Spreadsheet: 03a1f8e8-49fa-4cf3-9192-6722fcde7584
Sheet: Sheet1

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FEDERAL FUNDING REQUEST
For All Federal SAPT Block Grant Funding
Ohio Department of Alcohol & Drug Addiction Services
1. Header Information:
Agency/Board Name: |  |  |  |  |  |  | Purchase Order #: (If applicable)
2. Expenses  SFY 2011
Service Category | Total SFY11 [NAME] | 4th QTR Max 100% of SFY Award Eligible for Disbursement | SFY11 4th Quarter Actual Expense |  |  |  | Projected Expenses Thru                (Enter Date) | Total Cumulative Expenses | Cash Received To Date | Amount Requested | [NAME] for Request | SFY11 [NAME]
 |  |  | Prior Qtr(s) Cumulative Expenses | April | May | June
Prevention | ( A ) | ( B ) | ( C ) | ( D ) | ( E ) | ( F ) | ( G ) | (H) =C+D+E+F+G | ( I ) | ( J ) = H - I | (K) = B - I - J | (L) = A - I - J
2000C - Per Capita Prevention |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2000F - Board Request Special Needs Prevention |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2010C - UMADAOP |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2010G - Women's Prevention Grants |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2020C - Drug Free Coalitions |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2020E - Higher Education |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2020F - Prevention at Work |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2020I - Community Prevention |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2020J - Targeted Prevention Initiatives |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2030C - Parent Engagement |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2030E - Youth-Led Prevention |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2030G - Circle for Recovery |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2030M - Prevention Services |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
Total Prevention | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0
Treatment
2050C - Per Capita Treatment |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2060E - Women's Treatment Grants |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2070C - Adolescent Treatment |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2070G - TANF Treatment |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2070H - Targeted Treatment Initatives |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2080C - Therapeutic Community |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2080D - TC Expansion |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2080E - TASC |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2080F - Drug Courts |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2080I  - DYS Aftercare |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2080M - Circle for Recovery |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2100D - Outreach |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
2100I - SAMI |  | 0 |  |  |  |  |  | 0 |  | 0 | 0 | 0
Total Treatment | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0
GRAND TOTAL | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0
Federal regulations require that all federal funds be drawn down on a reimbursement basis and/or no more than thirty (30) days in advance of projected expenditures.  NO FUNDS WILL BE DISBURSED UNLESS ALL REQUIRED COLUMNS ARE COMPLETED.
3. CERTIFICATION
I certify that the financial information shown in this funding request is correct.
Requestor's Signature/Title | Phone Number |  | Date |  | Board Executive Director's Signature |  |  | Phone Number |  |  | Date