CAR REVIEW

REVIEWER OPTIONS

Request Revision Unapprove Section

Review Tips:

 Does the state provide complete and accurate information for questions 1-6?

 Are all mathematical calculations correct?

 Do the amounts listed in each of the rows in Column 10 correspond with the state's approved budget request(s) for the reporting year?

 Have more that 60 percent of the funds in Column 11 been obligated and liquidated by the state during the first 12 months of the grant award?

REPORT REVIEW

Financial Status Report

5. Grant Award Number:

State Basic Grant (Title I):

6. Grant Award Amount:

State Basic Grant (Title I):

Note: Question 7 below is optional. It needs to be completed only if the state is amending/revising its financial status report after a final submission.

7. Amended Interim FSR:

 Yes

Date of Amended FSR:

1. State Name:

2. Federal Funding Period:

Start Date:

End Date:

3. Reporting Period:

Start Date:

End Date:
4. Accounting Basis:

 Cash

 Accrual

1 2 3 4 5 6 7 8 9 10 11

Ro

w

Net Outlays 

Previously 

Reported

Total Outlays 

This Report 

Period

Program 

Income Credits

New Outlays 

This Report 

Period (Column 

2 - 3)

Net Outlays To 

Date (Column 1 

+ 4)

Non-Federal 

Share of 

Outlays

Total Federal 

Share of 

Outlays 

(Column 5 - 6)

Federal Share 

of Unliquidated 

Obligations

Federal Share 

of Outlays & 

Unliquidated 

Obligations 

(Column 7 + 8)

Federal Funds 

Authorized

Balance of 

Unobligated 

Federal Funds 

(Column 10 - 9)

A *TOTAL TITLE I FUNDS*

B LOCAL USES OF FUNDS

C RESERVE

D Funds for 

Secondary 

Recipients

E Funds for 

Postsecondar

y Recipients

F Total

(Row D + E)

G FORMULA DISTRIBUTION

H Funds for 

Secondary 

Recipients

I Funds for 

Postsecondar

y Recipients
J Total

(Row H + I)

K TOTAL LOCAL 

USES OF 

FUNDS

(Row F + J)

L STATE LEADERSHIP

M Nontraditional 

Training and 

Employment

N State

Institutions

O Other 

Leadership 

Activities

P TOTAL STATE 

LEADERSHIP

(Row M + N + 

O)

Q STATE ADMINISTRATION

R Total State 

Administratio

n

S TOTAL TITLE 

I FUNDS
(Row K + P + 

R)

Additional Information:

12. Certification:

I certify to the best of my knowledge and belief that this 

financial status report is accurate and complete. I understand 

that the use of my PIN to certify and submit the FSR is the 

same as certifying and signing this document.

Financial Auditor PIN:

Title/Agency:

Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control 

number for this information collection is 1830-0569. Public reporting burden for this collection of information is estimated to average 174 hours 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 obligation to respond to this collection is required to obtain or 

retain benefit (Carl D. Perkins Career and Technical Education Act of 2006 (Perkins IV) (20 U.S. C. 2301 et seq. as amended by P.L. 109-270). If you have comments or concerns regarding the status of 

your individual submission of this APR, please contact (Office of Career, Technical and Adult Education; Director, Division of Academic and Technical Education; 550 12th Street, SW; Washington, D.C. 

20202 directly. [Note: Please do not return the completed report to this address.]