+-----------------------------------+----------------------------------+
| **FEDERAL CASH TRANSACTION        | Approved by Office of Management |
| REPORT**                          | and Budget, No. 80-RO182         |
+-----------------------------------+----------------------------------+
| *(See instruction on the back. If | 1\. Federal sponsoring agency    |
| report is for more than one grant | and organizational element to    |
| or*                               | which this report is submitted   |
|                                   |                                  |
| *assistance agreement, attach     |                                  |
| completed Standard Form 272-A.)*  |                                  |
+-----------------------------------+----------------------------------+

+----------------------------------+----------------+------------------+
| 2\. RECIPIENT ORGANIZATION       | 4\. Federal    | 5\. Recipients   |
|                                  | grant of other | account number   |
| *Name* *:*                       | identifica-    | or identifying   |
|                                  |                | number           |
| *Number*                         | tion number    |                  |
|                                  |                |                  |
| *and Street :*                   |                |                  |
|                                  |                |                  |
| *City, State*                    |                |                  |
|                                  |                |                  |
| *and Zip Code:*                  |                |                  |
+----------------------------------+----------------+------------------+
|                                  | 6\. Letter of  | 7\. Last payment |
|                                  | credit number  | voucher number   |
+----------------------------------+----------------+------------------+
|                                  | *Give total    |                  |
|                                  | number for     |                  |
|                                  | this period*   |                  |
+----------------------------------+----------------+------------------+
|                                  | 8\. Payment    | 9\. Treasury     |
|                                  | vouches        | checks received  |
|                                  | credited to    | *(whether or not |
|                                  | your account   | deposited)*      |
+----------------------------------+----------------+------------------+
|                                  | 10\. PERIOD    |                  |
|                                  | COVERED BY     |                  |
|                                  | THIS REPORT    |                  |
+----------------------------------+----------------+------------------+
| 3\. FEDERAL EMPLOYER             | FROM *(month,  | TO *(month, day, |
|                                  | day, year)*    | year)*           |
| IDENTIFICATION NO.               |                |                  |
+----------------------------------+----------------+------------------+

+----------------------------------+-----------------------+-----------+
| 11\. STATUS OF                   | a\. Cash on hand      | \$        |
|                                  | beginning reporting   |           |
| FEDERAL                          | period                |           |
|                                  |                       |           |
| CASH                             |                       |           |
|                                  |                       |           |
| *(See specific*                  |                       |           |
|                                  |                       |           |
| *instructions*                   |                       |           |
|                                  |                       |           |
| *on the back)*                   |                       |           |
+----------------------------------+-----------------------+-----------+
|                                  | b\. Letter of credit  |           |
|                                  | withdrawals           |           |
+----------------------------------+-----------------------+-----------+
|                                  | c\. Treasury check    |           |
|                                  | payments              |           |
+----------------------------------+-----------------------+-----------+
|                                  | d\. Total receipts    |           |
|                                  | *(Sum of lines b and  |           |
|                                  | c)*                   |           |
+----------------------------------+-----------------------+-----------+
|                                  | e\. Total cash        |           |
|                                  | available *(Sum of    |           |
|                                  | lines a and d)*       |           |
+----------------------------------+-----------------------+-----------+
|                                  | f\. Gross             |           |
|                                  | disbursements         |           |
+----------------------------------+-----------------------+-----------+
|                                  | g\. Federal share of  |           |
|                                  | program income        |           |
+----------------------------------+-----------------------+-----------+
|                                  | h\. Net disbursements |           |
|                                  | *(Line f minus line   |           |
|                                  | g)*                   |           |
+----------------------------------+-----------------------+-----------+
|                                  | I. Adjustments of     |           |
|                                  | prior periods         |           |
+----------------------------------+-----------------------+-----------+
|                                  | j\. Cash on hand end  | \$        |
|                                  | of period             |           |
+----------------------------------+-----------------------+-----------+

+--------------+------------------------------------------+-----------+
| 12\. THE     | 13\. OTHER INFORMATION                   |           |
| AMOUNT SHOWN |                                          |           |
| ON LINE 11J, |                                          |           |
| ABOVE,       |                                          |           |
|              |                                          |           |
| REPRESENTS   |                                          |           |
| CASH RE-     |                                          |           |
|              |                                          |           |
| QUIREMENT    |                                          |           |
| FOR THE      |                                          |           |
|              |                                          |           |
| ENSUING      |                                          |           |
|              |                                          |           |
| *Days*       |                                          |           |
+--------------+------------------------------------------+-----------+
|              | a\. Interest income                      | \$        |
+--------------+------------------------------------------+-----------+
|              | b\. Advances to subgrantees or           | \$        |
|              | subcontractors                           |           |
+--------------+------------------------------------------+-----------+

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

  -----------------------------------------------------------------------

  -----------------------------------------------------------------------
  15\. CERTIFICATION

  -----------------------------------------------------------------------

+-------------+---------+--------------------------------+------------+
| I certify   | AUT     | SIGNATURE                      | DATE       |
| to the best | HORIZED |                                | REPORT     |
| of my       |         |                                | SUBMITTED  |
|             | CER     |                                |            |
| knowledge   | TIFYING |                                |            |
| and belief  |         |                                |            |
| that        | O       |                                |            |
|             | FFICIAL |                                |            |
| this report |         |                                |            |
| is true in  |         |                                |            |
| all re-     |         |                                |            |
|             |         |                                |            |
| spects and  |         |                                |            |
| that all    |         |                                |            |
| disburse-   |         |                                |            |
|             |         |                                |            |
| ments have  |         |                                |            |
| been made   |         |                                |            |
| for         |         |                                |            |
|             |         |                                |            |
| the purpose |         |                                |            |
| and         |         |                                |            |
| conditions  |         |                                |            |
|             |         |                                |            |
| of the      |         |                                |            |
| grant or    |         |                                |            |
| agreement   |         |                                |            |
+-------------+---------+--------------------------------+------------+
|             |         | TYPED OR PRINTED NAME AND      | TELEPHONE  |
|             |         | TITLE                          | *(Area     |
|             |         |                                | Code,*     |
|             |         |                                |            |
|             |         |                                | *Number,   |
|             |         |                                | E          |
|             |         |                                | xtension)* |
+-------------+---------+--------------------------------+------------+

  -----------------------------------------------------------------------
  THIS SPACE FOR AGENCY USE

  -----------------------------------------------------------------------

272-102 STANDARD FORM 272 (7-76)

Prescribed by Office of Management and Budget

Cir. No. A-11

**INSTRUCTIONS**

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]{.underline}*

3\. Enter employer identification number assigned by the U.S. Internal
Revenue Service or the FICE (institution) code.

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

4\. 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.

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 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.

*[Entry Item]{.underline}*

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 of 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. The 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 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 a plain sheets of paper if additional space
is required.