Spreadsheet: 17197f42-1a15-4bb8-a4fb-793f0ea49c65
Sheet: Sheet1

REIMBURSEMENT REQUEST from UTAH SCHOOL DISTRICTS & AGENCIES to UTAH STATE OFFICE OF EDUCATION | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10
Agency Name: |  |  |  | District #: |  | 0 |  | 0 |  | There Are Several COMMENTS Embedded To Assist You.  They Are Designated With a Small Red Triangle.  To Read, Click on That Cell.  To SHOW or HIDE a Comment Go Up To INSERT.
 |  | To Indicate Funding Source, CLICK on CELL Below  for a Drop Down Menu
 |  | [NAME]:  END |  |  |  |  | 0
[NAME] AND STATE OBJECT CODE     District Chart of Accounts Found in USOE Finance and Statistics' Annual Workshop Binder.  See Your Business Administrator |  |  | * Enter Indirect Cost Rate Line K | BUDGET APPROVED BY USOE | BUDGET CHANGE (When line budget equals/exceeds 10% of Approved Budget) | EXPENSE | [NAME] | [NAME] | TOTAL EXPENSE TO DATE
 |  |  |  |  |  | 1st Period | 2nd Period | 3rd Period
 |  |  |  |  |  | July - June | July-June | July-Sept
 |  |  |  |  |  | FY (XX) | FY (XX) | FY (XX)
A. | (100) | Salaries |  |  |  |  |  |  | 0
B. | (200) | Employee Benefits |  |  |  |  |  |  | 0
C. | (300) | Purchased Prof. & Tech. Svc. |  |  |  |  |  |  | 0
D. | (400) | Purchased [NAME]. |  |  |  |  |  |  | 0
E. | (500) | Other Purchased Svc. |  |  |  |  |  |  | 0
F. | (580) | Travel |  |  |  |  |  |  | 0
G. | (600) | Supplies & Materials |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  | 0
 |  |  |  |  |  |  |  |  | 0
H. |  | TOTAL DIRECT COSTS      (Lines A thru H) |  | 0 | 0 | 0 | 0 | 0 | 0
I. |  | * Indirect Cost Rate             1st Period:  Jul-Jun FY (XX) |  | 0 |  |  |  |  | 0
J. |  | * Indirect Cost Rate              2nd Period:  Jul-Jun FY (XX) |  |  |  |  | 0 |  | 0 | SOME STATE or FEDERAL FUNDS CANNOT CLAIM INDIRECT COSTS.   PLEASE REFER TO YOUR BUSINESS ADMINISTRATOR, AWARDED FUNDS APPROVAL, OR CALL THE PHONE# AT BOTTOM  FOR MORE INFO.
K. |  | * Indirect Cost Rate               3rd Period:  Jul-Sept  FY (XX) |  |  |  |  |  | 0 | 0
L. | (700) | Property (includes equipment) |  |  |  |  |  |  | 0
M. | (800) | Other |  |  |  |  |  |  | 0
N. |  | TOTAL(s)                              (Lines I Thru M) |  | 0 | 0 | 0 | 0 | 0 | 0
* NOTE |  | Enter the Indirect Cost Rate appropriate for the fiscal year in which expenses incurred and apply to line I, Total Direct Costs
0
ENTER DATE OF CURRENT REPORT PERIOD |  |  |  | FROM: |  | TO:
1 | Approved Budget |  |  | 0 |  | I certify the program has been conducted in accordance with all specifications and in compliance with federal/state laws, rules, regulations and funds have been expended in amounts reported, and documents are available for audit.  All expenditures claimed in this report were incurred subsequent to the effective dates and have not been claimed in or under any other program.
2 | Total Amount Previously Reported
3 | Expenditure Amount This Report Period Only
4 | Total Expenditure To Date
5 | Unexpended Balance of Budget |  |  | 0
0 |  |  |  |  |  | SIGN HERE
Amount Approved for Payment |  |  | $
 |  |  |  |  |  | Submitted By:            Agency Program Director                       Date
Approved By: |  |  |  | Date: |  | SIGN HERE
RETURN FORM TO
[NAME]
CTE/Adult Education |  |  |  |  |  | Submitted By:            Agency Accounting Office |  |  | Date
Utah State Office of Education |  |  |  |  |  | TYPE  /  PRINT
250 East 500 South |  |  | [NAME] | [EMAIL]
[NAME] |  |  | Phone | 8015387821
Salt Lake City, UT  84114-4200 |  |  | Fax | 8015387882 |  |  | CONTACT PERSON          Area Code & Ph#