3135-0112 Revenue Source Information Form (RAOs only)

OMB No. 3135-0112
Expires TBD

Revenue Sources Information
To be completed by Regional Arts Organizations only.

Name of Regional Arts Organization:

Revenue Sources for the Past and Current Fiscal Years
Previous Fiscal Year

Current Fiscal Year

FY

FY

NEA Partnership Agreement

$

$

Other Federal

$

$

SAAs -- Direct Unrestricted1

$

$

SAAs -- Direct Restricted Regional2

$

$

SAAs -- Direct Restricted Non-Regional3

$

$

SAAs -- In-Kind4

$

$

Private and Corporate Contributions

$

$

Earned Income

$

$

SUBTOTAL

$

SAAs – Indirect Contributions5

$

GRAND TOTAL

$

0

$
$

0

$

1

Cash contributions (or dues) paid directly to the organization for unrestricted support of operations, programs, and services.

2

Direct cash contributions or contracts for support of specific multi-state programs or services to a member state.

3

Direct cash contributions for support of specific programs and services that are not multi-state.

4
5

0

0

Non-cash third-party contributions in support of the organization's programs or services.
Cash contributions not made directly to or through the organization's accounts but which support its programs or services.

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