FNS-777 Financial Status Report

OMB APPROVED NO. 0584-0067
Expiration Date: XX/XX/XXXX

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FINANCIAL STATUS REPORT

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

FOOD AND NUTRITION SERVICE, USDA

3. RECIPIENT ORGANIZATION (Name and
4. AGENCY DUNS NUMBER
complete address, including Zip code. Also enter
assigned State code.)

5. RECIPIENT ACCOUNT NUMBER OR
IDENTIFYING NUMBER

FEDERAL GRANT OR OTHER
NUMBER

2. FISCAL YEAR

6. FINAL REPORT

7. BASIS

Letter of Credit
No. 12-35-

YES

NO

8. PROJECT/GRANT PERIOD

10. STATUS OF FUNDS

CHILD AND ADULT CARE PROGRAM
1
MEAL SERVICE

PROGRAMS/FUNCTIONS/ACTIVITIES

2
SPONSOR
ADMIN.

3
AUDIT

CASH

SUMMER PROGRAM

4
START-UP
& EXPANSION

ACCRUAL

9. PERIOD COVERED BY THIS REPORT

5
CASH FOR
COMMODITIES

6
MEAL SERVICE

7
SPONSOR
ADMIN.

8
INSPECTION

ADVANCES
9
STATE ADMIN.
FUNDS

10
TOTAL

(Add Cols. 1, 2, 6 & 7)

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
n. Advances Only
11. INDIRECT
EXPENSE

a. TYPE

b. RATE

c. PERIOD FROM

PERIOD TO

LAST UPDATED BY

LAST UPDATE ON

e. AMOUNT CHARGED

g. TOTALS
13. CERTIFICATION:
SIGNATURE OF AUTHORIZED CERTIFYING
I certify to the best of my
OFFICIAL
knowledge and belief that
this report is correct and
complete and that all outlays NAME
TITLE
and unliquidated obligations
are for the purposes set forth
in the award documents.

12. REMARKS: Attach any explanation deemed necessary or information required by Federal sponsoring agency
in compliance with governing legislation.
STAMP DATE

d. BASE

f. FEDERAL SHARE

DATE REPORT SUBMITTED

TELEPHONE NO.
AREA CODE NUMBER

No further monies or other benefits may be paid out under this program unless this
NOTE: When reordering this form specify "FNS-777 Child Nutrition"
report is completed and filed as required by existing regulation (34 C.F.R 256)
Public reporting burden for this collection of information is estimated to average 30 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis
(0584-0067), Alexandria, VA 22302. Do not return the completed form to this address.

FORM FNS-777 (06-11) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 9.1 Version

Form Approved OMB. NO. 0584-0067
Expiration Date 12-31-2011

FINANCIAL STATUS REPORT

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

FOOD AND NUTRITION SERVICE, USDA

3. RECIPIENT ORGANIZATION (Name and
4. AGENCY DUNS NUMBER
complete address, including Zip code. Also enter
assigned State code.)

5. RECIPIENT ACCOUNT NUMBER OR
IDENTIFYING NUMBER

FEDERAL GRANT OR OTHER
NUMBER

2. FISCAL YEAR

6. FINAL REPORT

7. BASIS

Letter of Credit
No. 12-35-

YES

8. PROJECT/GRANT PERIOD

10. STATUS OF FUNDS

SAE

11
SAE

PROGRAMS/FUNCTIONS/ACTIVITIES

12
SAE
(FD ONLY)

13
SPECIAL MILK

CASH

ACCRUAL

9. PERIOD COVERED BY THIS REPORT

SCHOOL PROGRAMS

14
SCHOOL LUNCH

NO

15
SCHOOL
BREAKFAST

16
SCH. CASH
FOR COMMOD.

17
SUMMER CASH
FOR COMMOD.

18

19

TOTALS
20

(Add Cols. 1-9, 11,
13-17)

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
Enter amount federal outlays & unpaid obligations for special developmental
project funds used or obligated by program. (Amounts included in item k)
11. INDIRECT
EXPENSE

a. TYPE

b. RATE

SMP
c. PERIOD FROM

NSLP
PERIOD TO

LAST UPDATED BY

LAST UPDATE ON

CACFP
d. BASE

SFSP
e. AMOUNT CHARGED

g. TOTALS
13. CERTIFICATION:
SIGNATURE OF AUTHORIZED CERTIFYING
I certify to the best of my
OFFICIAL
knowledge and belief that
this report is correct and
complete and that all outlays NAME
TITLE
and unliquidated obligations
are for the purposes set forth
in the award documents.

12. REMARKS: Attach any explanation deemed necessary or information required by Federal sponsoring agency
in compliance with governing legislation.
STAMP DATE

SBP

f. FEDERAL SHARE

DATE REPORT SUBMITTED

TELEPHONE NO.
AREA CODE NUMBER

No further monies or other benefits may be paid out under this program unless this
NOTE: When reordering this form specify "FNS-777 Child Nutrition"
report is completed and filed as required by existing regulation (34 C.F.R 256)
Public reporting burden for this collection of information is estimated to average 30 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. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis
(0584-0067), Alexandria, VA 22302. Do not return the completed form to this address.