INSTRUCTIONS

Please type or print legibly.  Items 1, 2, 3, 6, 7, 9, 10d, 10e, 10g, 10i, 10l, 11a, and 12 are self-explanatory; specific instructions for other items as follows:

Item                                  Entry

3.

4.       Enter the employer identification number assigned by the U.S. Internal Revenue Service or FICE (institution) code, if required by the Federal sponsoring agency.

5.       This space is reserved for an account number or other identifying numbers that may be assigned by the recipient.7.

8.       Enter the month, day, and year of the beginning and ending of this project period.  For formula grants that are not awarded on a project basis, show the grant period.9.

10.   The purpose of vertical columns (1) through (10) is to provide financial data for each program, function, and activity in the budget as approved by the Federal sponsoring agency.  If additional columns are needed, use as many additional forms as needed and indicate page number in space provided in upper right; however, the totals of all programs, functions or activities should be shown in column (10) of the first page.  For agreements pertaining to several Catalog of Federal Domestic Assistance programs that do not require a further functional or activity classification breakdown, enter under columns (1) through (10) the title of the program.  For grants or other assistance agreements containing multiple programs where one or more programs require a further breakdown by function or activity, use a separate form for each program showing the applicable functions or activities in the separate columns.  For grants or other assistance agreement s containing several functions or activities which are funded from several programs, prepare a separate form for each activity or function when requested by the Federal sponsoring agency.

10a.  Enter the net outlay.  This amount should be the same as the amount reported in Line 10e of the last report.  If there has been an adjustment to the amount shown previously, please attach explanation.  Show zero if this is the initial report.

10b.  Enter the total gross program outlays (less rebates, refunds, and other discounts) for this report period, including disbursements of cash realized as program income.  For reports that are prepared on a cash basis, outlays are the sum of actual cash disbursement s for goods and services, the amount of indirect expense charged, the value of in-kind contributions applied, and the amount of cash advances and payments made to contractors and subgrantees.  For reports prepared on an accrued expenditure basis, outlays are the sum of actual cash disbursements, the amount of indirect expense incurred, the value of in-kind contributions applied, and the net increase (or decrease) in the amounts owed by the recipient for goods and other property received and for services performed by employees, contractors, subgrantees, and other payees.

10c.  Enter the amount of all program income realized in this period that is required by the terms and conditions of the Federal award to be deducted from total project costs.  For reports prepared on a cash basis, enter the amount of cash income received during the reporting period.  For reports prepared on an accrual basis, enter the amount of income earned since the beginning of the reporting period.  When the terms or conditions allow program income to be added to the total award, explain in remarks, the source, amount and disposition of the income.10e.

10f.   Enter amount pertaining to the non-Federal share of program out lays included in the amount on line e. 10g.

10h.  Enter total amount of unliquidated obligations for this project or program.  Included in unliquidated obligations are:

Cash basis � obligations incurred but not paid

Accrued expenditure basis � obligations incurred but for which an outlay has not been recorded.

Do not include any amounts that have been included on lines a through g.  On the final report, line h should have a zero balance.10i.

10j.    Enter the Federal share of unliquidated obligations shown on line h.  The amount shown on this line should be the difference between the amounts on lines h and i.

10k.   Enter the sum of the amounts shown on lines g and j.  If the report is final the report should not contain any unliquidated obligations.10l.

10m.Enter the unobligated balance of Federal funds.  This amount should be difference between lines k and l.11.11a.

11b.  Enter rate in effect during the reporting period.

11c.  Enter amount of the base to which the rate was applied.

11d.  Enter total amount of indirect cost charged during the report period.

11e.  Enter amount of the Federal share charged during the report period.

If more than one rate was applied during the project period, include a separate schedule showing bases against which the indirect cost rates were applied, the respective indirect rates, the month, day, and year the indirect rates were in effect, amounts of indirect expense charged to the project, and the Federal share of indirect expense charged to the project to date.

NOTE:  Each column represents that portion of total outlays and/or obligations based on Direct Costs and allocated Indirect Costs.  In column 2, �Coupon Issuance,� report only issuance for coupons or cashout issuance systems.  Indirect issuance costs assigned by cost rates are reported in �Issuance Indirect� (Column 25).

For �Other Activities,� include costs for any other activities.  Include costs for the E&T program, Outreach, Nutrition Education, reinvestment, SAVE, ADP development, EBT, etc., and also report these costs in columns 11‑30 on pages 2 and 3 of this form.10.

11.   EMPLOYMENT AND TRAINING (E&T) PROGRAM GRANT ALLOCATION (100% GRANT):  Enter the amount of the unmatched Federal grant expended on administrative costs of the E&T program.  NOTE:  If applicable, do not include amount from line 28:  E&T ABAWD GRANT in this category.  Do not include participant reimbursements in this category.

12.   E&T ADMINISTRATIVE COSTS (50% MATCHING):  Enter the amount in excess of the E&T Program grant allocation (line 11 ) and, if applicable, the additional E&T grant allocation for �pledge� States (line 28), expended to operate the E&T program in accordance with the FNS-approved State E&T plan.  Do not include participant reimbursements in this category.

13.   E&T PARTICIPANT REIMBURSEMENT � DEPENDENT CARE:  Enter the amount expended to reimburse E&T participants for the costs of dependent care incurred as a result of E&T participation.  NOTE:  The Federal contribution may not exceed one-half of the lesser amount of either the actual cost of dependent care or the applicable payment rate for child care established in accordance with the Child Care and Development Block Grant provisions of 45 CFR 98.43.

14.   E&T PARTICIPANT REIMBURSEMENT � TRANSPORTATION AND OTHER COSTS:  Enter the amount expended to reimburse E&T participants for the costs of transportation and other reasonable and necessary costs (other than dependent care) incurred as a result of E&T participation.

15.   OPTIONAL WORKFARE:  Enter the operational costs for workfare programs operated under Section 20 of the Food Stamp Act.  These are only programs which are not included in Employment and Training Programs.  Include the cost when the participant has been reimbursed for workfare-related expenses such as transportation, child care, or the cost for personal safety items or equipment required for performance of work if these items are also purchased by regular employees.  (Do not include enhanced reimbursement which should be reported on the SF‑270.)

16.   OUTREACH:  Enter the outreach costs.  Include as outreach costs only those costs which were included in the FNS approved plan for Program informational activities.

17.   NUTRITION EDUCATION:  Enter the nutrition education costs.  Enter as nutrition education costs only those costs which were included in the FNS approved plan for Nutrition Education

18.   REINVESTMENT:  Enter those costs which were funded in full by the State agency in accordance with the State agency�s FNS approved plan without any Federal matching funds.

19.   SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS (SAVE):  Enter the administrative costs of planning, implementing and operating a SAVE system.

20.   PAGE 2 SUBTOTAL:  Enter sum of items identified and recorded in columns 11‑19.  The total in column 20 must be reported in column 9.

21.   50% FUNDING � ADP DEVELOPMENT:  Enter the computer system development costs which are to be reimbursed at the Federal Financial Participation rate of 50%.  Include EBT planning costs which are to be reimbursed at the Federal Financial Participation rate of 50%.

22.   63% FUNDING � ADP DEVELOPMENT:  Enter the computer system development costs which are to be reimbursed at the Federal Financial Participation rate of 63%.

23.   75% FUNDING � ADP DEVELOPMENT:  Enter the computer system development costs which are to be reimbursed at the Federal Financial Participation rate of 75%.

24.   ELECTRONIC BENEFIT TRANSFER (EBT) ISSUANCE:  Enter the costs for EBT issuance.  Include all EBT operational costs and EBT equipment costs.  Include direct costs and indirect costs charged through a public assistance cost allocation plan.  Do not include indirect EBT issuance costs charged through an indirect cost rate.

25.   ISSUANCE INDIRECT:  Enter the indirect costs for coupon and EBT issuance systems that are approved for cost charging through an indirect cost rate.

26.   EBT START-UP:  Enter the EBT system start-up costs incurred after the Implementation Advance Planning Document (IAPD) is approved and prior to issuance of benefits by the EBT system.  Start-up costs are design, development, and implementation costs excluding system planning approved by FNS.  (All EBT planning costs prior to approval of the IAPD should be reported in the appropriate ADP development column based on the appropriate Federal reimbursement rate � 50%, 63%, or 75%.)

27.   UNSPECIFIED PORTION OF OTHER:  Enter that portion of item 9, �Other Activities,� not specifically identified and recorded in items 11‑26, and 28.  Include Wage Matching, etc.

28.   E&T ABAWD GRANT:  Enter the amount of the unmatched additional Federal grant allocated under section 16 (h)(1)(E) of the Food Stamp Act expended to provide qualifying education/training or workfare opportunities to applicants and recipients subject to the 3‑month food stamp time limit for able-bodied adults without dependents.  NOTE:  This amount is separate from � and must not be included as part of � 100 percent Federal E&T grant expenditures on line 11.29.

30.   PAGE 3 SUBTOTAL:  Enter the total of items 21 through 28.  The total from item 30 must be reported in item 9.

31.   PROGRAM BENEFITS:  Enter the amount expended in program benefits under any FNS approved project or initiative in which program benefits were authorized through a grant award to State and funded through the State�s Letter of Credit.  Use a separate SF‑269 Addendum for each type of project (e.g., SSI/elderly cash-out, welfare reform initiative, etc.) and specify the type of project in the �Remarks� block.

DO NOT include program benefits in Columns 1‑30 on the SF‑269.