi-annual, or annual basis, as directed by the Federal agency. A final FFR shall be submitted at the completion of the award agreement. The following reporting period end dates shall be used for interim reports: 3/31, 6/30, 9/30, or 12/31. For final FFRs, the reporting period end date shall be the end date of the project or grant period.

2) Quarterly and semi-annual interim reports shall be submitted no later than 30 days after the end of each reporting period. Annual reports shall be submitted no later than 90 days after the end of each reporting period. Final reports shall be submitted no later than 90 days after the project or grant period end date.
Note: For single award reporting:

1) Federal agencies may require both cash management information on lines 10(a) through 10(c) and financial status information lines 10(d) through 10(o).



2) 10(b) and 10(e) may not be the same until the final report.

Line Item Instructions for the Federal Financial Report

FFR

Number

Reporting Item

Instructions

Cover Information

1

Federal Agency and Organizational Element to Which Report is Submitted

Enter the name of the Federal agency and organizational element identified in the award document or as instructed by the agency.

2

Federal Grant or Other Identifying Number Assigned by Federal Agency

For a single award, enter the grant number assigned to the award by the Federal agency. For multiple awards, report this information on the FFR Attachment. Do not complete this box if reporting on multiple awards.

3

Recipient Organization

Enter the name and complete address of the recipient organization including zip code.

4a

DUNS Number

Enter the recipient organization’s Data Universal Numbering System (DUNS) number or Central Contract Registry extended DUNS number.

4b

EIN

Enter the recipient organization’s Employer Identification Number (EIN).

5

Recipient Account Number or Identifying Number

Enter the account number or any other identifying number assigned by the recipient to the award. This number is for the recipient’s use only and is not required by the Federal agency. For multiple awards, report this information on the FFR Attachment. Do not complete this box if reporting on multiple awards.

6

Report Type

Mark appropriate box. Do not complete this box if reporting on multiple awards.

7

Basis of Accounting (Cash/Accrual)

Specify whether a cash or accrual basis was used for recording transactions related to the award(s) and for preparing this FFR. Accrual basis of accounting refers to the accounting method in which expenses are recorded when incurred. For cash basis accounting, expenses are recorded when they are paid.

8

Project/Grant Period, From: (Month, Day, Year)

Indicate the period established in the award document during which Federal sponsorship begins and ends.

Note: Some agencies award multi-year grants for a project period that is funded in increments or budget periods (typically annual increments). Throughout the project period, agencies often require cumulative reporting for consecutive budget periods. Under these circumstances, enter the beginning and ending dates of the project period not the budget period.



Do not complete this line if reporting on multiple awards.




Project/Grant Period, To: (Month, Day, Year)

See the above instructions for “Project/Grant Period, From: (Month, Day, Year).”

9

Reporting Period End Date: (Month, Day, Year)

Enter the ending date of the reporting period. For quarterly, semi-annual, and annual interim reports, use the following reporting period end dates:

March 31, June 30, September 30, or December 31. For final FFRs, the reporting period end date shall be the end date of the project or grant period.



10

Transactions

Enter cumulative amounts from date of the inception of the award through the end date of the reporting period specified in line 9.

Use Lines 10a through 10c, Lines 10d through 10o, or Lines 10a through 10o, as specified by the Federal agency, when reporting on single grants.

Use Line 12, Remarks, to provide any information deemed necessary to support or explain FFR data.



Federal Cash (To report multiple grants, also use FFR Attachment)

10a

Cash Receipts

Enter the cumulative amount of actual cash received from the Federal agency as of the reporting period end date.

10b

Cash Disbursements

Enter the cumulative amount of Federal fund disbursements (such as cash or checks) as of the reporting period end date. Disbursements are the sum of actual cash disbursements for direct charges for goods and services, the amount of indirect expenses charged to the award, and the amount of cash advances and payments made to subrecipients and contractors.

For multiple grants, report each grant separately on the FFR Attachment. The sum of the cumulative cash disbursements on the FFR Attachment must equal the amount entered on Line 10b, FFR.



10c

Cash On Hand (Line 10a Minus Line 10b

Enter the amount of Line 10a minus Line 10b. This amount represents immediate cash needs. If more than three business days of cash are on hand, the Federal agency may require an explanation on Line 12, Remarks, explaining why the drawdown was made prematurely or other reasons for the excess cash.

Federal Expenditures and Unobligated Balance: Do not complete this section if reporting on multiple awards.

10d

Total Federal Funds Authorized

Enter the total Federal funds authorized as of the reporting period end date.

10e

Federal Share of Expenditures

Enter the amount of Federal fund expenditures. For reports prepared on a cash basis, expenditures are the sum of cash disbursements for direct charges for property and services; the amount of indirect expense charged; the value of third-party in-kind contributions applied; and the amount of cash advance payments and payments made to subrecipients. For reports prepared on an accrual basis, expenditures are the sum of cash disbursements for direct charges for property and services; 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 recipient for (1) goods and other property received; (2) services performed by employees, contractors, subrecipients, and other payees; and (3) programs for which no current services or performance are required. Do not include program income expended in accordance with the deduction alternative, rebates, refunds, or other credits. (Program income expended in accordance with the deduction alternative should be reported separately on Line 10o.)

10f

Federal Share of Unliquidated Obligations

Unliquidated obligations on a cash basis are obligations incurred, but not yet paid. On an accrual basis, they are obligations incurred, but for which an expenditure has not yet been recorded. Enter the Federal portion of unliquidated obligations. Those obligations include direct and indirect expenses incurred but not yet paid or charged to the award, including amounts due to subrecipients and contractors. On the final report, this line should be zero unless the awarding agency has provided other instructions.

Do not include any amount in Line 10f that has been reported in Line 10e. Do not include any amount in Line 10f for a future commitment of funds (such as a long-term contract) for which an obligation or expense has not been incurred.

10g

Total Federal Share (Sum of Lines 10e and 10f)

Enter the sum of Lines 10e and 10f.

10h

Unobligated Balance of Federal Funds (Line 10d Minus Line 10g)

Enter the amount of Line 10d minus Line 10g.

Recipient Share: Do not complete this section if reporting on multiple awards.

10i

Total Recipient Share Required

Enter the total required recipient share for reporting period specified in line 9. The required recipient share should include all matching and cost sharing provided by recipients and third-party providers to meet the level required by the Federal agency. This amount should not include cost sharing and match amounts in excess of the amount required by the Federal agency (for example, cost overruns for which the recipient incurs additional expenses and, therefore, contributes a greater level of cost sharing or match than the level required by the Federal agency).

10j

Recipient Share of Expenditures

Enter the recipient share of actual cash disbursements or outlays (less any rebates, refunds, or other credits) including payments to subrecipients and contractors. This amount may include the value of allowable third party in-kind contributions and recipient share of program income used to finance the non-Federal share of the project or program. Note: On the final report this line should be equal to or greater than the amount of Line 10i.

10k

Remaining Recipient Share to be Provided (Line 10i Minus Line10j)

Enter the amount of Line 10i minus Line 10j. If recipient share in Line 10j is greater than the required match amount in Line 10i, enter zero.

Program Income: Do not complete this section if reporting on multiple awards.

10l

Total Federal Program Income Earned

Enter the amount of Federal program income earned. Do not report any program income here that is being allocated as part of the recipient's cost sharing amount included in Line10j.

10m

Program Income Expended in Accordance With the Deduction Alternative

Enter the amount of program income that was used to reduce the Federal share of the total project costs.

10n

Program Income Expended in Accordance With the Addition Alternative

Enter the amount of program income that was added to funds committed to the total project costs and expended to further eligible project or program activities.

10o

Unexpended Program Income (Line 10l Minus Line 10m or Line 10n)

Enter the amount of Line 10l minus Line 10m or Line 10n. This amount equals the program income that has been earned but not expended, as of the reporting period end date.

11

Indirect Expense: Complete this information only if required by the awarding agency and in accordance with agency instructions.

11a

Type of Rate(s)

State whether indirect cost rate(s) is Provisional, Predetermined, Final, or Fixed.

11b

Rate

Enter the indirect cost rate(s) in effect during the reporting period.

11c

Period From; Period To

Enter the beginning and ending effective dates for the rate(s).

11d

Base

Enter the amount of the base against which the rate(s) was applied.

11e

Amount Charged

Enter the amount of indirect costs charged during the time period specified. (Multiply 11b. x 11d.)

11f

Federal Share

Enter the Federal share of the amount in 11e.

11g

Totals

Enter the totals for columns 11d, 11e, and 11f.

Remarks, Certification, and Agency Use Only

12

Remarks

Enter any explanations or additional information required by the Federal sponsoring agency including excess cash as stated in line 10c.

13a

Typed or Printed Name and Title of Authorized Certifying Official

Enter the name and title of the authorized certifying official.

13b

Signature of Authorized Certifying Official

The authorized certifying official must sign here.

13c

Telephone (Area Code, Number and Extension)

Enter the telephone number (including area code and extension) of the individual listed in Line 13a.

13d

E-mail Address

Enter the e-mail address of the individual listed in Line 13a.

13e

Date Report Submitted (Month, Day, Year)

Enter the date the FFR is submitted to the Federal agency using the month, day, year format.

14

Agency Use Only

This section is reserved for Federal agency use.

Line Item Instructions for the Federal Financial Report Attachment

(To be completed if reporting on cash management activity for multiple grants.)



Box

Number

Reporting Item

Instructions

1

Federal Agency and Organizational Element to Which Report is Submitted

Enter the name of the Federal agency and organizational element identified in the award document or otherwise instructed by the agency. (This information should be identical to that entered in Box 1, FFR.)

2

Recipient Organization

Enter the name and complete address of the recipient organization including zip code. (Same information as entered in Box 3, FFR.)

3a

DUNS Number

Enter the recipient organization’s Data Universal Numbering System (DUNS) number or Central Contract Registry extended DUNS number. (Same information as entered in Box 4a, FFR.)

3b

EIN

Enter the recipient organization’s Employer Identification Number (EIN). (Same information as entered in Box 4b, FFR.)

4

Reporting Period End Date:(Month, Day, Year)

Enter the ending date of the reporting period of this report. (Same information as entered in Box 9, FFR.)

5

Federal Grant Number

Enter the grant number assigned to each award by the Federal agency.

Recipient Account Number

Enter the account number or any other identifying number assigned by the recipient to each award. This number is for the recipient’s use only and is not required by the Federal agency.

Cumulative Federal Cash Disbursement

Enter the cumulative amount of the Federal share of cash disbursed for each award. Cash disbursements are the sum of actual cash disbursements for direct charges for goods and services, the amount of indirect expenses charged to the award, and the amount of cash advances and payments made to subrecipients and contractors.




Total

Enter the total for the Cumulative Cash Disbursement. This column should equal the amount reported on Line 10b, FFR.





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