ENCLOSURE_1_UNDER_THE_SOW.pdf

ENCLOSURE1 UNDER THE SOW

MLSR FINANCIAL STATUS REPORT FORMAT

Contract No.:

Job Code Number: J-TBD (Specialized internal NRC account number)

TITLE: TECHNICAL ASSISTANCE TO SUPPORT NRC REVIEW OF NRC FORM 396,

CERTIFICATION OF MEDICAL EXAMINATION BY FACILITY LICENSEE

Project Period of Performance: From MM/DD/YYYY to MM/DD/YYYYY

1. Contract Ceiling:

$XXX,XXX.XX

2. Total Funds Obligated to Date:

$XXX,XXX.XX

3. Total Cost Incurred this Reporting Period: $XXX,XXX.XX

4. Total Cost incurred to Date:

$XXX,XXX.XX

5. Total Staff Hours Worked this Reporting Period: $XXX,XXX.XX

Current Month Fiscal

Year to Date Cumulative Pr oject to Date

Management Hours Worked XXX.XX XXX.XX XXX.XX Technical Hours Worked XXX.XX XXX.XX XXX.XX Clerical Hours Worked XXX.XX XXX.XX XXX.XX

6. Total Staff Hours Worked to Date:

XXX.X

X

7. Balance of Obligations Remaining (Line 2 minus Line 4 above)

$XXX,

XXX.XX

8. Remaining Funds to be Obligated (Line 1 minus Line 2 above)

$XXX,

XXX.XX

9. Cumulative Project Completion Percentage(Line 4 divided by Line 1) XX.XX%

10. Significant Changes to Contractor Spending Plan: (Note any)

11. Direct and Indirect Cost Incurred this Reporting Period:

Current Month Fiscal

Year to Date Cumulative Pr oject to Date

Direct Labor $XXX.XX $XXX.XX $XXX.XX Travel Expenses $XXX.XX $XXX.XX $XXX.XX Subcontracts/Consultants $XXX.XX $XXX.XX $XXX.XX Other Direct Cost $XXX.XX $XXX.XX $XXX.XX

G&A $XXX.XX $XXX.XX $XXX.XX

Fee $XXX.XX $XXX.XX $XXX.XX Total $XXX.XX $XXX.XX $XXX.XX