Directions on use of ADD-02
What is the ADD-02?
The ADD-02 in combination with the SF-269 is the required financial status reporting
form for the State Council on Developmental Disabilities program funded under
Subtitle B of the Developmental Disabilities Assistance and Bill of Rights Act
of 2000 (DD Act), Public Law 106-402. The ADD-02/SF-269 supersedes the old ADD-01/SF-269
that was formerly used to report financial status information. This new form is
designed for reporting on a single form the financial status of funding provided
during the current fiscal year together with the financial status of one-year
prior and two-years prior fiscal years funding.
Submitting the ADD-02
Two reports are to be submitted to the Regional Office annually using this form:
the Mid-Year Report and the Year-End Report.
- Mid-Year Report:Submit this report to cover the report period of October 1 through March 31
- Year-End Report:Submit this report to cover the report period of April 1 through September 30.
These reports must be submitted within 30 days after the end of the period, based on then available data. If data are missing for some transactions at the time of these deadlines for these reports, then the additional data should be incorporated in later reports.
Four other financial status reports are submitted using this form:
- Revised Reports
- Waiver Reports
- Final Reports and
- DSA Redesignation Interim Reports
These additional reports are described below.
Completing the ADD-02
The numbered items below refer to numbered parts of ADD-02.
Item 1. Designated State Agency: Official name of the agency designated by the Governor to carry out Section 125(d) of the Act.
Item 2. State:Provide the name of the State or territory.
Item 3. Report Period: __/__/_____ to __/__/______
Provide the beginning and end dates of the period being reported, in the form
of MM/DD/YYYY. In these directions, "current Federal fiscal year" refers
to the Federal fiscal year of the "Report Period." The report period for these
reports are as follows:
- for a Mid-Year report: For FFY 2004: 10/01/2003 to 03/31/2004.
- for a Year-End report: For FFY 2004: 4/01/2004 to 9/30/2004.
- for a Revised Report: Same as the report it revises.
- for a Waiver Report: Provide dates of the beginning and end of the waiver period (see "Waiver Report").
- for a Final Report: Provide dates for the beginning of the award-fiscal-year and the end of the last period in which the funding was expended.
- for an Interim report during a change in the designated State agency: Use effective date of redesignation.
Financial Status: Provide the following data, rounded to the nearest dollar, for each of these rows.
Rows a. through g.
a. "Goal Activities, undertaken by Council/staff": Subtitle B Federal funding for activities related to the goals referenced in Section 124(c)(5)(B)(i) undertaken in-house by State Council members or State Council staff
b. "Goal Activities, Poverty Area": Subtitle B Federal funding for activities related to the goals referenced in Section 124(c)(5)(B)(i) not done in-house, benefiting persons with developmental disabilities residing in poverty areas
c. "Goal Activities, Other": Subtitle B Federal funding for activities related to the goals referenced in Section 124(c)(5)(B)(i) other than above
d. "General Management": Subtitle B Federal funding for personnel, budget/finance/reporting not included as part of Goal Activities nor Functions of the Designated State Agency
e. "Functions of Designated State Agency (FDSA), Federal Participation": Subtitle B Federal funding for Federal participation in the Functions of the Designated State Agency, as referenced in Section 124(c)(5)(B)(vi)
f. "Total Federal (a. through e.)": For each column, sum of the lines a. through e., described above (see SF-269, Col.III)
g. "State Match (including FDSA + Prog.Inc.)": Total funding (or in-kind value) from State or local sources
row h.
"Functions of Designated State Agency (FDSA), State Participation": Report
only funding actually expended (or estimated to be expended) in the reported Federal
fiscal year... report only one number (expenditures) for each previous year
| Expended | Obligated | Planned | ||||
|---|---|---|---|---|---|---|
| Total FDSA (actual cost): | $60,000 | $10,000 | $50,000 | |||
| Federal Partic.(Row e, column 4): | $25,000 | $4,167 | $20,833 | |||
| State Partic.(Row h, column 4): | $35,000 | $5,833 | $29,617 |
Records show State Participation in FDSA last Federal Fiscal Year came to $68,000 (reported on row h, column 5); this is in compliance since State Participation increased to $70,000.
| Expended | Obligated | Planned | ||||
|---|---|---|---|---|---|---|
| Total FDSA (actual cost): | $115,000 | $0 | $0 | |||
| Federal Partic.(Row e, column 4): | $47,000 | $0 | $0 | |||
| State Partic.(Row h, column 4): | $68,000 | --- | --- |
Note that there is only $47,000 Federal Participation, due to maintenance of State participation ($68,000, State Participation during previous Federal Fiscal Year). The unused $3,000 of current year Federal funding planned for FDSA can be used elsewhere in the program.
row i.
"Program Income(including used as match)": Program income is reported by
semiannual (6 month) period only (expenditures during and balance at end of).
Report program income by: 1. total expended during the period (a half year); 2.
balance of unliquidated obligations; and 3. balance remaining unobligated
and unexpended (in the "Estimates" column). If reported program income data are
found to be in error after submission of the report, then correct by adjusting
the next period's program income reported, and indicate the correction in the
"Remarks" section. Please contact the regional office about significant errors.
Period 1 (Mid-Year Report) |
||||||
|---|---|---|---|---|---|---|
| The Council does not have a history of program income. | ||||||
| Expended | Obligated | Planned | ||||
| i. Program Income | -0- | -0- | -0- |