State Programs For State Programs- Financial Status Report - Pacific Grants

FY 2010 Allotment

State

FINANCIAL STATUS REPORT
IMLS State Programs
1. Federal Agency and Organizational

OMB Approval No.

2. Federal Grant or Other Identifying Number Assigned By Federal Agency

Element to which Report is submitted.

EXAMPLE:

LS –

IMLS - State Programs

Page

3137-0071

00-00-0000-00

00-10-XXXX-10

of

1

1

Exp. Date: 8-31-2013

Pages

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

4. Employer Identification Number

5. Recipient Account Number or Identifying Number

6. Final Report

7.

__ Cash

__ Yes __ No

8. Funding Grant Period (See instructions)

9. Period Covered by This Report

From: (Month, Day, Year)

From: (Month, Day, Year)

To (Month, Day, Year)

October 1, 2009
10.

September 30, 2011

Basis
__ Accrual

To: (Month, Day, Year)

October 1, 2009

September 30, 2011

STATE MOE

a. Total SLAA funds expended to meet the purposes of LSTA, including the Five-Year Plan (MOE)
10.

STATE, LOCAL and PRIVATE MATCH

b. (1) SLAA funds expended specifically on the Five-Year Plan
(2) All local or private funds expended on the Five-Year Plan

$ 0.00

(3) Total of b(1) and b(2) (Match)
10.

OTHER SPECIAL FUNDS

c. All other recipient outlays not shown on lines a and b (1-3)
10.

TOTAL

$ 0.00

d. Total recipient share of net outlays (sum of lines a, b(2) and c)
10.

FEDERAL SHARE

e. Total Federal funds authorized for this funding period (Allotment)
f. Total unliquidated obligations (expected to clear by Dec. 30 or later IMLS-approved date)
Enter IMLS-approved date in 11 b below

g. Unobligated balance of Federal funds (these funds will be deobligated)
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

$ 0 x 4% =
Allotment

$ 0.00

–

$ 0.00

=

Allowable

Actual

Difference

b. IMLS-approved date obligations in 10 f above are expected to clear
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.

Typed or Printed Name and Title

Telephone (area code, number, extension)

Signature of Authorized Certifying Official

Date Report Submitted

IMLS 9-26-11

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