FINANCIAL  STATUS REPORT	
(Short Form)	
(Follow Instructions on the back)	
1. Federal Agency and Organizational	2. Federal Grant or Other Identifying 	OMB Approval No	Page 		of	
Element to which Report is Submitted	Number Assigned by Federal Agency	0348-0038			pages	
     	     	     	     		     	
3. Recipient Organization (Name and complete address, including ZIP code)	
     	
4. Employer Identification Number	5. Recipient Account Number or Identifying Number	6. Final Report	7. Basis	
      	     	 	Yes	   	No		Cash		Accrual	
8. Funding/Grant Period (See Instructions)		9. Period Covered by this Report		
From: (Month, Day, Year)	To: (Month, Day, Year)	From: (Month, Day, Year)	To: (Month, Day, Year)	
     	     	     	     	
	I	II	III	
10.  Transactions:	Previously Reported	This Period	Cumulative	
a.  Total outlays	     	     	     	
b.  Recipient share of outlays	     	     	     	
c.  Federal share of outlays	     	     	     	
d.  Total unliquidated obligations			     	
e.  Recipient share of unliquidated obligations			     	
f.  Federal share of unliquidated obligations			     	
g.  Total Federal share (Sum of lines c and f)			     	
h.  Total Federal funds authorized for this funding period			     	
i.   Unobligated balance of Federal funds (Line h minus line g)			     	
11. Indirect Expense	a. Type of rate (place ``x'' in appropriate box)	
     		 	Provisional	   	Predetermined	   	Final	   	Fixed	
	b.  Rate	c.  Base	d.  Total Amount	e.  Federal Share	
					
12.  Remarks:  Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with
      governing legislation.	
     	
13. Certification:	I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents.	
Typed or Printed Name and Title	Telephone (Area Code, number and extension)	
     	     	
Signature of Authorized Certifying Official	Date Report Submitted	
     	     	
NSN 7450-01-218-4387	269-202	Standard Form 269A (REV 2-92)	
Prescribed by OMB circulars A-102 and A-110	
This form was electronically produced using Applix 4.41	
FINANCIAL  STATUS REPORT	
(Short Form)	
	Public reporting burden for this collection of information is estimated to average 90 minutes 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 (0348-0038), Washington, DC 20503..
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND 
BUDGET; SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.		
Item	Entry	Item	Entry	
1, 2, 3.   Self explanatory.	
4.	Enter the employer identification number assigned by the		grantees and other payees, and other amounts becoming 	
	 U.S. Internal Revenue Service.		owed under programs for which no current services or	
			performances are required, such as annuities, insurance	
5.	Space reserved for an account number or other identifying		claims, and other benefit payments.	
	 number assigned by the recipient.			
		10b.	Self-explanatory.	
6.	Check yes only if this is the last report for the period			
	shown in item 8.	10c.	Self-explanatory.	
				
7.	Self-explanatory.	10d.	Enter the amount of unliquidated obligations, including	
			unliquidated obligations to subgrantees and contractors.	
8.	Unless you have received other instructions from the 			
	awarding agency, enter the beginning and ending dates of		Unliquidated obligations on a cash basis are obligations	
	the current funding period.  If this is a multi-year program, 		incurred, but not yet paid.  On an accrual basis, they are	
	the Federal agency might require cumulative reporting		obligations incurred, but for which  an outlay has not yet	
	through consecutive funding periods.  In that case, enter		been recorded.	
	the beginning and ending dates of the grant period, and in			
	the rest of these instructions, substitute the term ``grant		Do not include any amounts on line 10d that have been	
	period'' for ``funding period.''		included on lines 10a, b or c.	
				
9.	Self explanatory.		On the final report, line 10d must be zero.	
				
10.	The purpose of columns I, II, and III is to show the effect	10e, f,	Self-explanatory.	
	of this reporting period's transactions on cumulative	g, h, i		
	financial status. The amounts entered in column I will nor-			
	mally be the same as those in column III of the previous	11a.	Self-explanatory.	
	report in the same funding period.  If this is the first or			
	only report of the funding period, leave columns I and II	11b.	Enter the indirect cost rate in effect during the report	
	blank.  If you need to adjust amounts entered on previous		 period.	
	reports, footnote the column I entry on this report and			
	attach an explanation.	11c.	Enter the amount of the base against which the rate was 	
 			applied.	
10a.	Enter total program outlays less any rebates, refunds, or 			
	other credits.  For reports prepared on a cash basis, outlays	11d.	Enter the total amount of indirect costs charged during the	
	are the sum of actual cash disbursements for direct costs		report period.	
	for goods and services, the amount of indirect expense			
	charged, the value of in-kind contributions applied, and the	11e.	Enter the Federal share of the amount in 11d.	
	amount of cash advances and payments made to sub-			
	recipients.  For reports prepared on an accrual basis, out-	Note:	If more than one rate was in effect during the period 	
	lays are the sum of actual cash disbursements for direct 		shown in item 8, attach a schedule showing the bases 	
	expense incurred, the value of in-kind contributions		against which the different rates were applied, the 	
	applied, and the net increase or decrease in the amounts 		respective rates, the calendar periods they were in effect,	
	owed by the recipients for goods and other property		amounts of indirect expense charged to the project, and 	
	received, for services performed by employees, 		the Federal share of indirect expense to the project to date.