Attachment B - Cumulative Financial Report.pdf
PDF 194 KB Posted
- Solicitation number
- 005-RFP-0273-2023
- Issued by
- Polk County, Davenport City, Iowa
About this file
This document is a Cumulative Financial Report template from the Iowa Department on Aging (IDA) for the 2020 "Empowering Communities to Reduce Falls and Falls Risk" program. The template is designed to track financial expenditures across various budget line items, including personnel, fringe benefits, travel, supplies, equipment, premises, technology, contractual services, and other costs. The form allows for reporting of total budgeted amounts, cumulative expenditures, and current expenditures, with specific columns for federal and non-federal (cash and in-kind) funding sources.
The financial report provides a comprehensive framework for tracking and certifying financial activities, with sections for indirect cost rates, cumulative receipts, and expenditures. The form includes a certification statement where an authorized official must verify the accuracy and completeness of the reported financial information, acknowledging potential criminal, civil, or administrative penalties for false or fraudulent reporting. The document is structured to capture detailed financial data across different categories, enabling precise monitoring of program spending and adherence to budgetary allocations.
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Text version
Attachment B Cumulative Financial Report
1. Name Iowa Department on Aging (IDA) Address 510 E. 12th St., Suite 2 City, State, ZIP Des Moines, Iowa 50319
2. DUNS # Monthly Cash Quarterly Accrual 6. Reporting Period End Date
3. Contract/Award # Semi-Annual Annual 7. Contract/Award Period Final From To
Total a. Federal Total a. Federal Total a. Federal
8. Line Item b. Cash c. In-Kind b. Cash c. In-Kind b. Cash c. In-Kind
a. Personnel
b. Fringe Benefits
c. Travel
d. Supplies
e. Equipment
f. Premise
g. Technology
h. Contractual
i. Other
j. Total
k. Indirect
l. Grand Totals
a. Type b. Rate c. Period From Period To d. Base e. Amt Charged f. Federal Share Federal Non-Fed Cash
a. Cum Receipts
b. Cum Expend
g. Totals: c. Balance:
14. Remarks:
a. Typed or Printed Name and Title of Authorizing Official
16. Prepared by:
b. Signature of Authorized Certifying Official c. Date Submitted
15. Certification: By signing this report, I certify that to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the award. I am aware that any false, fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties.
Version.pdf (5/4/2021)
11. Current Expenditures
Non-Federal Non-Federal Non-Federal
12. Indirect Expense
13. Amount Due
4. Report Type 5. Basis of Acounting
9. Budget 10. Cumulative Expenditures
2020 Empowering Communities to Reduce Falls and Falls Risk Cumulative Financial Report
Rpt No.
1 Enter the name and complete address of the recipient organization including zip code.
2 Enter the recipient organization’s Data Universal Numbering System (DUNS) number.
3 Enter the number assigned to the contract/award by the Department on Aging.
4 Mark the appropriate box.
5 Mark Accrual and prepare the report accordingly.
6 Enter the ending date (Month, Day, Year) of the reporting period.
7 Enter the period (Month, Day, Year) established in the contract/award document during which expenditures can be incurred.
8 Enter the Line Items as detailed in the contract/award on lines 8a. thru 8i. unless pre-filled on the report form.
9 Enter the Total approved Budget amounts for Line Items a. thru l.
9a Enter the Federal approved Budget amounts for Line Items a. thru l.
9b Enter the Non-Federal, Cash approved Budget amounts for Line Items a. thru l.
9c Enter the Non-Federal, In-Kind approved Budget amounts for Line Items a. thru l.
10 Enter the Total Cumulative Expenditure amounts for Line Items a. thru l.
10a Enter the Federal expenditure amounts of as of the reporting period end date for Line Items a. thru l.
10b Enter the Non-Federal, Cash expenditure amounts of as of the reporting period end date for Line Items a. thru l.
10c Enter the Non-Federal, In-Kind amounts of as of the reporting period end date for Line Items a. thru l.
11 Enter the Total Current Expenditure amounts for Line Items a. thru l.
11a Enter the Federal expenditure amounts as of the reporting period end date on Line Items a. thru l.
11b Enter the Non-Federal, Cash expenditure amounts as of the reporting period end date on Line Items a. thru l.
11c Enter the Non-Federal, In-Kind amounts as of the reporting period end date on Line Items a. thru l.
12a Enter whether the indirect cost rate(s) is Provisional, Predetermined, Final, Fixed, or De Minimis.
12b Enter the indirect cost rate(s) in effect during the reporting period.
12c Enter the beginning and ending effective dates for the rate(s).
12d Enter the amount upon which the rate(s) was applied.
12e Enter the amount of indirect costs charged during the time period specified. (Multiply 12b. x 12d.)
12f Enter the Federal share of the amount in 12e.
12g Enter the totals for columns 12d, 12e, and 12f.
13a Enter the amount of Federal and/or Non-Federal Cash funding received as of the reporting period end date.
13b Enter the amount of Federal and/or Non-Federal Cash expenditures reported under 10. on line 10l.
13c Enter the Federal and/or Non-Federal Cash difference (Subtract 13b. from 13a.)
14 Enter any explanations or additional information.
15a Enter the name and title of the authorized certifying official.
15b The authorized certifying official must sign here.
15c Enter the date the report was submitted.
16 Enter the name of the individual who prepared the report.
Date Submitted
Prepared by
Cumulative Receipts
Cumulative Expenditures
Balance
Remarks
Name & Title of Authorized Certifying Official
Signature of Authorized Certifying Official
Totals
Cumulative Expenditures, Non-Fed, In-Kind
Current Expenditures
Current Expenditures, Federal
Current Expenditures, Non-Fed, Cash
Current Expenditures, Non-Fed, In-Kind
Type of Rate
Rate
Period From, Period To
Base
Amount Charged
Federal Share
Cumulative Expenditures, Non-Fed, Cash
Report Type
Basis of Accounting
Reporting Period End Date
Contract/Award Period
Line Item
Budget
Budget, Federal
Budget, Non-Fed, Cash
Budget, Non-Fed, In-Kind
Cumulative Expenditures
Cumulative Expenditures, Federal
Contract/Award Number
Reporting Item Financial Report Instructions (Do Not Enter in Shaded Regions)
Contractor/Awardee
DUNS Number
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File details come from the government source that posted it. Updated .