Form FEMA Form 112-0-6 FEMA Form 112-0-6 Reconcilliation of Grants and Cooperative Agreement

DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY

See reverse side for Paperwork
Burden Disclosure Notice

RECONCILIATION OF GRANTS AND COOPERATIVE AGREEMENTS

O.M.B. No. 1660-0025
Expires November 30, 2013

REPORT OF UNOBLIGATED BALANCE OF FEDERAL FUNDS, DRAW DOWNS, AND UNDRAWN FUNDS
1. RECIPIENT

2a. GRANT/COOPERATIVE AGREEMENT NUMBER

2b. DISASTER NUMBER

3. GRANT/COOPERATIVE AGREEMENT DESCRIPTION

4. CFDA NUMBER

5. PROJECT/TASK NUMBER

6a. PERIOD BEGINNING DATE

6b. ENDING DATE

7. COMPLETION DATE

8. ACCS

9. HISTORY OF TRANSACTIONS

(a)
Transaction Date
Mo/Day/Yr

(b)
Description of Transaction

(c)
Award Amount

(d)
Total Federal Share of Outlays
and Unliquidated Obligations

(e)
Unobligated Balance
of Federal Funds
(e) = (c) - (d)

TOTAL
FEMA Form 112-0-6 (11/2010)

Undrawn

Drawn Down

Financial Status of Federal Funds

PREVIOUS EDITIONS OBSOLETE

(f)
Amount

(g)
Cumulative
Amount

(h)
Funds Available
To Be Drawn
(h) = (c) -(g)

PAPERWORK BURDEN DISCLOSURE NOTICE
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regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW,
Washington, DC 20472-3100, and Paperwork Reduction Project (1660-0025). NOTE: Do not send your completed form to this address.

INSTRUCTIONS
1. Recipient: Name of grantee (example: State of XYZ Emergency Management Agency).
2a. Grant/Cooperative Agreement Number: Number assigned by the Regional Office to identify a grant/cooperative agreement. Can be found on FEMA Form 76-10A, Obligating Document for Award/Amendment.
2b. Disaster Number: Number assigned to identify a disaster.
3. Grant/Cooperative Agreement Description: Acronym of grant/cooperative agreement being funded (example: SLA, ATT).
4. CFDA Number: 5-digit number in the Catalog of Federal Domestic Assistance (CFDA) that identifies FEMA's programs (example: 83.534).
5. Project/Task Number: Number assigned by implementing organization to identify project/task.
6a. Period Beginning Date: Date grant/cooperative agreement is to begin.
6b. Ending Date: Date grant/cooperative agreement is to end. 7. Completion Date: 90 days after project ends. If the Ending Date changes, the completion Date automatically changes so that it is 90 days after Ending Date.
8. ACCS Code: Code used in IFMIS to identify and track funds example: 1998-28-4997-XXXX-4120-D). This number can be found on FEMA Form 76-10A.
9. History of Transactions:
(a) Transaction Date: Date Transaction is being made.
(b) Description of Transaction: Identifies the type of transaction being made (example: award, 1st quarter report); or the voucher assigned to the transaction (example: vo.98-1, vo. 98-2).
(c) Award Amount: Dollar amount of initial award or amendment. This figure is found on FEMA Form 76-10A.
(d) Total Federal Share of Outlays and Unliquidated Obligations: Can be found on line 10g of FEMA Form 20-10, or line 11q of FEMA Form 20-17.
(e) Unobligated Balance of Federal Funds (e) = (c) - (d): Self-explanatory, compute formula shown.
(f) Draw Down Amount: Dollar amount of draw down.
(g) Cumulative Draw Down Amount: Total dollar amount of draw downs made after each transaction.
(h) Funds Available to be Drawn (h) = (c) - (g): Self-explanatory, compute formula shown.