1. Federal Agency and Organizational Element to Which Report is Submitted

4a. DUNS Number

Recipient Organization Name:

Street1:

Street2:

City:

State:

Country: ZIP / Postal Code:

Quarterly

Federal Financial Report

(Follow form Instructions)

County:

Province:

2. Federal Grant or Other Identifying Number Assigned by Federal

Agency (To report multiple grants, use FFR Attachment)

3. Recipient Organization (Name and complete address including Zip code)

4b. EIN 5. Recipient Account Number or Identifying Number

(To report multiple grants, use FFR Attachment)

6. Report Type

Semi-Annual

Annual

Final

7. Basis of Accounting

Accrual

Cash

8. Project/Grant Period

From: To:

9. Reporting Period End Date

a. Cash Receipts

c. Cash on Hand (line a minus b)

b. Cash Disbursements

10. Transactions Cumulative

(Use lines a-c for single or multiple grant reporting)

Federal Cash (To report multiple grants, also use FFR attachment):

(Use lines d-o for single grant reporting)

Federal Expenditures and Unobligated Balance:

d. Total Federal funds authorized

e. Federal share of expenditures

f. Federal share of unliquidated obligations

g. Total Federal share (sum of lines e and f)

h. Unobligated balance of Federal Funds (line d minus g)

Recipient Share:

i. Total recipient share required

k. Remaining recipient share to be provided (line i minus j)

j. Recipient share of expenditures

Program Income:

l. Total Federal program income earned

o. Unexpended program income (line l minus line m or line n)

m. Program Income expended in accordance with the deduction alternative

n. Program Income expended in accordance with the addition alternative

OMB Number: 4040-0014

Expiration Date: 01/31/2019
b. Signature of Authorized Certifying Official

e. Date Report Submitted

First Name: Middle Name:

Last Name: Suffix:

Title:

c. Telephone (Area code, number and extension)

d. Email Address

Prefix:

13. Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false,

fictitious, or fraudulent information may subject me to criminal, civil or administrative penalties. (U.S. Code, Title 18, section 1001)

11. Indirect Expense

a. Type b. Rate c. Period From Period To d. Base f. Federal Share e. Amount

Charged

g. Totals:

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

a. Name and Title of Authorized Certifying Official

14. Agency use only:

Standard Form 425
Federal Financial Report Instructions

Report Submissions

1) Recipients will be instructed by Federal agencies to submit the Federal Financial Report (FFR) to

a single location, except when an automated payment management reporting system is utilized. In

this case, a second submission location may be required by the agency.

2) If recipients need more space to support their FFRs, or FFR Attachments, they should provide

supplemental pages. These additional pages must indicate the following information at the top of

each page: Federal grant or other identifying number (if reporting on a single award), recipient

organization, Data Universal Numbering System (DUNS) number, Employer Identification Number

(EIN), and period covered by the report.

Reporting Requirements

Note: For single award reporting:

1) Federal agencies may require both cash management information on lines 10(a) through 10(c) and

financial status information lines 10(d) through 10(o).

2) 10(b) and 10(e) may not be the same until the final report.

Line Item Instructions for the Federal Financial Report

FFR

Number

Reporting Item Instructions

Cover Information

1 Federal Agency and

Organizational Element to

Which Report is Submitted

Enter the name of the Federal agency and organizational element

identified in the award document or as instructed by the agency.

2 Federal Grant or Other

Identifying Number

Assigned by Federal

Agency

For a single award, enter the grant number assigned to the award by the

Federal agency. For multiple awards, report this information on the FFR

Attachment. Do not complete this box if reporting on multiple awards.

3 Recipient Organization Enter the name and complete address of the recipient organization

including zip code.

4a DUNS Number Enter the recipient organization's Data Universal Numbering System

(DUNS) number or Central Contract Registry extended DUNS number.

4b EIN Enter the recipient organization's Employer Identification Number (EIN).

5 Recipient Account Number

or Identifying Number

Enter the account number or any other identifying number assigned by the

recipient to the award. This number is for the recipient's use only and is

not required by the Federal agency. For multiple awards, report this

Revised 6/28/2010

The submission of interim FFRs will be on a quarterly, semi-annual, or annual basis, as directed by

the Federal agency. A final FFR shall be submitted at the completion of the award agreement. The

following reporting period end dates shall be used for interim reports: 3/31, 6/30, 9/30, or 12/31.

For final FFRs, the reporting period end date shall be the end date of the project or grant period.

1)

Quarterly and semi-annual interim reports shall be submitted no later than 30 days after the end of

each reporting period. Annual reports shall be submitted no later than 90 days after the end of each

reporting period. Final reports shall be submitted no later than 90 days after the project or grant

period end date.

2)
information on the FFR Attachment. Do not complete this box if

reporting on multiple awards.

6 Report Type Mark appropriate box. Do not complete this box if reporting on multiple

awards.

7 Basis of Accounting

(Cash/Accrual)

Specify whether a cash or accrual basis was used for recording

transactions related to the award(s) and for preparing this FFR. Accrual

basis of accounting refers to the accounting method in which expenses are

recorded when incurred. For cash basis accounting, expenses are

recorded when they are paid.

8 Project/Grant Period,

From: (Month, Day, Year)

Indicate the period established in the award document during which

Federal sponsorship begins and ends.

Note: Some agencies award multi-year grants for a project period that is

funded in increments or budget periods (typically annual increments).

Throughout the project period, agencies often require cumulative

reporting for consecutive budget periods. Under these circumstances,

enter the beginning and ending dates of the project period not the budget

period.

Do not complete this line if reporting on multiple awards.

Project/Grant Period, To:

(Month, Day, Year)

See the above instructions for "Project/Grant Period, From: (Month, Day,

Year)."

9 Reporting Period End

Date: (Month, Day, Year)

Enter the ending date of the reporting period. For quarterly, semi-annual,

and annual interim reports, use the following reporting period end dates:

3/31, 6/30, 9/30, or 12/31. For final FFRs, the reporting period end date

shall be the end date of the project or grant period.

10 Transactions

Enter cumulative amounts from date of the inception of the award through the end date of the

reporting period specified in line 9.

Use Lines 10a through 10c, Lines 10d through 10o, or Lines 10a through 10o, as specified by the

Federal agency, when reporting on single grants.

Use Line 12, Remarks, to provide any information deemed necessary to support or explain FFR data.

Federal Cash (To report multiple grants, also use FFR Attachment)

10a Cash Receipts Enter the cumulative amount of actual cash received from the Federal

agency as of the reporting period end date.

10b Cash Disbursements Enter the cumulative amount of Federal fund disbursements (such as cash

or checks) as of the reporting period end date. Disbursements are the sum

of actual cash disbursements for direct charges for goods and services, the

amount of indirect expenses charged to the award, and the amount of cash

advances and payments made to subrecipients and contractors.

For multiple grants, report each grant separately on the FFR Attachment.

The sum of the cumulative cash disbursements on the FFR Attachment

must equal the amount entered on Line 10b, FFR.

10c Cash On Hand (Line 10a

Minus Line 10b)

Enter the amount of Line 10a minus Line 10b. This amount represents

immediate cash needs. If more than three business days of cash are on

hand, the Federal agency may require an explanation

Revised 6/28/2010

FFR Reporting Item Instructions

Number
FFR

Number

Reporting Item Instructions

on Line 12, Remarks, explaining why the drawdown was made

prematurely or other reasons for the excess cash.

Federal Expenditures and Unobligated Balance: Do not complete this section if reporting on multiple

awards.

10d Total Federal Funds

Authorized

Enter the total Federal funds authorized as of the reporting period end

date.

10e Federal Share of

Expenditures Enter the amount of Federal fund expenditures. For reports prepared on a

cash basis, expenditures are the sum of cash disbursements for direct

charges for property and services; the amount of indirect expense charged;

and the amount of cash advance payments and payments made to

subrecipients. For reports prepared on an accrual basis, expenditures are

the sum of cash disbursements for direct charges for property and services;

the amount of indirect expense incurred; and the net increase or decrease

in the amounts owed by the recipient for (1) goods and other property

received; (2) services performed by employees, contractors, subrecipients,

and other payees; and (3) programs for which no current services or

performance are required. Do not include program income expended in

accordance with the deduction alternative, rebates, refunds, or other

credits. (Program income expended in accordance with the deduction

alternative should be reported separately on Line 10o.)

10f Federal Share of

Unliquidated Obligations

Unliquidated obligations on a cash basis are obligations incurred, but not

yet paid. On an accrual basis, they are obligations incurred, but for which

an expenditure has not yet been recorded. Enter the Federal portion of

unliquidated obligations. Those obligations include direct and indirect

expenses incurred but not yet paid or charged to the award, including

amounts due to subrecipients and contractors. On the final report, this line

should be zero unless the awarding agency has provided other

instructions.

Do not include any amount in Line 10f that has been reported in Line 10e.

Do not include any amount in Line 10f for a future commitment of funds

(such as a long-term contract) for which an obligation or expense has not

been incurred.

10g Total Federal Share (Sum

of Lines 10e and 10f)

Enter the sum of Lines 10e and 10f.

10h Unobligated Balance of

Federal Funds (Line 10d

Minus Line 10g)

Enter the amount of Line 10d minus Line 10g.

Recipient Share: Do not complete this section if reporting on multiple awards.

10i Total Recipient Share

Required

Enter the total required recipient share for reporting period specified in

line 9. The required recipient share should include all matching and cost

sharing provided by recipients and third-party providers to meet the level

required by the Federal agency. This amount should not include cost

sharing and match amounts in excess of the amount required by the

Federal agency (for example, cost overruns for which the recipient incurs

additional expenses and, therefore, contributes a greater level of cost

Revised 6/28/2010
FFR

Number

Reporting Item Instructions

sharing or match than the level required by the Federal agency).

10j Recipient Share of

Expenditures

Enter the recipient share of actual cash disbursements or outlays (less any

rebates, refunds, or other credits) including payments to subrecipients and

contractors. This amount may include the value of allowable third party

in-kind contributions and recipient share of program income used to

finance the non-Federal share of the project or program. Note: On the

final report this line should be equal to or greater than the amount of Line

10i.

10k Remaining Recipient Share

to be Provided (Line 10i

Minus Line 10j)

Enter the amount of Line 10i minus Line 10j. If recipient share in Line

10j is greater than the required match amount in Line 10i, enter zero.

Program Income: Do not complete this section if reporting on multiple awards.

10l Total Federal Program

Income Earned

Enter the amount of Federal program income earned. Do not report any

program income here that is being allocated as part of the recipient's cost

sharing amount included in Line10j.

10m Program Income Expended

in Accordance With the

Deduction Alternative

Enter the amount of program income that was used to reduce the Federal

share of the total project costs.

10n Program Income Expended

in Accordance With the

Addition Alternative

Enter the amount of program income that was added to funds committed

to the total project costs and expended to further eligible project or

program activities.

10o Unexpended Program

Income (Line 10l Minus

Line 10m or Line 10n)

Enter the amount of Line 10l minus Line 10m or Line 10n. This amount

equals the program income that has been earned but not expended, as of

the reporting period end date.

11 Indirect Expense: Complete this information only if required by the awarding agency. Enter

cumulative amounts from date of the inception of the award through the end date of the reporting

period specified in line 9.

11a Type of Rate(s) State whether indirect cost rate(s) is Provisional, Predetermined, Final, or

Fixed.

11b Rate Enter the indirect cost rate(s) in effect during the reporting period.

11c Period From; Period To Enter the beginning and ending effective dates for the rate(s).

11d Base Enter the amount of the base against which the rate(s) was applied.

11e Amount Charged Enter the amount of indirect costs charged during the time period

specified. (Multiply 11b. x 11d.)

11f Federal Share Enter the Federal share of the amount in 11e.

11g Totals Enter the totals for columns 11d, 11e, and 11f.

Remarks, Certification, and Agency Use Only

12 Remarks Enter any explanations or additional information required by the Federal

sponsoring agency including excess cash as stated in line 10c.

13a Typed or Printed Name and

Title of Authorized

Certifying Official

Enter the name and title of the authorized certifying official.

13b Signature of Authorized

Certifying Official

The authorized certifying official must sign here.

13c Telephone (Area Code,

Number and Extension)

Enter the telephone number (including area code and extension) of the

individual listed in Line 13a.

13d E-mail Address Enter the e-mail address of the individual listed in Line 13a.

Revised 6/28/2010
FFR

Number

Reporting Item Instructions

13e Date Report Submitted

(Month, Day, Year)

Enter the date the FFR is submitted to the Federal agency using the

month, day, year format.

14 Agency Use Only This section is reserved for Federal agency use.

Revised 6/28/2010