SF-272 Report of Federal Cash Transactrions

OMB APPROVAL NO. 0348-0003

FEDERAL CASH TRANSACTIONS REPORT
(See instructions on the back. If report is for more than one grant or
assistance agreement, attach completed Standard Form 272-A.
2. RECIPIENT ORGANIZATION

1. Federal sponsoring agency and organizational element to which this report
is submitted

4. Federal grant or other
identification
number

5. Recipient's account number or
identifying number

6. Letter of credit number

7. Last payment voucher number

Name

Number
and Street

Give total number for this period
8. Payment Vouchers credited to
your account
City, State
and ZIP Code

10.

PERIOD COVERED BY THIS REPORT

FROM (month, day, year)

3. FEDERAL EMPLOYER
IDENTIFICATION NO.

9. Treasury checks received (whether
or not deposited)

a. Cash on hand beginning of reporting period

TO (month, day, year)

$

b. Letter of credit withdrawals

c. Treasury check payments
11. STATUS OF
d. Total receipts (Sum of lines b and c)
FEDERAL
e. Total cash available (Sum of lines a and d)

CASH

f. Gross disbursements

g. Federal share of program income
(See specific
instructions

h. Net disbursements (Line f minus line g)

on the back)

i. Adjustments of prior periods

j. Cash on hand end of period
12. THE AMOUNT SHOWN ON
LINE 11j, ABOVE,
REPRESENTS CASH REQUIREMENTS FOR THE
ENSUING
Days

13.

$
OTHER INFORMATION

a. Interest income

$

b. Advances to subgrantees or subcontractors

$

14. REMARKS (Attach additional sheets of plain paper, if more space is required)

15.
I certify to the best of my
knowledge and belief that
this report is true in all respects and that all disbursements have been made for
the purpose and conditions
of the grant or agreement

CERTIFICATION
SIGNATURE

DATE REPORT SUBMITTED

TYPED OR PRINTED NAME AND TITLE

TELEPHONE (Area Code,
Number, Extension)

AUTHORIZED
CERTIFYING
OFFICIAL

THIS SPACE FOR AGENCY USE

NSN 7540-01-016-5435
272-103

This form was electronically produced by Elite Federal Forms, Inc.

STANDARD FORM 272 (Rev. 2-92)
Prescribed by Office of Management and
Budget
Cir. No. A-102 and A-110

INSTRUCTIONS

Public reporting burden for this collection of information is estimated to average 120 minutes 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. Send comments regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction
Project (0348-0003), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE MANAGEMENT AND BUDGET, SEND IT TO THE
ADDRESS PROVIDED BY THE SPONSORING AGENCY.

Please type or print legibly. Items 1, 2, 8, 9, 10, 11d, 11e, 11h, and 15 are self explanatory, specific
instructions for other items are as follows:

Item
3

Entry

Item

Enter employer identification number assigned by the U.S.
Internal Revenue Service or the FICE (institution) code.

Entry
employee's share of benefits if treated as a direct cost,
interdepartmental charges for supplies and services, and the
amount to which the recipient is entitled for indirect costs.

If this report covers more than one grant or other
agreement, leave items 4 and 5 blank and provide the
information on Standard Form 272-A, Report of Fed- eral
Cash Transactions--Continued; otherwise;

11g Enter the Federal share of program income that was required
to be used on the project or program by the terms of the grant
or agreement.

4

Enter Federal grant number, agreement number, or other
identifying numbers if requested by sponsoring agency.

11i

5

This space reserved for an account number or other
identifying number that may be assigned by the recipient.

Enter the amount of all adjustments pertaining to prior
periods affecting the ending balance that have not been
included in any lines above. Identify each grant or agreement for which adjustment was made, and enter an explanation for each adjustment under "Remarks." Use plain
sheets of paper if additional space is required.

11j

Enter the total amount of Federal cash on hand at the end of
the reporting period. This amount should include all funds on
deposit, imprest funds, and undeposited funds (line e, less
line h, plus or minus line i).

12

Enter the estimated number of days until the cash on hand,
shown on line 11j, will be expended. If more than three
days cash requirements are on hand, provide an explanation
under "Remarks" as to why the drawdown was made
prematurely, or other reasons for the excess cash. The
requirement for the explanation does not apply to
prescheduled or automatic advances.

6.

Enter the letter of credit number that applies to this report.
If all advances were made by Treasury check, enter "NA"
for not applicable and leave items 7 and 8 blank.

7

Enter the voucher number of the last letter-of-credit
payment voucher (Form TUS 5401) that was credited to
your account.

11a

Enter the total amount of Federal cash on hand at the
beginning of the reporting period including all of the
Federal funds on deposit, imprest funds, and undeposited Treasury checks.

13a Enter the amount of interest earned on advances of Fed- eral
funds but not remitted to the Federal agency. If this includes
any amount earned and not remitted to the Federal
sponsoring agency for over 60 days, explain under
"Remarks." Do not report interest earned on advances to
States.

11b

Enter total amount of Federal funds received through
payment vouchers (Form TUS 5401) that were credited to
your account during the reporting period.

11c

Enter the total amount of all Federal funds received during
the reporting period through Treasury checks, whether or
not deposited.

13b Enter amount of advance to secondary recipients included in
item 11h.

11f

Enter the total Federal cash disbursements, made during
the reporting period, including cash received as program
income. Disbursements as used here also include the
amount of advances and payments less refunds to
subgrantees or contractors, the gross amount of direct
salaries and wages, including the

14

In addition to providing explanations as required above, give
additional explanation deemed necessary by the recipient
and for information required by the Federal sponsoring
agency in compliance with governing legis- lation. Use plain
sheets of paper if additional space is required.

STANDARD FORM 272 (BACK) (Rev. 2-92)