Appendix H Financial Status Report.pdf

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Attached to
Review of NEA Data Collection Tools & Performance Measurements
Solicitation number
NEARFP10-04
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INDEX OF APPENDICES

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File Type Posted
RFP 10-04 Amendment 0002 Page 2 Question and Answer —
RFP 10-04 SF30 FORM Amendment 0002 CLARIFICATION Question Answer —
RFP 10-04 SF30 FORM Amendment 0001 Questions Answers —
RFP 10-04 Amendment 0001 Page 2 Questions and Answers —
Appendix B NEA FY2009 Performance Accountability Report.pdf PDF
Solicitation RFP 10-04 NEA's Strategic Plan and Performance Measurements.pdf PDF
Appendix C1 OMB Circular A-11.pdf PDF
Appendix E Application Package.pdf PDF
Appendix A NEA Strategic Plan FY06-11.pdf PDF
Appendix I Geographic Location.pdf PDF
Appendix J Literature Fellowships.pdf PDF
Appendix K Partnership.pdf PDF
Appendix F Consortium Form.pdf PDF
Appendix G Final Descriptive Report.pdf PDF
APPENDIX D - Overview of NEA Data Collection Forms.pdf PDF
Appendix C2 OMB Circular A-11.pdf PDF
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FINANCIAL STATUS REPORT

(Short Form)

• Final report due no later than 90 days after the award end date.

• Please type or print clearly.

• FAX one copy to 202/682-5610 or 202/682-5609 — OR— Mail to:

Grants & Contracts Office, National Endowment for the Arts, 1100 Pennsylvania Avenue, N.W., Washington, DC 20506-0001

1. FEDERAL AGENCY TO WHICH

REPORT IS SUBMITTED:

National Endowment for the Arts

2. FEDERAL GRANT OR OTHER IDENTIFYING NUMBER

ASSIGNED BY THE FEDERAL AGENCY:

OMB APPROVAL #:

0348-0039

3. RECIPIENT ORGANIZATION (Name and complete address, including ZIP code):

4. EMPLOYER IDENTIFICATION

NUMBER:

5. RECIPIENT ACCOUNT NUMBER

OR IDENTIFYING NUMBER:

6. FINAL REPORT:

YES NO

7. BASIS:

CASH

ACCRUAL

8. GRANT PERIOD:

9. PERIOD COVERED BY THIS REPORT:

From: (Month, Day, Year)

To: (Month, Day, Year)

From: (Month, Day, Year)

To: (Month, Day, Year)

10. TRANSACTIONS

I

PREVIOUSLY

REPORTED

II

THIS

PERIOD

III

CUMULATIVE

a. TOTAL ACTUAL OUTLAYS (allocable and allowable)

b. RECIPIENT SHARE OF OUTLAYS (non-Federal)

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 FUNDING PERIOD

i. UNOBLIGATED BALANCE OF FEDERAL FUNDS (Line h minus g)

a. TYPEOF RATE: (Place “X” in the appropriate box.)

PROVISIONAL PREDETERMINED FINAL FIXED

11. INDIRECT

EXPENSE

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: Phone: ext.

Fax:

E-mail:

SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL:

Date report submitted:

FOR AGENCY USE ONLY

GRANTS & CONTRACTS REVIEWER: __________________ G &C APPROVAL: ___________________

FINANCIAL STATUS REPORT
National Endowment for the Arts
FOR AGENCY USE ONLY

Untitled

ID Number 1:
ID Number 2:
ID Number 3:
ID Number 4:
ID Number 5:
ID Number 6:
ID Number 7:
ID Number 8:
ID Number 9:
ID Number 10:
Organization:
EIN 1:
EIN 2:
EIN 3:
EIN 4:
EIN 5:
EIN 6:
EIN 7:
EIN 8:
EIN 9:
Recipient Account or ID:
Final Report Yes: Off
Final Report No: Off
Basis: Cash: Off
Basis: Accrual: Off
Grant Period From:
Grant Period To:
Period Covered: From:
Period Covered: To:
Total Outlays I:
Recipient Shares I:
Federal Share I:
Total Outlays II:
Recipient Share II:
Federal Share II:
Total Outlays III:
Recipient Share IIi:
Federal Share III:
Total Unliquidated III:
Recipient Unliquidated III:
Federal Unliquidated III:
Total Federal Share:
Total Fed Funds Authorized:
Unobligated Balance:
Rate: Provisional: Off
Rate: Predetermined: Off
Rate: Final: Off
Rate: Fixed: Off
Rate:
Base:
Total Amount:
Federal Share:
Remarks:
Name and Title:
Extension:
Fax:
Telephone:
E-mail:
Date Report Submitted:

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