Form FNS 778 FNS 778 Financial Status Report

FORM APPROVED OMB NO. 0584-XXXX
Expiration Date: XX/XXXX

FINANCIAL STATUS REPORT

2a. FISCAL YEAR

1. FEDERAL AGENCY & ORGANIZATIONAL ELEMENT TO WHICH REPORT IS SUBMITTED

FOOD AND NUTRITION SERVICE, USDA

4. AGENCY DUNS NUMBER
3. STATE AGENCY (Name and complete address,
including ZIP code. Also enter assigned State code).

5. STATE AGENCY ACCOUNT OR ID NO.

Letter of Credit
No. 12-356. FINAL REPORT

7. BASIS

YES

CASH

ACCRUAL

9. PERIOD COVERED BY THIS REPORT

8. PROJECT/GRANT PERIOD

10. STATUS OF FUNDS

NO

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
1
CERTIFICATION

SNAP FUNCTIONS/ACTIVITIES

2
EBT
ISSUANCE

3
QUAL. CNTL.

4
MGT. EVAL.

5
FRAUD CNTL.

6
ADP. DEV.

7
ADP OPER

8
FAIR
HEARINGS

9
OTHER
ACTIVITIES

10
GRAND TOTAL

a. Net outlays previously reported
b. Total outlays this report period
c. Less: Program income credits
d. Net outlays this report period
(Line b minus line c)
e. Net outlays to date
(Line a plus line d)
f. Less: Non-Federal share of outlays
g. Total Federal share of outlays
(Line e minus line f )
h. Total unliquidated obligations
i. Less: Non-Federal share of unliquidated
obligat ions shown on line h
j. Federal share of unliquidated obligations
k. Total Federal share of outlays and
unliquidated obligations
l. Total cumulative amount of Federal
funds authorized
m. Unobligated balance of Federal funds
11. INDIRECT
EXPENSE

a. TYPE OF RATE
PROVISIONAL
b. RATE

c. BASE

PREDETERMINED
d. TOTAL AMOUNT

FINAL

FIXED

e. FEDERAL SHARE

12. REMARKS: Attach any explanation deemed necessary or information required by Federal sponsoring agency in
compliance with governing legislation.
No further monies or other benefits may be paid out under this program unless this
report is completed and filed as required by existing regulation (34 C.F.R. 256)

13. CERTIFICATION

SIGNATURE OF AUTHORIZED
CERTIFYING OFFICIAL

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.

SBU

NAME

TITLE

DATE REPORT SUBMITTED

TELEPHONE NO.
AREA CODE

NUMBER

FNS-778 (10-08) Electronic Form Version Designed in Adobe 8.1 verison

FINANCIAL STATUS REPORT - Page 2
3. STATE AGENCY (Name and complete
address including ZIP code. Also enter assigned
State code).

1. FEDERAL AGENCY & ORGANIZATIONAL ELEMENT TO WHICH REPORT IS SUBMITTED

FOOD AND NUTRITION SERVICE, USDA
4. AGENCY DUNS NUMBER

5. STATE AGENCY ACCOUNT OR ID NO.

Letter of Credit
No. 12-356. FINAL REPORT
YES

8. PROJECT/GRANT PERIOD

10. STATUS OF FUNDS
SNAP FUNCTIONS/ACTIVITIES

FORM APPROVED OMB NO. 0584-XXXX
2a. FISCAL YEAR

7. BASIS
NO

CASH

ACCRUAL

9. PERIOD COVERED BY THIS REPORT

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
11
E&T
100% GRANT

12
E&T
50% GRANT

13
15
14
E&T
E&T
E&T
DEPENDENT CARE TRANS. & OTHER ABAWD GRANT

16
OPTIONAL
WORKFARE

17
OUTREACH

18
NUTRITION
EDUCATION

19
NEW
INVESTMENT

20
PAGE 2
SUBTOTAL

a. Net outlays previously reported
b. Total outlays this report period
c. Less: Program income credits
d. Net outlays this report period
(Line b minus line c)
e. Net outlays to date
(Line a plus line d)
f. Less: Non-Federal share of outlays
g. Total Federal share of out lays
(Line e minus line f )
h. Total unliquidated obligations
i. Less: Non-Federal share of unliquidated
obligations shown on line h
j. Federal share of unliquidated obligations
k. Total Federal share of outlays and
unliquidated obligations
l. Total cumulative amount of Federal
funds authorized
m. Unobligated balance of Federal funds

12. Remarks

No further monies or other benefits may be paid out under this program unless this
report is completed and filed as required by existing regulation (34 C.F.R. 256)

FNS-778 (10-08) Electronic Form Version Designed in Adobe 8.1 verison

FORM APPROVED OMB NO. 0584-XXXX

FINANCIAL STATUS REPORT - Page 3
3. STATE AGENCY (Name and complete
address including ZIP code. Also enter assigned
State code).

FOOD AND NUTRITION SERVICE, USDA
4. AGENCY DUNS NUMBER

5. STATE AGENCY ACCOUNT OR ID NO.

21
ISSUANCE
INDIRECT

Letter of Credit
No. 12-356. FINAL REPORT

7. BASIS

YES
8. PROJECT/GRANT PERIOD

10. STATUS OF FUNDS
SNAP FUNCTIONS/ACTIVITIES

2a. FISCAL YEAR

1. FEDERAL AGENCY & ORGANIZATIONAL ELEMENT TO WHICH REPORT IS SUBMITTED

22
EBT
STARTUP

23
SAVE

NO

CASH

ACCRUAL

9. PERIOD COVERED BY THIS REPORT

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM
27
26
24
25
100%
75% INDIAN
50% UNSPECIFIED
STATE EXCHANGE ADMINISTRATION
OTHER

28

29

30
PAGE 3
SUBTOTAL

a. Net outlays previously reported
b. Total outlays this report period
c. Less: Program income credits
d. Net outlays this report period
(Line b minus line c)
e. Net outlays to date
(Line a plus line d)
f. Less: Non-Federal share of outlays
g. Total Federal share of outlays
(Line e minus line f )
h. Total unliquidated obligations
i. Less: Non-Federal share of unliquidated
obligations shown on line h
j. Federal share of unliquidated obligations
k. Total Federal share of outlays and
unliquidated obligations
l. Total cumulative amount of Federal
funds authorized
m. Unobligated balance of Federal funds

12. Remarks

No further monies or other benefits may be paid out under this program unless this
report is completed and filed as required by existing regulation (34 C.F.R. 256)

FNS-778 (10-08) Electronic Form Version Designed in Adobe 8.1 verison

INSTRUCTIONS
The FNS-778 is used to report State administrative costs for the Supplemental Nutrition Assistance Program (SNAP). NOTE:
Program benefits are reported on the FNS-778A. DO NOT include program benefits in Columns 1 - 30 on the FNS-778.
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

4.

Enter the State agency's Universal Identifier (DUNS) Number.

5.

This space is reserved for an account number or other identifying numbers that may be assigned by the State agency.

8.

Enter the month, day, and year of the beginning and ending of this grant period.

10. The purpose of vertical columns (1) through (30) is to provide financial data for each function and activity in the budget as
approved by FNS.
10a. Enter the amount reported in Line 10e of the last report. If there has been an adjustment to the amount shown previously,
please attach an explanation or explain in the Remarks block. 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 disbursements 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 accrual 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 State agency 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 reporting period that is required by Program regulations to be
deducted from total program 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 this
reporting period. When Program regulations allow program income to be added to the total award, explain in remarks, the source,
amount and disposition of the income.
10f. Enter amount pertaining to the non-Federal share of program outlays included in the amount on line e.
10h. Enter total amount of unliquidated obligations for the Supplemental Nutrition Assistance Program (SNAP). Included in
unliquidated obligations are:
Cash basis - obligations incurred but not paid.
Accrual 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.
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.

10m.Enter the unobligated balance of Federal funds. This amount should be difference between lines k and l.
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 the Federal share of the amount entered in item 11d.
If more than one rate was applied during the grant period, enter in the remarks block on pages 2 and 3 (or include in a separate
schedule) information 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 program, and the Federal share of indirect
expense charged to the program to date.
NOTE: Each column represents that portion of total outlays and/or obligations based on Direct Costs and allocated Indirect Costs.
Indirect issuance costs assigned by indirect cost rates are reported in “Issuance Indirect” (Column 21).
1.CERTIFICATION: Enter the costs for certification activity, including accepting and processing the application. Include salaries,
benefits, travel expenses, supervisory, clerical, and other support costs.
2. 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 (PACAP). Do
not include indirect EBT issuance costs charged through an indirect cost rate. (These are reported in Column 21.).
3. QUALITY CONTROL: Enter the costs for Quality Control activity, including travel expenses.
4. MANAGEMENT EVALUATION: Enter the costs for Management Evaluation activities.
5. FRAUD CONTROL: Enter the costs for qualified employees engaged specifically in the investigation and prosecution of SNAP
fraud activity.
6. 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%
7. ADP OPERATIONS: Enter the operational costs of computer systems which are charges under an approved cost allocation plan.
8. FAIR HEARINGS: Enter the costs for Fair Hearing activities
9. OTHER COSTS: Enter the sum of Columns 20 and 30, These columns respectively capture the sums of Columns 11 - 19 (page
2) and 21 - 24 (page 3) of this form. They thereby capture the costs for all other SNAP activities, including the E&T function,
Outreach, Nutrition Education, New Investment, SAVE, etc..
10. GRAND TOTAL: Enter the total administrative costs for the SNAP. This is the sum of Columns 1 through 9.
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
Column 15: 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 allocation (Column 11 ) and, if
applicable, the additional E&T allocation for “pledge” States (Column 15), 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. E&T ABAWD GRANT: Enter the amount of the unmatched additional Federal grant allocated under section 16 (h)(1)(E) of the Act
expended to provide qualifying education/training or workfare opportunities to applicants and recipients subject to the 3-month SNAP
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 in Column 11.
16. OPTIONAL WORKFARE: Enter the operational costs for workfare programs operated under Section 20 of the 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.)
17. OUTREACH: Enter the outreach costs. Include as outreach costs only those costs which were included in the FNS approved
plan for Program informational activities.
18. 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
19. NEW INVESTMENT: 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.
20. PAGE 2 SUBTOTAL: Enter sum of items identified and recorded in columns 11-19. The total in Column 20 must be included in
Column 9.
21. ISSUANCE INDIRECT: Enter the indirect costs for EBT issuance systems that are approved for cost charging through an
indirect cost rate.
22. 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 include design, development, and implementation costs.
They do NOT include system planning approved by FNS; all EBT planning costs prior to approval of the IAPD should be reported in
Column 6 (ADP Development.)
23. SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENTS (SAVE): Enter the administrative costs of planning, implementing
and operating a SAVE system.
24. 100% STATE EXCHANGE: Enter the travel costs and costs for printed materials and electronic or other media related to the
exchange of ideas and experience for improving program management among States that are approved by FNS and reimbursed with
100% State Exchange funds.
25. 75% INDIAN ADMINISTRATION: Enter the costs incurred to administer the program on an Indian reservation and that will be
claimed at the 75% enhanced reimbursement rate for this activity.
26. 50% UNSPECIFIED OTHER: Enter that portion of Column 9, "Other Activities," not specifically identified and recorded in columns
11-19 and 21-25. Include Wage Matching, etc.
30. PAGE 3 SUBTOTAL: Enter the total of Columns 21 through 26. The total from Column 30 must be included in Column 9.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a Collection of Information unless it displays a
valid OMB control number. The valid OMB number is 0584-XXXX. The time required to complete this information collection is estimated to
average 16.8 hours per response, including the time to review the instructions, search data sources, gather the data needed, and complete
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