ETA 9130 K Senior Community Service Employment Program

Senior Community Service Employment Program

U.S. DOL ETA FINANCIAL REPORT
(Follow instructions on the back.)
1. Federal Agency and Organizational Element to Which Report is Submitted

OMB Approval No. 1205-0461

2. Federal Grant or Other Identifying Number Assigned by DOL

Expires 04/30/2019
3. Recipient Organization (Name and complete address including Zip code)
4a. Unique Entity Identifier

4b. EIN

5. Recipient Account Number or Identifying Number

6. Final Report

7. Basis of Reporting

□ Yes □ No
8. Project/Grant Period From: (MM/DD/YYYY)

To: (MM/DD/YYYY)

□ Accrual

9. Reporting Period End Date (MM/DD/YYYY)

10. Transactions
Federal Cash:
a. Cash Receipts
b. Cash Disbursements
c. Cash on Hand (line a minus b)

$

-

Federal Expenditures and Unobligated Balance:
d. Total Federal Funds Authorized
e. Federal Share of Expenditures
f. Total Administrative Expenditures
g. Federal Share of Unliquidated Obligations
h. Total Federal Obligations (sum of lines e and g)
i. Unobligated Balance of Federal Funds (line d minus h)

$
$

-

Recipient Share:
j. Total Recipient Share Required
k. Recipient Share of Expenditures
l. Remaining Recipient Share to Be Provided (line j minus k)

$

-

Program Income:
m. Total Program Income Earned
n. Program Income Expended in Accordance with the Addition Method
o. Unexpended Program Income (line m minus line n)

$

-

11.
a.
b.
c.
d.
e.

Cumulative

Additional Expenditure Data Required
Other Federal Funds Expended
Administration - Headquarters
Administration - Local
Enrollee Wages and Fringe Benefits
Other Enrollee Expenditures

12. Remarks: (Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation.)

13. Indirect Expenditures
a. Type of Rate

b. Rate

c. Rate Approval Date

d. Period From
(MM/DD/YYYY)

Period To
(MM/DD/YYYY)

e. Base

h. Totals: $

f. Amount Charged

-

$

g. Federal Share

-

$

-

14. Certification: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes
and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729–3730 and 3801–3812).
a. Typed or Printed Name and Title of Authorized Certifying Official

c. Telephone (Area code, number, and extension)
d. Email Address

b. Signature of Authorized Certifying Official

e. Date Report Submitted (MM/DD/YYYY)
15. Agency Use Only:
Prescribed by OMB Uniform Guidance 2 CFR 200.

Persons are not required to respond to this collection of information unless it displays a currently valid OMB number. Public reporting burden for this collection of information, which is required to obtain or retain
benefits (2 CFR 200.327 and WIOA Section 185(e)(2)), is estimated to average 45 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. The reason for the collection of information is general program oversight, evaluation and performance assessment. Send comments
regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to ETA Office of Management and Administrative Services, Rm N-4653, U.S.
Department of Labor, Washington DC 20210.
ETA-9130 (K)

U.S. Department of Labor Employment and Training Administration
Financial Report Instructions

ETA-9130 (K) – Senior Community Service Employment Program
There are different variations of form ETA-9130, each pertaining to a specific program/funding stream.
The instructions for the various ETA-9130 forms are not identical.
Please ensure that you are using the correct ETA-9130 form and instructions.
Report Submission
1)

The U.S. Department of Labor (DOL) Employment and Training Administration (ETA) requires all grant recipients to submit the ETA-9130
Financial Report electronically through an on-line reporting system.

2)

Recipients are issued a password and a PIN to enable reporting via the on-line reporting system at www.etareports.doleta.gov. Upon
accessing the system, detailed on-line reporting instructions are provided.

3)

Report submission is a three step process:
1.
2.
3.

DATA ENTRY – the Secondary Contact person, designated by the recipient organization, is responsible for entering the required
data on the ETA-9130, using the password;
DATA CERTIFICATION – the Primary Contact person, the designated authorized official in the recipient organization, is
responsible for certifying the accuracy of the data by entering the PIN; and
DATA ACCEPTANCE – DOL/ETA is responsible for reviewing the certified ETA-9130, communicating with recipients, as
necessary, and accepting the report within 10 working days after report certification. If a modification is required, the certification
and acceptance processes must be repeated.

Reporting Requirements
1)

Submission of the ETA-9130 is required on a quarterly basis. Reporting quarter end dates shall correspond to the following calendar
quarter end dates: March 31, June 30, September 30, and December 31. A final quarter ETA-9130 is required at the completion of the
quarter, encompassing the grant award end date, or at the completion of the quarter in which all funds have been expended, whichever
comes first. The final quarter ETA-9130 must be indicated by selecting “YES” in Item 6, Final Report.

2)

Quarterly reports, including the final quarter report, are required to be submitted no later than 45 calendar days after the end of each
specified reporting period. The reporting due dates are: May 15, August 14, November 14, and February 14. The deadlines for ETA9130 submissions do not change, even in instances when the reporting due date falls on a weekend or holiday. The e-reporting system is
available 24 hours a day, 7 days a week, and reports can be submitted in advance of the due date. However, technical support is
available only during normal business hours (EST), Monday through Friday.

3)

A closeout report is required to be submitted no later than 90 calendar days after the grant end date. The closeout report is separate
from (and additional to) the final quarter report and becomes accessible on-line after submittal of the final quarter report. (The closeout
report does not need to be completed until the grant closeout process begins.)

4)

All financial data is required to be reported cumulative from grant inception, through the end of each reporting period. Expenditure data
is required to be reported on an accrual basis.

5)

A separate ETA-9130 is required for each program and each fund source (subaccount) awarded to a grant recipient.

6)

All sections of the report must be completed unless otherwise noted in the grant agreement.

For more information regarding DOL/ETA grants and financial reporting, please visit http://www.doleta.gov/grants/. Additional assistance may be
provided through your Federal Project Officer. Technical issues with the on-line reporting system should be directed to:
appsupport.egrants@dol.gov.
Please ensure that the certifying official information contained in Items 14a -14d is correct. Any outdated information will delay transmission of
the grant’s closeout package and relevant information affecting the grant. To request a change in the signatory/certifying official, you must
send an e-mail to ETApassword.pin@dol.gov.

Financial Report Instructions

Line Item
Number

ETA-9130 (K) – Senior Community Service Employment Program

Reporting/Line Item

Instructions

1

Federal Agency and Organizational
Element to Which Report is Submitted

2

Federal Grant or Other Identifying
Number Assigned by DOL

3

Recipient Organization

4a

Unique Entity Identifier

4b

EIN

5

Recipient Account Number or
Identifying Number

6

Final Report
(Yes/No)

“U.S. Department of Labor Employment & Training Administration.”
PRE-ENTERED
Grant number assigned for the award by DOL/ETA and contained on the grant award
document. Also called Federal Award Identification Number (FAIN) under the Uniform
Guidance (2 CFR 200).
PRE-ENTERED
Name and complete address of recipient organization.
PRE-ENTERED
Recipient organization’s Unique Entity Identifier, currently known as the Data Universal
Numbering System (DUNS) number or Central Contractor Registry extended DUNS number
until such time a Unique Entity Identifier (UEI) is determined.
PRE-ENTERED
Recipient organization’s Employer Identification Number (EIN). Also known as the Federal
Employer Identification Number (FEIN), or the Federal Tax Identification Number, the EIN is
a unique nine-digit number assigned by the Internal Revenue Service (IRS) to business
entities operating in the United States for the purpose of identification.
PRE-ENTERED
Enter the account number or any other identifying number assigned by the recipient to the
grant award. This number is strictly for the recipient’s use and is not required by
DOL/ETA.
Select appropriate box. Check “Yes” only if this is the final quarter report for subject grant
subaccount. For grants with multiple subaccounts, each subaccount may be indicated “final”
at the time all funds in that subaccount are expended. However, the grant closeout will not
occur until after the grant end date
ACCRUAL has been pre-entered on all ETA-9130 reports.

Cover Information

DOL/ETA regulations require that all recipients report expenditures and program
income on an accrual basis. For accrual basis reporting, accrued expenditures are
recorded when a requirement to pay is established.
7

Basis of Reporting
(Accrual)

Project/Grant Period, From:
(MM/DD/YYYY)
8

9

Project/Grant Period, To:
(MM/DD/YYYY)
Reporting Period End Date:
(MM/DD/YYYY)

NOTE: Uniform Guidance, 2 CFR 2900.14: “In addition to the guidance set forth in 2 CFR
200.327, for Federal awards from the Department of Labor, the DOL awarding agency will
prescribe whether the report will be on a cash or an accrual basis. If the DOL awarding
agency requires reporting on an accrual basis and the recipient’s accounting system is not
on the accrual basis, the recipient will not be required to convert its accounting system, but
must develop and report such accrual information through best estimates based on an
analysis of the documentation on hand.”
The beginning date of the grant award as defined in the grant award document.
PRE-ENTERED
The ending date of the grant award as defined in the grant award document, and the final
date for which any accrued expenditures can be incurred under the subject grant award.
PRE-ENTERED
The last date of the quarter for which cumulative data is provided on the subject ETA-9130.
(Required reporting quarter end dates are contained in the “Reporting Requirements” in the
first section of these instructions.)
PRE-ENTERED

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Financial Report Instructions
Line Item
Number

Reporting/Line Item

ETA-9130 (K) – Senior Community Service Employment Program
Instructions

Transactions
Enter cumulative amounts in the Cumulative Column for each line item requiring data entry, as of the reporting period end date.
NOTE: If any line item does NOT require data entry for a particular grant/program, a ZERO must be entered.
10

Line items which will be automatically calculated are grayed out, and no data entry will be permitted by the reporting entity.
Cumulative data for the current reporting quarter will become the Previous Period Column in the following quarter. This Period data
will be automatically calculated. Use Section 12, Remarks, to provide any information deemed necessary to support/explain data
provided in this section.

Federal Cash
This amount will be PRE-ENTERED to agree with DOL cumulative quarter-end drawdown
records associated with this grant and the specific subaccount identified in Item 2. This is
equal to the cumulative drawdowns posted in the Payment Management System (PMS)
through the end of the reporting period end date.
10a

Cash Receipts
NOTE: For grant recipients operating on a reimbursement basis, this amount will NOT reflect
cash utilized from other fund sources of the recipient organization to pay for subject grant
activities, until such funds are drawn down under the subaccount specifically associated with
this grant as identified in Item 2.
Enter the cumulative amount of cash disbursed from the cash receipts identified on 10a,
as of the reporting period end date. The cash disbursements reported must be all or a
portion of the cash receipts reflected on Item 10a.
This entry should reflect the sum of actual cash disbursements for direct charges for goods
and services, the amount of cash paid out for indirect expenses, and the amount of cash
advance payments and payments made to subrecipients and subcontractors.

10b

Cash Disbursements

NOTE: Line 10e (Federal Share of Expenditures) will typically be greater than Line 10b due
to the inclusion of accruals, for which payment has not been made. If allowable advances
made to subrecipients, cause Line 10b to exceed Line 10e, a valid explanation should be
provided in Section 12, Remarks.
If the cumulative entry for this line item is less than the previous period cumulative amount, a
valid explanation should be provided in Section 12, Remarks.
This is an automatic calculation, which is Line 10a (Cash Receipts) minus Line 10b (Cash
Disbursements).

10c

Cash on Hand
(line 10a minus line 10b)

The cash on hand amount should represent immediate cash needs. An explanation for the
excess cash on hand amount should be provided in Section 12, Remarks.
NOTE: In accordance with Department of Treasury regulations, federal cash must be
drawn solely to accommodate immediate needs.

Federal Expenditures and Unobligated Balance:
10d

Total Federal Funds Authorized

10e

Federal Share of Expenditures

This amount is pre-entered for all grants, except WIA or WIOA formula-funded. This entry
should agree with the grant award amount specified in the official grant award document for
this subaccount, as identified in Item 2. (Discrepancies must be identified by recipient and
corrected, as necessary, by the Grant Officer.)
Enter the cumulative amount of accrued expenditures for allowable costs associated with
the funds authorized on Line10d (Total Federal Funds Authorized).
DOL/ETA requires reporting on an accrual basis. If the recipient’s accounting system is not
on an accrual basis, the recipient will not be required to convert its accounting system, but
must develop and report such accrual information through best estimates based on an
analysis of the documentation on hand (2 CFR 2900.14).
Page 2 of 7

Financial Report Instructions
Line Item
Number

Reporting/Line Item

ETA-9130 (K) – Senior Community Service Employment Program
Instructions
Expenditures for reports prepared on an accrual basis are the sum of: actual cash
disbursements specified in Line 10b for direct charges for goods and services; the amount of
indirect expenses incurred; net increase or decrease in the amounts owed by the nonFederal entity for goods and property received; and services performed by employees,
contractors, subrecipients, and other payees, and programs for which no current services or
performance are required such as annuities, insurance claims, or other benefit payments,
minus any rebates, refunds, or other credits.
Unless cash advances have been made to subrecipients or there is a reduction for rebates,
refunds, or other credits, this entry will usually be greater than Line 10b (Cash
Disbursements) because accruals (goods and services received but not yet paid for) must
be included on this line item. Non-Federal entities must liquidate existing cash advances
before requesting additional advances (2 CFR 2900.7). In addition, recipients operating on a
reimbursement basis must report all accrued expenditures (including cash disbursements for
allowable grant activities) in the quarter in which they occur.
NOTE: If the cumulative entry for this line item is less than the previous period cumulative
amount, a valid explanation should be provided in Section 12, Remarks.
An entry is required for this line item for all grants subject to an administrative cost limitation.
This line item is a portion of the amount reported on Line 10e (Federal Share of
Expenditures).
Enter the cumulative amount of accrued expenditures for administrative activities.

10f

Total Administrative Expenditures

Consult the appropriate program rules and regulations and/or grant award specifications for
specific definitions and/or limitations on administrative costs. Some grants may be identified
in the grant agreement as exempt from breaking out administrative costs.
If no data entry is required, a ZERO must be entered.
Enter any obligations incurred, for which an accrued expenditure has not yet been recorded,
as of the reporting period end date.
Unliquidated obligations should include amounts which will become due to subrecipients and
contractors. On the final report, this line item should be zero.

10g

Federal Share of Unliquidated
Obligations

The OMB Uniform Guidance defines “Obligation” in 2 CFR 200.71 as follows: “When used
in connection with a non-Federal entity’s utilization of funds under a Federal award,
obligations means orders placed for property and services, contracts and subawards made,
and similar transactions during a given period that require payment by the non-Federal entity
during the same or a future period.” Please refer to 2 CFR 200 and 2 CFR 2900 for
additional guidance.
NOTE: For DOL/ETA grants, the only liquidation that can occur during closeout is the
liquidation of accrued expenditures (NOT obligations) for goods and/or services received
during the grant period.

10h

Total Federal Obligations
(sum of lines 10e and 10g)

Do not include any amount on Line 10g that has been reported on Line 10e (Federal Share
of Expenditures) or 10f (Total Administrative Expenditures). Do not include any amount on
Line 10g for a future commitment of funds/encumbrances (e.g., entire lease, budgeted
salary costs) for which an obligation has not yet been incurred.
This is an automatic calculation, which is the sum of Lines 10e (Federal Share of
Expenditures) and 10g (Federal Share of Unliquidated Obligations).

10i

Unobligated Balance of Federal Funds
(line 10d minus line 10h)

This is an automatic calculation, which is Line 10d (Total Federal Funds Authorized) minus
Line Item 10h (Total Federal Obligations).

Recipient Share:
10j

Total Recipient Share Required

Enter the total match requirement, if applicable. A match requirement will be listed in the
grant award document and on the SF-424a, Section A, Column F “Non-Federal.”
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Financial Report Instructions
Line Item
Number

Reporting/Line Item

ETA-9130 (K) – Senior Community Service Employment Program
Instructions
If there is no match requirement, a ZERO must be entered.
Enter any non-Federal funds expended, by recipient organization, for the purposes or
activities of subject grant. Expenditures identified on this line item must be allowable costs
which could otherwise have been paid for out of subject grant funds. These expenditures
should include both match and other non-Federal leveraged resources. The value of
allowable non-Federal in-kind match contributions should also be included.

10k

10l

Recipient Share of Expenditures

Remaining Recipient Share to Be
Provided
(line 10j minus line10k)

This entry may (and often will) exceed the required match entered on Line 10j (Total
Recipient Share Required).
NOTE: Non-Federal funds expended for the purposes or activities of the subject grant,
which are allowable under the OMB Uniform Guidance (2 CFR 200 and 2 CFR 2900), but
which are not completely allowable under the subject grant (due to a program specific
restriction), should not be reported on this line item, but should be included in the quarterly
progress report. Other federal funds expended for the purpose and benefit of this grant
should be included in line item 11a (Other Federal Funds Expended).
This is an automatic calculation, which is Line 10j (Total Recipient Share Required) minus
Line 10k (Recipient Share of Expenditures). When the match requirement identified on
Line 10j has been met, or if Line 10j is zero, the value on Line 10l will automatically be
set to zero.

Program Income:
Enter the total amount of program income earned as the result of allowable grant activity.
The addition method for recording and reporting program income is typically required for all
ETA programs/grants. For additional reference, program income is defined in the applicable
program regulations and in 2 CFR 200.80 and 2 CFR 200.307.
10m

Total Program Income Earned

10n

Program Income Expended in
Accordance with the Addition Method

10o

Unexpended Program Income
(line 10m minus line 10n)

11

Additional Expenditure Data Required

Either gross or net program income may be reported. If gross program income is reported,
the costs for generating the income should be included on Line 10e (Federal Share of
Expenditures). If net program income is reported, the costs for generating the income are
subtracted from the total income earned before entering the net amount on 10m.
If no program income is earned, a ZERO must be entered.
Enter the cumulative amount of accrued expenditures incurred against the program income
earned on Line 10m (Total Program Income Earned).
NOTE: Program income is to be expended during the same grant period in which it is
earned and must be disbursed before requesting new cash advance payments (2 CFR
200.305 (b)(5)).
This is an automatic calculation, which is Line10m (Total Program Income Earned) minus
10n (Program Income Expended in Accordance with the Addition Method).

Enter any other Federal funds expended, by the recipient organization and any subrecipient
organizations for the same purposes or activities of the subject grant. Expenditures
included must be allowable costs which could otherwise have been paid for out of
subject grant funds.
11a

11b

Other Federal Funds Expended

Administration - Headquarters

Other Federal funds expended by any non-subrecipient partner organizations for the benefit
of this grant program should be included in the quarterly progress report.
This entry should include expenditures of all Federally funded leveraged resources, whether
or not such expenditures are the result of a leveraging requirement.
Enter expenditures at the direct recipient level for administrative costs, including both
personnel-related and non-personnel-related, and both direct and indirect, as described in
OAA-2006 section 502(c) (4) and 20 CFR 641.856.
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Financial Report Instructions
Line Item
Number

Reporting/Line Item

11c

Administration - Local

11d

Enrollee Wages and Fringe Benefits

11e

Other Enrollee Expenditures

ETA-9130 (K) – Senior Community Service Employment Program
Instructions
Enter expenditures at the program operator level for administrative costs, including both
personnel-related and non-personnel-related and both direct and indirect, as described in
OAA-2006 section 502(c) (4) and 20 CFR 641.856. The sum of lines 11b (Administration
– Headquarters) and 11c (Administration – Local) should equal line 10f (Total
Administrative Expenditures).
Enter expenditures for participant wages, benefits, and other costs described in OAA-2006
section 502(c) (4).
Enter expenditures for allowable program activities, excluding participant wages and
benefits, as described in OAA-2006 section 502(c)(6)(A)(ii-v). The sum of lines 11b
(Administration – Headquarters), 11c (Administration – Local), 11d (Enrollee Wages
and Fringe Benefits), and 11e should equal line 10e (Federal Share of Expenditures).

Remarks
12

13

13a

Enter any explanations deemed necessary by the recipient or information required by DOL/ETA. (This section supports transactions
entered on lines identified in Sections 10, 11, and 13, as applicable.)
Indirect Expenditures
Complete this information only for indirect expenses incurred by the non-federal entity receiving direct awards from DOL and using an
indirect cost rate. State recipients using a Statewide Cost Allocation Plan (SWCAP) and/or subrecipients will not report indirect
expenditures.
Indirect cost expenditures are only required to be reported on the Final Report. Recipients must enter information on lines 13a – 13h
at the end of the project/grant period.
State whether indirect cost rate(s) is Provisional, Predetermined, Final, Fixed, Fixed with
Type of Rate
Carry-Forward, DeMinimis, or other.

13b

Rate

Enter the indirect cost rate(s) in effect during the reporting period.

13c

Rate Approval Date

Enter the date on which the indirect cost rate was approved.
Enter the date on which the approved indirect cost rate became effective.

Period From
13d
Period To

NOTE: The indirect cost rate period must apply to the Project/Grant Period in line 8 above.
Enter the last date (ending date) on which the approved indirect cost rate was (or is going to
be) effective.
NOTE: The indirect cost rate period must apply to the Project/Grant Period in line 8 above.
Enter the amount of the distribution base against which the rate(s) was applied, such as
modified total direct costs (MTDC). Distribution bases are described in 2 CFR Part 200 and
the Federal Acquisition Regulations (FAR). MTDC is defined at 2 CFR Part 200.68.
Enter the amount of indirect costs charged during the time period specified. Multiply 13b
(Rate) x 13e (Base).

13e

Base

13f

Amount Charged

13g

Federal Share

Enter the Federal share of the amount in 13f (Amount Charged).

13h

Totals

Enter the totals for 13e (Base), 13f (Amount Charged), and 13g (Federal Share)
respectively.

Certification
The authorized official certifies accuracy of reported data by entering assigned PIN.
14a-b

14c

“By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal
award. I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal,
civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31,
Sections 3729–3730 and 3801–3812).”
The telephone number of the certifying official is automatically displayed. If the information
Telephone (Area Code, Number and
contained in this field is outdated or incorrect, please contact your Federal Project Officer
Extension)
(FPO) and Grant Officer to inform him/her of the error and the need to request a change.
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Financial Report Instructions
Line Item
Number

Reporting/Line Item

ETA-9130 (K) – Senior Community Service Employment Program
Instructions

14d

Email Address

The email address of the certifying individual is automatically displayed. If the information
contained in this field is outdated or incorrect, please contact your Federal Project Officer
(FPO) and Grant Officer to inform him/her of the error and the need to request a change.

14e

Date Report Submitted
(MM/DD/YYYY)

The date the ETA-9130 is certified/submitted to DOL/ETA is automatically displayed.

15

Agency Use Only

This section is reserved for DOL/ETA use.

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