FNS-777 Financial Status Report

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

Print

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 (10-12) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 10.0 Version

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

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.

INSTRUCTIONS

Please note that the instructions given below may be used as appropriate for completing forms FNS-777 State Administrative Expense (SAE) and/or FNS-777 (CN).
Items 1, 2, 3, 6, 7, 9, 10d, 10e, 10g, 10i, 10l and 12 are self-explanatory; specific instructions for other items as follows:

Item Entry
4.
Enter the State agency 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 Project/Grant period.

10.

The purpose of vertical columns (1) through (20) is to provide financial data for each program, function, and activity for which the State agency received Federal program funds.

10a. Enter the cumulative net outlays previously reported. This amount should be the same as the amount reported in Line 10e of the last report. If there has been an adjustment to
the amount shown previously, please attach explanation. Show zero if this is the initial report.
10b. Enter the total gross program outlays (less rebates, refunds, and other discounts) for this calendar quarter, 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 quarter that is required by the terms and conditions of the Federal grant 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 the reporting period. When the terms or conditions allow program income to be added to the total award, explain in remarks, the source, amount
and disposition of the income.
10f. Enter the amount pertaining to the non-Federal share of program outlays included in the amount on line e. For all columns except 11 and 12 (SAE), this entry should be zero.
10h. Enter total amount of unliquidated obligations for this program. 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. If it does not, the State agency’s justification
must accompany the final report.
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 the difference between lines k and l.
10n. Enter the amount of the advance which has not been offset by valid claims. (As per 7 CFR Part 226.2, advanced payments mean financial assistance made available
to an institution for its Program costs prior to the month in which such costs will be incurred).
11.

Indirect Expense: This section captures information on indirect costs assessed against the State agency’s direct program costs. Indirect cost can be charged only to the following
Federal funding sources: Child and Adult Care Food Program Audit (column 3), Summer Food Service Program State Administrative Costs (column 9), and SAE (columns 11 and
12). Complete this information in accordance with the following instructions. If there are no indirect costs to report, you may enter zero or leave the field blank.

11a. Type of Rate(s): State whether each indirect cost rate is Provisional, Predetermined, Final, or Fixed.
11b. Rate: Enter the indirect cost rate(s) in effect during the reporting period.
11c. Period From; Period To: Enter the beginning and ending effective dates for the rate(s).
11d. Base: Enter the amount of the direct cost base against which each rate was applied.
11e. Amount Charged: Enter the amount of the indirect costs charged during the time period specified (Multiply 11b. x 11d.)
11f. Federal Share: Enter the Federal share of the amount in 11e.
11g. Totals: Enter the totals for columns 11d, 11e, and 11f.