State Grants 2 State Grants Financial Status Report - IMLS Pacific Comp

FY 2008 Grant Award									Enter the name of your state. State
					FINANCIAL STATUS REPORT
					IMLS Pacific Competitive Grant
1. Federal Agency and Organizational		2. Federal Grant or Other Identifying Number Assigned By Federal Agency							OMB Approval No.		Page of
Element to which Report is submitted.		EXAMPLE: 00-00-0000-00							3137-0071		1 1
IMLS - State Program			LS –	Enter the ten-digit Grant Award Number for your state’s FY-2008 Award.					Exp. Date: 7-31-2010		Pages
Enter the name of your State Library Administrative Agency (a.k.a., the SLAA) along with the complete address. 3. Recipient Organization (Name and complete address, including ZIP codes
Enter the EIN for your SLAA. 4. Employer Identification Number		Enter the applicable number, if you use one. 5. Recipient Account Number or Identifying Number					After printing the form, check “Yes” if this is your “Final” FSR for 2008; check “No” if this is an “Interim” FSR. You cannot submit an Interim Report unless you have received approval from IMLS and a Final submission date has been approved. 6. Final Report		7.        Basis
							__ Yes	__ No	__ Cash __ Accrual
8.  Funding Grant Period (See instructions)					9.  Period Covered by This Report
From: (Month, Day, Year)		To (Month, Day, Year)			From: (Month, Day, Year)				To: (Month, Day, Year)
October 1, 2007		September 30, 2009			October 1, 2007				September 30, 2009
10. STATE, LOCAL and PRIVATE MATCH
a.   Grantee funds expended for Match
10. FEDERAL SHARE
b. Total Federal funds authorized for this funding period (Grant Award)
c. Total Federal unliquidated obligations (expected to clear by Dec. 30 or later IMLS-approved date)
Enter IMLS-approved date in 11 b below
d. Unobligated balance of Federal funds (these funds will be deobligated)
e. Federal share of net outlays (b minus c and d)										$ 0.00
f.   TOTAL OUTLAYS (sum of lines a and e)										$ 0.00
11. ADMINISTRATION OF THE ACT
a. LSTA Administration costs claimed by the grantee				x 4% =			–			=
		Federal Grant Award			Allowable			Actual			Difference
b. IMLS-approved date obligations in 10 c above are expected to clear
								Date
12. Certification: 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 are set forth in the award documents.
Enter the name and title of the SLAA’s current “Authorized Official” as reflected on the form entitled “Certification of Appropriate State Legal Officer” that has been submitted by the SLAA and is on file at the State Programs office. Typed or Printed Name and Title								Enter the telephone number for the “Authorized Official”. Telephone (area code, number, extension)
Signature of Authorized Certifying Official								Enter the date the form is being submitted to the State Programs office. In the case of a re-submission of the form, enter the new date of submission along with the word “Revised”. Date Report Submitted
											IMLS 7-23-09
Burden Estimate and Request for Public Comments Public reporting burden for this collection of information is estimated to average one hour 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. Send comment regarding this burden estimate or any other aspect of this collection of information, including suggestion for reducing this burden, to the Institute of Museum and Library Services, Chief Information Officer, 1800 M Street, NW / 9th Floor, Washington, DC 20036-5802, and to the Office of Management and Budget, Paperwork Reduction Project (3137-0071), Washington, DC 20503.