272- form

HHS Payment Management System Forms PMS-270 - Request for Advance or Reimbursement and PMS-272 - Federal Cast Transaction Report

PSC 272A.txt

272- form

OMB: 0937-0200

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PSC 272 FEDERAL CASH TRANSACTION REPORT


STATUS OF FEDERAL CASH OMB NO. 0990-078


PERIOD COVERED BY THIS REPORT:


04/01/2007 -06/30/2007

PIN: PAN: IN: USER CODE: F15

ACH REGION: 05 STATE: MN GENERAL


1. CASH ON HAND BEGINNING OF REPORTING PERIOD

2. TOTAL RECEIPTS (SEE STATEMENT OF CASH ACCOUNTABILITY FOR DETAILS)

3. TOTAL CASH AVAILABLE

4. NET DISBURSEMENTS (FROM PSC 272-A)

5. CASH ON HAND END OF PERIOD (LINE 3, MINUS LINE 4)

6. THE AMOUNT SHOWN ON LINE 5, ABOVE,

REPRESENTS CASH REQUIREMENTS FOR THE ENSUING ' ' DAYS

7. INTEREST INCOME

8. ADVANCES TO SUBGRANTEES OR SUBCONTRACTORS

THE PMS CONTACT WHO IS RESPOIVSIBLE FOR YOUR ACCOUNT IS

NICOLE DUNNING OR STAFF AT: 301-443-0395

RETURN THE COMPLETED FORM TO:

DIVISIOIV OF PAYMENT MANAGEMENT

P.O. BOX 6021

ROCKVILLE, MD. 20852




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PSC272-A FEDERALCASHTRANSACTIONREPORT


HHS -PMS


PERIOD COVERED BY THIS REPORT:

PIN: PAN: EIN: 04/01/2007 -06/30/2007

ACH REGION: 05 STATE: MN GENERAL


"'-=---7.8-*.-~--~~m~.~.-m--.,----~~-*-*..fla~v


LINE [ FED GRANT ] [ RECIP A/C OR ] ( AUTHORIZED

I* M . .c . ,, . ] FEDERAL SHARE NET DISBURSEMENT

NUM OR OTHER ID OTHER ID NO * AMOUNT * CUM -PREV PER CUM -CURR PER

(A (0) (C) (Dl (El

1 G 90REO 1 166,619.00 98,154.00


SU B-TOTAL 166,619.00 98,154.00 0.00


PLEASE ENTER DOCUMENTS MISSING FROM ABOVE


TOTALS

NET DISBURSEMENTS: (COLUMN E MINUS COLUMN D) MUST CORRESPOND

WITH AMOUNT SHOWN ON PSC 272



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