**Directions on Use of ADD-02**

The ADD-02 is a required supplement to the SF-269 Financial Status
Report form for the program of the State Council on Developmental
Disabilities funded under Subtitle B of the Developmental Disabilities
Assistance and Bill of Rights Act. Submit just one ADD-02 for each
reporting, for the supplemental data for all three years of funding
being reported.

Item 1. **[Designated State Agency]{.underline}**: Official name of the
agency designated by the Governor to carry out Section 125(d) of the Act

Item 2. **[State]{.underline}**: Name of the State or territory

Item 3. **[Report Period]{.underline}**: \_\_/\_\_/\_\_\_\_\_\_ to
\_\_/\_\_/\_\_\_\_\_\_

Provide the beginning and end dates of the period being reported, in the
form of [MM]{.underline}/[DD]{.underline}/[YYYY]{.underline}. \"Current
Federal fiscal year\" refers to the Federal fiscal year of the \"Report
Period\"

**[Financial Status:]{.underline}** Provide the following data, rounded
to the nearest dollar, for each of the rows a. through i.

a\. \"[Goal Activities, undertaken by Council/staff]{.underline}\":
Subtitle B Federal funding for activities related to the goals
referenced in Section 124(c)(5)(B)(i) undertaken in-house by
State Council members or State Council staff

b\. \"[Goal Activities, Poverty Area]{.underline}\": Subtitle B Federal
funding for activities related to the goals referenced in Section
124(c)(5)(B)(i) not done in-house, benefiting persons with developmental
disabilities residing in poverty areas

c\. \"[Goal Activities, Other]{.underline}\": Subtitle B Federal funding
for activities related to the goals referenced in Section
124(c)(5)(B)(i) other than above

d\. \"[General Management]{.underline}\": Subtitle B Federal funding for
personnel, budget/finance/reporting not included as part of Goal
Activities nor Functions of the Designated State Agency

e\. \"[Functions of Designated State Agency (FDSA), Federal
Participation]{.underline}\": Subtitle B Federal funding for Federal
participation in the Functions of the Designated State Agency, as
referenced in Section 124(c)(5)(B)(vi)

f\. \"[Total Federal (a. through e.)]{.underline}\": For each column,
sum of the lines a. through e., described above (see SF-269, Col.III)

g\. \"[State Match (including FDSA + Prog.Inc.)]{.underline}\": Total
funding (or in-kind value) from State or local sources

h\. \"[Functions of Designated State Agency (FDSA), State
Participation]{.underline}\": Report only funding actually expended (or
estimated to be expended) in the reported Federal fiscal year\... report
only one number for each previous year

i\. \"[Program Income (including used as match)]{.underline}\": Program
income is reported by semiannual (6 month) period only (expenditures
during and balance at end of). Balance available is shown under
"Unobligated Estimates."

Items 4, 5, and 6. **[Fiscal Year Funding Columns]{.underline}**

The three major columns are for reporting of fiscal status data on
funding that was awarded during three Federal fiscal years: the
**[Current]{.underline}**; the **[Current Minus One]{.underline}**; and
the **[Current Minus Two]{.underline}**. For each of these major
columns, report the fiscal year of the funding being reported.

**[Award Amount]{.underline}**: Provide the cumulative total of funds
awarded in the Federal fiscal year, including any subsequent negative
awards applicable, as of the most recent Notice of Award within the
reporting period (see SF-269, Col.III, line o.)

Under the major columns are three subcolumns for reporting of three
status categories:

**[Expended]{.underline}**: Provide, for each of the \"Budget/Cost
Category\" rows, the amount of funds that have been expended (see
SF-269, Col.III line j.).

**[Unliquidated Obligations]{.underline}**: Provide, for each of the
\"Budget/Cost Category\" rows, the amount of funds that have been
obligated but not yet liquidated (see SF-269, line m.).

**[Unobligated Estimates]{.underline}**: Provide, for each of the
\"Budget/Cost Category\" rows, the amount of funds that have not yet
been obligated or expended but that are estimated for the particular
budget/cost category (see SF-269, line p.). For program income, show
balance available, regardless of plans.

Item 7. **[Remarks]{.underline}**: Provide any explanatory remarks that
will clarify the reported data.

Item 8. **[Signature]{.underline}**: Provide the name, title, and dated
signature of the official authorized to certify the accuracy of the
reported data.