Form SF-269 Financial Status Report

FINANCIAL STATUS REPORT
(Long Form)
(Follow instructions on the back)
1. Federal Agency and Organizational Element
to Which Report is Submitted

2. Federal Grant or Other Identifying Number Assigned
By Federal Agency

OMB Approval
No.

Page

of

0348-0039
pages
3. Recipient Organization (Name and complete address, including ZIP code)

4. Employer Identification Number

5. Recipient Account Number or Identifying Number

6. Final Report
Yes

8. Funding/Grant Period (See Instructions)
From: (Month, Day, Year)

To: (Month, Day, Year)

10. Transactions:

9. Period Covered by this Report
From: (Month, Day, Year)

I
Previously Reported

a.

Total outlays

b.

Refunds, rebates, etc.

c.

Program income used in accordance with the deduction alternative

d.

Net outlays (Line a, less the sum of lines b and c)

7. Basis
No

Cash

Accrual

To: (Month, Day, Year)

II
This Period

III
Cumulative

Recipient's share of net outlaws, consisting of:
e. SBDC Network In-Kind Match
f.

SBDC Network Waived Indirect costs

g.

Program income used in accordance with the matching or cost
sharing alternative

h.

All SBDC Network Cash Match

i.

Total recipient share of net outlays (Sum of lines e, f, g and h)

j.

Federal share of net outlays (line d less line i)

k.

Total unliquidated obligations

l.

Recipient's share of unliquidated obligations

m.

Federal share of unliquidated obligations

n.

Total federal share (sum of lines j and m)

o.

Total federal funds authorized for this funding period

p.

Unobligated balance of federal funds (Line o minus line n)

q.

Program income: See Attached SBA Form 2113.
a. See Attached SBDC Network Schedule of All Indirect Costs.

11. Indirect
Expense

b. Rate

c. Base

d. Total Amount

e. Federal Share

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

13. Certification:

I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and
unliquidated obligations are for the purposes set forth in the award documents.

Typed or Printed Name and Title

Telephone (Area code, number and extension)

Signature of Authorized Certifying Official

Date Report Submitted

Previous Edition Usable
NSN 7540-01-012-4285
This form was electronically produced by Elite Federal Forms, Inc.

Standard Form 269 (REV 9-99)
Prescribed by OMB Circulars A-102 and A-110