State Programs - Reporting Subawards Executive Compensation

FY 2013 Grant # ___________________

STATE INFORMATION
For Reporting Subawards and Executive Compensation
(2 C.F.R Part 170 – Requirements for Federal Funding Accountability and Transparency Act
Implementation; Appendix A to Part 170 – Award Term)
The person designated as the authorized certifying official for this grant (as designated on the
form, State Legal Officer’s Certification of the Authorized Certifying Official) is responsible for
selecting, and signing one option in both Parts I and II.
__________________________________________________ (Name of State)
__________________________________________________ (Name of State Agency)

PART I. Reporting of first-tier subawards
Complete one of the following:
A. The State DOES NOT utilize IMLS funds to (circle one):
1) make subawards; or
2) make awards of $25,000 or more.
_____________________________________________
Signature
_____________________________________________
Print Name and Title
_____________________________________________
Date
OR
B. The State does utilize IMLS funds to make subawards, with individual awards of $25,000 or
more. The subawards will be made in ______________________________(month, 20__).
The grantee acknowledges its responsibility to track and report on the subawards within the
FFATA Subaward Reporting System as outlined in guidance provided by IMLS.
_____________________________________________
Signature
_____________________________________________
Print Name and Title
_____________________________________________
Date

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OR
C. The State has not made a decision whether or not to utilize IMLS funds to make
subawards, with individual awards of $25,000 or more. The state will resubmit this form
once that decision is made.
____________________________________________
Signature
_____________________________________________
Print Name and Title
_____________________________________________
Date

PART II. Reporting total compensation of recipient executives
Complete one of the following:
A. The State meets the applicability requiring reporting of total compensation of recipient
executives and will report total compensation for the preceding completed fiscal year.
_____________________________________________
Signature
_____________________________________________
Print Name and Title
_____________________________________________
Date
OR
B. The State DOES NOT meets the applicability requiring reporting of total compensation of
recipient executives and will NOT report total compensation for the preceding completed
fiscal year.
_____________________________________________
Signature
_____________________________________________
Print Name and Title
_____________________________________________
Date
Mail this signed form to your Program Officer within 10 business days from date of receipt of
this form.

OMB No. 3137-0071; Expiration Date: 8/31/2013
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