SF 272 Federl Cash Transaction Report

Federal Cash Transactions Report

OMB Approval No. 0348-0003
1. Federal sponsoring agency and organizational element to which this report is submitted

(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

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

9. Treasury checks received
(whether or not deposited)

10. Period covered by this report
From (month, day, year)

3. Federal Employer
Identification Number
a. Cash on hand beginning of reporting period

To (month, day, year)

$

b. Letter of credit withdrawals
c. Treasury check payments

11. Status of
Federal
Cash

(See
specific
Instructions
on back)

d. Total receipts (Sum of lines b and c)

0.00

e. Total cash available (Sum of lines a and d)

0.00

f. Gross disbursements
g. Federal share of program income

0.00

h. Net disbursements (Line f minus line g)
i.

Adjustments of prior periods

j.

Cash on hand end of period

$

13.
12. The amount shown
on Line 11j. above
represents cash
requirements for the a. Interest income
ensuing
days

Other Information
$

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 re- Authorized
spects and that all disburse- Certifying
ments have been made for Official
the purpose and conditions
of the grant agreement.

Certification
Signature

Date Report Submitted

Typed or printed name and title

Phone (Area code, number, extension)

This space for agency use

Authorized for local reproduction. Previous edition usable
NSN 7540-01-016-5435
272-103

Standard Form 272 (Rev. 7/97)
Prescribed by Office of Management and Budget
Cir. No. A-102 and A-110

Public reporting burden for this collection of information is estimated to average 12 0 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Agencies may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.
Please do not return your completed form to the Office of Management and Budget. Send it to the address provided by the Sponsoring Agency

Instructions
Please type or print legibly. Most items are self explanatory. Specific instructions for other items are as follows:
Item

Entry

3

Enter Employer Identification Number (EIN) assigned by the
U.S. Internal Revenue Service or the FICE (institution) code.

4.

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; otherwise:

Item

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.
11i.

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."

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 j).

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 pre-scheduled or automatic
advances.

Enter Federal grant number, agreement number, or other
identifying numbers if requested by sponsoring agency.
5.

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

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.
11b. Enter total amount of Federal funds received though 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.

13a. Enter the amount of interest earned on advances of Federal
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.
13b. Enter amount of advance to secondary recipients included in
item 11h.
14.

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 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.

Authorized for local reproduction. Previous edition usable
NSN 7540-01-016-5435
272-103

Entry

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 legislation.

Standard Form 272 (Back) (Rev. 2/92)
Prescribed by Office of Management and Budget
Cir. No. A-102 and A-110

Federal Cash Transactions Report

OMB Approval No. 0348-0003
1. Federal sponsoring agency and organizational element to which this report is submitted

Continuation
(This form is completed and attached to Standard Form 272 only
when reporting more than one grant or assistance agreement.)
2. Recipient Organization (Give name only as shown in item 2, SF-272)

3. Period covered by this report (As shown on SF-272)
From (month, day, year)

To (month, day, year)

4. List information below for each grant or other agreement covered by this report. Use additional forms if more space is required.

Federal Grant or Other
Identification Number

Federal Share of Net Disbursements
Net Disbursements
Cumulative
(Gross disbursements less program
Net Disbursements

Recipient Account Number
or Other Identifying Number

(Show a subdivision by other identifying
numbers if required by the Federal
Sponsoring Agency)
(a)

income received)
for Reporting Period
(c)

(b)

5. Totals (Should correspond with amounts shown on SF-272 as follows:
column (c) the same as line 11h; column (d) the same as lines line 11h and
11i and cumulative disbursements shown on last report. Attach explanation
of any differences.)

$

(d)

$

Public reporting burden for this collection of information is estimated to average 120 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Agencies may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless that collection displays a valid OMB control number.
Please do not return your completed form to the Office of Management and Budget. Send it to the address provided by the Sponsoring Agency
Authorized for local reproduction. Previous edition usable
NSN 7540-01-016-5435
272-103

Standard Form 272-A (Rev. 7/97)
Prescribed by Office of Management and Budget
Cir. No. A-102 and A-110