Form ETA 191 ETA 191 ETA 191 - STATEMENT OF EXPENDITURES & FINANCIAL ADJS OF

ETA 191 - STATEMENT OF EXPENDITURES & FINANCIAL ADJS
OF FEDERAL FUNDS FOR UC FOR UCFE-UCX
STATE

REGION

REPORT FOR PERIOD ENDING

SECTION A: SUMMARY STATEMENT OF EXPENDITURES AND ADJUSTMENTS
UCFE
1.

Benefit Expenditures

2.

Adjustments Assigned to Agencies:

UCX

(a) Cancellations
(b) Restoration of Overpayments
(c) Other - Explain in Comments
3.

Total Assigned Expenditures
and Adjustments
(Items 1 and 2; these totals must match
the totals reported in Section B.)

4.

Expenditures and Adjustments
Not Assigned to Agencies:
(a) Penalties and Interest
(b) Other - Explain in Comment

5.

Total Expenditures and Adjustments
Not Assigned to Agencies
(Items 4a and 4b)

6.

Grand Total - All Expenditures
and Adjustments
(Items 3 and 5)

ETA 191 - STATEMENT OF EXPENDITURES & FINANCIAL ADJS
OF FEDERAL FUNDS FOR UC FOR UCFE-UCX
STATE

REGION

REPORT FOR PERIOD ENDING

SECTION B: DETAILED STATEMENT OF EXPENDITURES AND ADJUSTMENTS BY FEDERAL
(CIVILIAN) AND MILITARY AGENCIES
Agency
Code

Agency
Title

(1)

(2)

Expenditures and Adjustments
UCFE

UCX

(3)

(4)

OM B No.: 1205-0162
OM B Expiration Date: 03/31/2016
OM B Burden Hours: 6
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