Template 1- Return Funds.pdf
PDF 173 KB Posted
- Attached to
- DOD-2023-APEX-ACCELERATOR-SUPPLEMENTAL-FUNDING
- Opportunity number
- DOD-2023-APEX-ACCELERATOR-SUPPLEMENTAL
- Issued by
-
Department of Defense
About this file
This document is a template for returning unspent federal grant funds to the Department of Defense. It requests information on unexpended funds by cost element including personnel, fringe benefits, travel, equipment, supplies, contractual costs, other expenses, and indirect costs for both non-distressed and distressed areas. The template asks whether the applicant wants to reduce just the federal share or both the federal share and remaining obligation. It solicits a narrative on why funds were not expended as planned and an estimate to complete the project with revised final costs for both federal and non-federal shares. Several attachments are listed relating to cost matching, commitments, rates, analyses, execution plans, positions, audits, and budgets providing additional detail for the project. The associated federal grant opportunity is for supplemental funding through the DOD's APEX Accelerator Program assigned under the Procurement Technical Assistance for Business Firms federal grant program.
Template 1- Return Funds
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Text version
Statement of Interest Return Funds
Applicant Name
Applicant Unique Entity Identifier
Applicant Address
Applicant Point of Contact
By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. (U.S.
Code, Title 18, Section 1001).
** I Agree
Authorized Representative Name Title Signature
1. Provide amount of obligated funds that cannot be expended during fiscal year, by cost element.
Non- Distressed Distressed
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Indirect Costs
Total
2. Do you wish to have your federal share reduced by this amount, or only have the obligation drawn down?
Reduce Federal Share and Obligation Value
Reduce only Obligation Value
3. Input a narrative explaining why there are funds that cannot be expensed (for example, unexpected vacancy, delay in event).
4. Provide an estimate detailing the new obligation total and showing estimate to complete.
Award Value Expensed to date
Estimate to Complete
Estimated Final Cost
Federal
Non-Federal Share
| Attachment 1- Certification of Cost Matching Funds APEX Program |
| Attachment 2- Third Party Letter of Commitment APEX Accelerator Program |
| Attachment 3- Fringe Rate Basis |
| Attachment 4- Indirect Costs |
| Attachment 5- Distressed Area Analysis |
| Attachment 6- Determination of Statewide Coverage |
| Attachment 7- Program Execution Plan |
| Attachment 8- Personnel Positions |
| Attachment 9- Program Manager Resume |
| Attachment 10- Subaward SF 424a Budgets |
| Attachment 11- Single Aduit Act |
| Attachment 12- Budget Breakdown |
| Attachment 13- Personnel Costs |
| Attachment 14- Program Goals |
| Appendix 1-Additional detail for Attachment 12, Budget: |
| Applicant Name: |
| Applicant Unique Entity Identifier: |
| Applicant Address: |
| Applicant Point of Contact: |
| Authorized Representative: |
| Name: |
| Title: |
| Signature: |
| NonDistressedPersonnel: |
| DistressedPersonnel: |
| NonDistressedFringe Benefits: |
| DistressedFringe Benefits: |
| NonDistressedTravel: |
| DistressedTravel: |
| NonDistressedEquipment: |
| DistressedEquipment: |
| NonDistressedSupplies: |
| DistressedSupplies: |
| NonDistressedContractual: |
| DistressedContractual: |
| NonDistressedOther: |
| DistressedOther: |
| NonDistressedIndirect Costs: |
| DistressedIndirect Costs: |
| NonDistressedTotal: |
| DistressedTotal: |
| Award ValueFederal: |
| Expensed to dateFederal: |
| Estimate to CompleteFederal: |
| Estimated Final CostFederal: |
| Award ValueNonFederal Share: |
| Expensed to dateNonFederal Share: |
| Estimate to CompleteNonFederal Share: |
| Estimated Final CostNonFederal Share: |
| Text1: |
| Check Box2: Off |
| Check Box3: Off |
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