Form State Grants 1 State Grants 1 State Grants Financial Status Report

FY 2005 Allotment									Enter the name of your state. State
					FINANCIAL STATUS REPORT
					IMLS State Programs
1. Federal Agency and Organizational		2. Federal Grant or Other Identifying Number Assigned By Federal Agency							OMB Approval No.		Page of
Element to which Report is submitted.		EXAMPLE: 00-00-0000-00							3137-0056		1 1
IMLS - State Program			LS –	Enter the ten-digit Grant Award Number for your state’s FY-2005 Award.					Exp. Date: 04-30-2008		Pages
Enter the name of your State Library Administrative Agency (a.k.a., the SLAA) along with the complete address. 3. Recipient Organization (Name and complete address, including ZIP codes
Enter the EIN for your SLAA. 4. Employer Identification Number		Enter the applicable number, if you use one. 5. Recipient Account Number or Identifying Number					After printing the form, check “Yes” if this is your “Final” FSR for 2005; check “No” if this is an “Interim” FSR. You cannot submit an Interim Report unless you have received approval from IMLS and a Final submission date has been approved. 6. Final Report		7.        Basis
							__ Yes	__ No	__ 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)
October 1, 2004		September 30, 2006			October 1, 2004				September 30, 2006
10. STATE MOE
a.  Total SLAA funds expended to meet the purposes of LSTA, including the Five-Year Plan (MOE)									10. a - Enter the total State funds that were appropriated to and expended by your SLAA to support the purposes of LSTA, including SLAA funds to support the Five-Year Plan. These funds must be in the SLAA Budget. This figure will represent your MOE.
10. STATE, LOCAL and PRIVATE MATCH
b. (1)   SLAA funds expended specifically on the Five-Year Plan									10. b (1) - Enter the state funds that the SLAA expended to specifically support your state’s current Five-Year Plan.
(2) All local or private funds expended on the Five-Year Plan									10. b (2) - Enter the funds that local governments, corporations, and foundations expended to specifically support your state’s current Five-Year Plan.
(3) Total of b(1) and b(2) (Match)										$ 0.00
10. OTHER SPECIAL FUNDS
c. All other recipient outlays not shown on lines a and b (1-3)									10. c - Enter the amount of any other funds that were used to support library development, but that are not reported in lines a and b (1-3).
10. TOTAL
d. Total recipient share of net outlays (sum of lines a, b(2) and c)										$ 0.00
10. FEDERAL SHARE
e. Total Federal funds authorized for this funding period (Allotment)									10. e - Enter the amount of the federal award (the state’s Allotment) applicable to this FSR.
f. Total unliquidated obligations (expected to clear by Dec. 30 or later IMLS-approved date)									10. f - Enter the amount of any 2005 LSTA funds that you have obligated by Sep. 30 but will not have liquidated by Dec. 30. (You can only do this if you have received prior approval from State Programs staff to go beyond the 90-day liquidation period) These are funds that you fully expect will be spent.
Enter IMLS-approved date in 11 b below
g. Unobligated balance of Federal funds (these funds will be deobligated)									10. g - Enter the amount of 2005 LSTA funds that were not obligated before Sep. 30 or that your SLAA will not be able to liquidate within the Grant Award Period, including any extensions provided by State Programs staff. These are funds that you know will not be spent and will have to be written off.
h. Federal share of net outlays (e minus f and g)										$ 0.00
i.   TOTAL OUTLAYS (sum of lines d and h)										$ 0.00
11. ADMINISTRATION OF THE ACT
a. LSTA Administration costs claimed by the SLAA		11. a - “Allotment” – Enter the amount of the 2005 Allotment (a.k.a., Grant Award) that your SLAA received.		x 4% =	$ 0.00		–	11. a - “Actual” – Enter the amount (if any) of 2005 LSTA funds your SLAA spent to administer the program. This figure cannot exceed the pre-calculated amount shown in “Allowable” which represents 4% of your Allotment.		=	$ 0.00
		Allotment			Allowable			Actual			Difference
b. IMLS-approved date obligations in 10 f above are expected to clear								11. b - "Date" – Enter the date that has been agreed to by State Programs staff for you to extend your liquidation period. On or before that date you must submit a Final FSR to reflect any changes. This refers to item 10 f above.
								Date
12. 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 are set forth in the award documents.
Enter the name and title of the SLAA’s current “Authorized Official” as reflected on the form entitled “State Legal Officer’s Certification of Authorized Certifying Official” that has been submitted by the SLAA and is on file at the State Programs office. Typed or Printed Name and Title								Enter the telephone number for the “Authorized Official”. Telephone (area code, number, extension)
Signature of Authorized Certifying Official								Enter the date the form is being submitted to the State Programs office. In the case of a re-submission of the form, enter the new date of submission along with the word “Revised”. Date Report Submitted
											IMLS 8-21-06
Burden Estimate and Request for Public Comments Public reporting burden for this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comment regarding this burden estimate or any other aspect of this collection of information, including suggestion for reducing this burden, to the Institute of Museum and Library Services, Chief Information Officer, 1800 M Street, NW / 9th Floor, Washington, DC 20036-5802, and to the Office of Management and Budget, Paperwork Reduction Project (3137-0029), Washington, DC 20503.