Form Report form 4 Report form 4 Native American Library Services Final Financial and Per

Institute of Museum and Library Services

Native American Library Services

Basic Grant Final Financial and Performance Report

Use this format to submit your final financial and performance report for the IMLS Native American Library Services Basic Grant. File a separate report for each grant awarded; do not combine two or more grants onto one report form. Final reports are due ninety (90) days after the end of the grant period.

Grantee (Name of Tribe):

Grant number:

Amount of grant award: $

Name of Project Director:

Telephone number of Project Director:

Describe how the grant funds were used to support library and information services. The activities described should follow the categories identified in the spending plan approved when the grant was awarded (e.g., salaries and wages, books and journals, equipment and supplies). Please identify any significant differences between your approved spending plan and your actual expenditures of the grant funds. Any unspent funds must be returned.

Funds expended: $_______________

Funds remaining (if any) *: _______________

Total:

*to be returned to IMLS with Final Report; make check payable to IMLS

________________________________________________________________________________________

Name and title of person submitting this report (if different than Project Director):______________________

Telephone number of person submitting this report: ______________________________________________

By signing below, I certify that the information provided is true and correct and that all funds were used in accordance with the grant guidelines or returned to the Institute of Museum and Library Services.

Signature of person submitting this report: _________________________ Date: __________________

You may either fax this report to IMLS Grants Administration at 202-653-4604 or mail it to Grants Administration; Institute of Museum and Library Services; 1800 M Street, NW / 9^th Floor; Washington, DC 20036-5802.

OMB No. 3137-xxxx, expires 00/00/00

Burden Estimate and Request for Public Comments: Public reporting burden for this collection of information is estimated to average 1 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, 9^th Floor, Washington, DC 20036-5802, and to the Office of Management and Budget, Paperwork Reduction Project (3137-xxxx), Washington, DC 20503.