Form SF269A Financail Status Report

Office of Justice Programs Instructions

for Financial Status Reporting (SF269A)

The quarterly Financial Status Report (FSR) is due no later than 45 days after the end of the calendar quarter. Please be reminded that this is a report of expenditures not a request for reimbursement. To request reimbursement, use your assigned OJP payment system.

This FSR should be filed on-line at https://sf269.ojp.usdoj.gov/sf269/ The attached form and instructions are provided for information. When filing on-line, you will not need to fill in each box on the form, as previously reported information is pre-populated on-line. The on-line system will calculate cumulative data for you. You can change or modify only the most recent report shown on-line. Without a current FSR on file, requests for funds will not be approved and funds will not be disbursed.

1. Pre-printed as: U.S. Dept. of Justice, Office of Justice Programs

2. OJP grant number found on your grant award document.

For example, 2005-AB-CD-0000.

3. Current name and address of the award recipient.

4a. OJP-assigned 9-digit vendor number as recorded on your grant award document.

4b. The recepient organization’s Data Universal Numbering System (DUNS) number assigned by the Central Contract Registry.

5. Enter any identifying number assigned by your organization for your internal use. If none, leave blank.

6. If you have finished expending funds and recording your required match related to this award, regardless of whether they have been or will be reimbursed by the Federal Government, check “Yes.” Otherwise, check “No.”

7. Indicate whether your accounting system uses a CASH or an ACCRUAL basis for recording transactions related to this award. For reports prepared on a CASH basis, outlays are the sum of actual cash disbursement for direct purchases of goods and services at the lowest funding level. For reports prepared on an ACCRUAL basis, outlays are the sum of actual cash disbursement at the lowest funding level. Unpaid obligations represent the amount of obligations that you incurred at the lowest funding level but have not yet paid out.

8. The begin and end dates of the award period.

9. The current reporting calendar quarter as listed below.

Reporting Quarter Jan 1 through Mar 31 Apr 1 through Jun 30 Jul 1 through Sep 30 Oct 1 through Dec 31

Reports Due Not Later than May 15 Aug. 14 Nov 14 Feb 14

Note: Data for more than one calendar quarter may be rolled up into one report for the first report submitted.

10. Lines 10a, 10b, and 10c refer to your cash outlays including the value of in-kind match contributions for this award at the lowest funding level (i.e., monies you have spent). Column I is the cumulative total of expenditures for the prior reported calendar quarter. Amounts in this column came from your previous report. Column II is for the current reporting calendar quarter’s outlays and for any corrections needed. Column III is for the result when adding across the amounts reported in Columns I and II. Columns I and II are pre-populated in the on-line system. The total of lines 10b and 10c should equal the amount reported on line 10a for each column.

Lines 10d, 10e, and 10f should only be completed if you indicated in Box 7 that you are on an accrual basis of accounting. Lines 10d, 10e, and 10f refer to the amount of unpaid obligations or accounts payable you have incurred. An item such as payroll (which has been earned, but not yet paid) is an example of an accrued expense. Line 10d is the total of your unpaid obligations to date.

Line 10e is your share of these unpaid obligations. Line 10f is the Federal share of unpaid obligations. The total of lines 10e and 10f should equal the amount on line 10d.

Line 10g is the total Federal share of your cash outlays and unpaid obligations regardless of whether you have received reimbursement. It will be the total of Column III, Lines 10c and 10f. Line 10h is the total amount of your award. Change this amount only if you have received a supplemental award. Line 10i is the amount of your total award which has not either been expended through a cash outlay or encumbered by an unpaid obligation. It is the difference between Column III, Lines 10h minus 10g equals Line 10i.

11. Please refer to your award documents to complete this section. This section will only be completed if you have a Negotiated Indirect Cost Rate with your cognizant agency.

Line 11a Indicate the type of rate that you have. Line 11b is the indirect cost rate in effect during this current reporting period. Line 11c is the amount of the base against which the cost rate is applied. Line 11d is the total amount of indirect costs charged during this current reporting period. Line 11e is the Federal Government share of the amount reported on Line 11d. (11b x 11c = 11d)

11 e. Note: If more than one rate was in effect during this reporting period, add the additional rate amounts in Box 12 in the Remarks section.

12. Line 12A is the cumulative amount of Federal funds your State agency has passed-through to local units of government, other specified groups or organizations as directed by the legislation of the program.

Line 12B is the cumulative amount of Federal funds subgranted including amounts subgranted to State agencies and amounts reported on Line 12A.

Line 12C is the cumulative Federal portion of forfeited assets to be used in this grant whether the assets were forfeited as a result of this grant or another grant.

Line 12D is the cumulative Federal portion of program income earned from other than forfeited assets. This is income from sources such as registration fees, tuition, and royalties. This amount should not be included in Box 10.

Line 12E is the cumulative amount of program income from all sources, including forfeited assets and interest earned, which have been expended by your organization. This amount should not be included in Box 10.

Line 12F is the balance of unexpended program income

(12C + 12D - 12E).

13. Type your name, title, phone number, and e-mail address. A written

signature is not required on-line. However, if a paper copy is submitted,

please remember to sign and date it, and print your name and telephone

number.

If you submit your SF269 on-line, DO NOT fax or mail a paper copy to OJP unless requested to do so by OJP.

FINANCIAL STATUS REPORT

(Short Form)

File the SF269 report on-line at https://sf269.ojp.usdoj.gov/sf269/

1. Federal Agency and Organizational Element to which Report is Submitted U.S. Dept. of Justice Office of Justice Programs (OJP)

2. Grant or Award Number Assigned by OJP

OMB Approval No. 1121-0264 Expires: 01/3/2006

Page 1

of 1 pages

3. Recipient Organization (Name and complete address, including ZIP code)

4a. Vendor Number

4b. DUNS Number

5. Recipient internal code or Identifying Number (if any)

6. Final Report ☐ Yes ☐ No

7. Basis ☐ 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)

10. Transactions:	(Pre-populated) Previously Reported I	This Period II	(Pre-populated) Cumulative III
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.

A. Block/Formula passthrough $ B. Federal Funds Subgranted $

PROGRAM INCOME: C. Forfeit $ E. Expended $

D. Other $ F. Unexpended $

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) E-mail Address
Signature of Authorized Certifying Official	Date Report Submitted

Standard Form 269a (REV 2002)

Paperwork Reduction Act Notice. Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. We try to create forms and instructions that are accurate, can be easily understood, and which impose the least possible burden on you to provide us with information. You can write to the Office of Justice Programs, US Department of Justice, 810 Seventh Street, NW, Washington, DC 20531.

Submit the SF 269a on-line, DO NOT FAX or MAIL paper copies to OJP unless requested to do so.