SF 272 Federal Cash Transaction Report

OMB APPROVAL NO. 0348-0003

FEDERAL CASH TRANSACTIONS REPORT

1. Federal sponsoring agency and organizational element to which this report
is submitted

(See instructions on the back. If report is for more than one grant or
assistance agreement, attach completed Standard Form 272A.)
4. Federal grant or other identification

2. RECIPIENT ORGANIZATION

5. Recipient’s account number or

number

identifying number

Name:
6. Letter of credit number

7. Last payment voucher number

Number
and Street:
Give total number for this period
City, State
and ZIP Code:

8. Payment Vouchers credited to

3. FEDERAL EMPLOYER

FROM (month, day, year)

9. Treasury checks received (whether

or not deposited)

your account

10.

PERIOD COVERED BY THIS REPORT
TO (month, day, year)

IDENTIFICATION NO.
a. Cash on hand beginning of reporting period

$

b. Letter of credit withdrawls
c. Treasury check payments

11. STATUS OF
FEDERAL
CASH

d. Total receipts (Sum of lines b and c)

0.00

e. Total cash available (Sum of lines a and d)

0.00

f. Gross disbursements

(See specific
instructions
on the back)

g. Federal share of program income

0.00

h. Net disbursements (Line f minus line g)
i. Adjustments of prior periods
j. Cash on hand end of period
12. THE

AMOUNT SHOWN
ON LINE 11j, ABOVE,
REPRESENTS CASH REQUIREMENTS FOR THE
ENSUING

13.

$

OTHER INFORMATION

a. Interest income

$

b. Advances to subgrantees or subcontractors

$

Days
14. REMARKS (Attach additional sheets of plain paper, if more space is required)

15.

CERIFICATION
SIGNATURE

I certify to the best of my
knowledge and belief that this
report is true in all respects and
that all disbursements have
been made for the purpose and
conditions of the grant or
agreement.

AUTHORIZED
CERTIFYING

DATE REPORT SUBMITTED

08/03/2009
TYPED OR PRINTED NAME AND TITLE

TELEPHONE (Area Code,

Number, Extension)
OFFICIAL

THIS SPACE FOR AGENCY USE

NSN 7540-01-016-5434
272-103

STANDARD FORM 272 (Rev. 7-97)
Prescribed by OMB Circulars A-102 and A-110

INSTRUCTIONS
Public reporting burden for this collection of information is estimated to average 120 minutes per response, including time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of
Management and Budget, Paperwork Reduction Project (0348-0003), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.
SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Please type or print legibly. Items 1, 2, 8, 9, 10, 11d, 11e, 11h, and 15 are self explanatory, specific
instructions for other items are as follows:

Item

Entry

3

Enter Employer Identification Number (EIN) assigned by
the U.S. Internal Revenue Service or the FICE (institution)
code.

4

If this report covers more than one grant or other
agreement, leave items 4 and 5 blank and provide the
information on Standard Form 272A, Report of Federal
Cash Transactions - Continued.

Item

benefits if treated as a direct cost, interdepartmental
charges for supplies and services, and the amount to
which the recipient is entitled for indirect costs.
11g

Enter the Federal share of program income that was
required to be used on the project or program by the
terms of the grant or agreement.

11i

Enter the amount of all adjustments pertaining to prior
periods affecting the ending balance that have not been
included in any lines above. Identify each grant or
agreement for which adjustment was made, and enter
an explanation for each adjustment under "Remarks."
Use plain sheets of paper if additional space is required.

11j

Enter the total amount of Federal cash on hand at the
end of the reporting period. This amount should include
all funds on deposit, imprest funds, and undeposited
funds (line e, less line h, plus or minus line i).

12

Enter the estimated number of days until the cash on
hand, shown on line 11j, will be expended. If more than
three days cash requirements are on hand, provide an
explanation under "Remarks" as to why the drawdown
was made prematurely, or other reasons for the excess
cash. The requirement for the explanation does not
apply to prescheduled or automatic advances.

13a

Enter the amount of interest earned on advances of
Federal funds but not remitted to the Federal agency. If
this includes any amount earned and not remitted to the
Federal sponsoring agency for over 60 days, explain
under "Remarks." Do not report interest earned on
advances to States.

13b

Enter the amount of advance to secondary recipients
included in item 11h.

14

In addition to providing explanations as required above,
give additional explanation deemed necessary by the
recipient and for information required by the Federal
sponsoring agency in compliance with governing
legislation. Use plain sheets of paper if additional
space is required.

Enter Federal grant number, agreement number, or other
identifying numbers if requested by sponsoring agency.
5

This space reserved for an account number or other
identifying number that may be assigned by the recipient.

6

Enter the letter of credit number that applies to this report.
If all advances were made by Treasury check, enter "NA"
for not applicable and leave items 7 and 8 blank.

7

Enter the voucher number of the last letter-of-credit
payment voucher (Form TUS 5401) that was credited to
your account.

11a

Enter the total amount of Federal cash on hand at the
beginning of the reporting period including all of the
Federal funds on deposit, imprest funds, and undeposited
Treasury checks.

11b

Enter total amount of Federal funds received through
payment vouchers (Form TUS 5401) that were credited to
your account during the reporting period.

11c

Enter the total amount of all Federal funds received
during the reporting period through Treasury checks,
whether or not deposited.

11f

Enter the total Federal cash disbursements, made during
the reporting period, including cash received as program
income. Disbursements as used here also include the
amount of advances and payments less refunds to
subgrantees or contractors; the gross amount of direct
salaries and wages, including the employee’s share of

Entry

STANDARD FORM 272 (Rev. 7-97) Back