Attachment 19 - SF-425 Federal Financial Report

Attachment 19- SF- 425
Federal Financial Report

Federal Financial Report

OMB Number: 4040-0014
Expiration Date: 01/31/2019

(Follow form Instructions)
1. Federal Agency and Organizational Element to Which Report is Submitted

2. Federal Grant or Other Identifying Number Assigned by Federal
Agency (To report multiple grants, use FFR Attachment)

3. Recipient Organization (Name and complete address including Zip code)
Recipient Organization Name:
Street1:
Street2:
City:

County:
Province:

State:
Country: USA: UNITED STATES
4a. DUNS Number

6. Report Type

ZIP / Postal Code:

4b. EIN

7. Basis of Accounting

Quarterly

Cash

Semi-Annual

Accrual

5. Recipient Account Number or Identifying Number
(To report multiple grants, use FFR Attachment)

8. Project/Grant Period
From:

9. Reporting Period End Date

To:

Annual
Final
10. Transactions

Cumulative

(Use lines a-c for single or multiple grant reporting)
Federal Cash (To report multiple grants, also use FFR attachment):
a. Cash Receipts

0.00

b. Cash Disbursements

0.00

c. Cash on Hand (line a minus b)

0.00

(Use lines d-o for single grant reporting)
Federal Expenditures and Unobligated Balance:
d. Total Federal funds authorized

0.00

e. Federal share of expenditures

0.00

f. Federal share of unliquidated obligations

0.00

g. Total Federal share (sum of lines e and f)

0.00

h. Unobligated balance of Federal Funds (line d minus g)

0.00

Recipient Share:
i. Total recipient share required

0.00

j. Recipient share of expenditures

0.00

k. Remaining recipient share to be provided (line i minus j)

0.00

Program Income:
l. Total Federal program income earned

0.00

m. Program Income expended in accordance with the deduction alternative

0.00

n. Program Income expended in accordance with the addition alternative

0.00

o. Unexpended program income (line l minus line m or line n)

0.00

11. Indirect Expense
a. Type

b. Rate

c. Period From

Period To

e. Amount
Charged

d. Base

f. Federal Share

g. Totals:
12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
Add Attachment

Delete Attachment

View Attachment

13. Certification: By signing this report, I certify that it is true, complete, and accurate to the best of my knowledge. I am aware that any false,
fictitious, or fraudulent information may subject me to criminal, civil or administrative penalties. (U.S. Code, Title 18, section 1001)
a. Name and Title of Authorized Certifying Official
Prefix:

First Name:

Last Name:

Middle Name:
Suffix:

Title:
b. Signature of Authorized Certifying Official

c. Telephone (Area code, number and extension)

d. Email Address

e. Date Report Submitted

14. Agency use only:

Standard Form 425

Federal Financial Report Instructions
Report Submissions
1) Recipients will be instructed by Federal agencies to submit the Federal Financial Report (FFR) to
a single location, except when an automated payment management reporting system is utilized. In
this case, a second submission location may be required by the agency.
2)

If recipients need more space to support their FFRs, or FFR Attachments, they should provide
supplemental pages. These additional pages must indicate the following information at the top of
each page: Federal grant or other identifying number (if reporting on a single award), recipient
organization, Data Universal Numbering System (DUNS) number, Employer Identification Number
(EIN), and period covered by the report.

Reporting Requirements
1) The submission of interim FFRs will be on a quarterly, semi-annual, or annual basis, as directed by
the Federal agency. A final FFR shall be submitted at the completion of the award agreement. The
following reporting period end dates shall be used for interim reports: 3/31, 6/30, 9/30, or 12/31.
For final FFRs, the reporting period end date shall be the end date of the project or grant period.
2) Quarterly and semi-annual interim reports shall be submitted no later than 30 days after the end of
each reporting period. Annual reports shall be submitted no later than 90 days after the end of each
reporting period. Final reports shall be submitted no later than 90 days after the project or grant
period end date.
Note: For single award reporting:
1) Federal agencies may require both cash management information on lines 10(a) through 10(c) and
financial status information lines 10(d) through 10(o).
2) 10(b) and 10(e) may not be the same until the final report.

Line Item Instructions for the Federal Financial Report
Reporting Item
FFR
Number
Cover Information
1
Federal Agency and
Organizational Element to
Which Report is Submitted
2
Federal Grant or Other
Identifying Number
Assigned by Federal
Agency
3
Recipient Organization
4a
4b
5

Instructions
Enter the name of the Federal agency and organizational element
identified in the award document or as instructed by the agency.
For a single award, enter the grant number assigned to the award by the
Federal agency. For multiple awards, report this information on the FFR
Attachment. Do not complete this box if reporting on multiple awards.

Enter the name and complete address of the recipient organization
including zip code.
DUNS Number
Enter the recipient organization's Data Universal Numbering System
(DUNS) number or Central Contract Registry extended DUNS number.
EIN
Enter the recipient organization's Employer Identification Number (EIN).
Recipient Account Number Enter the account number or any other identifying number assigned by the
or Identifying Number
recipient to the award. This number is for the recipient's use only and is
not required by the Federal agency. For multiple awards, report this
Revised 6/28/2010

FFR
Number
6
7

8

9

Reporting Item

Instructions

information on the FFR Attachment. Do not complete this box if
reporting on multiple awards.
Report Type
Mark appropriate box. Do not complete this box if reporting on multiple
awards.
Basis of Accounting
Specify whether a cash or accrual basis was used for recording
(Cash/Accrual)
transactions related to the award(s) and for preparing this FFR. Accrual
basis of accounting refers to the accounting method in which expenses are
recorded when incurred. For cash basis accounting, expenses are
recorded when they are paid.
Indicate the period established in the award document during which
Project/Grant Period,
From: (Month, Day, Year) Federal sponsorship begins and ends.
Note: Some agencies award multi-year grants for a project period that is
funded in increments or budget periods (typically annual increments).
Throughout the project period, agencies often require cumulative
reporting for consecutive budget periods. Under these circumstances,
enter the beginning and ending dates of the project period not the budget
period.
Do not complete this line if reporting on multiple awards.
Project/Grant Period, To: See the above instructions for "Project/Grant Period, From: (Month, Day,
(Month, Day, Year)
Year)."
Enter the ending date of the reporting period. For quarterly, semi-annual,
Reporting Period End
Date: (Month, Day, Year) and annual interim reports, use the following reporting period end dates:
3/31, 6/30, 9/30, or 12/31. For final FFRs, the reporting period end date
shall be the end date of the project or grant period.

10

Transactions
Enter cumulative amounts from date of the inception of the award through the end date of the
reporting period specified in line 9.
Use Lines 10a through 10c, Lines 10d through 10o, or Lines 10a through 10o, as specified by the
Federal agency, when reporting on single grants.
Use Line 12, Remarks, to provide any information deemed necessary to support or explain FFR data.
Federal Cash (To report multiple grants, also use FFR Attachment)
10a
Cash Receipts
Enter the cumulative amount of actual cash received from the Federal
agency as of the reporting period end date.
10b
Cash Disbursements
Enter the cumulative amount of Federal fund disbursements (such as cash
or checks) as of the reporting period end date. Disbursements are the sum
of actual cash disbursements for direct charges for goods and services, the
amount of indirect expenses charged to the award, and the amount of cash
advances and payments made to subrecipients and contractors.

10c

For multiple grants, report each grant separately on the FFR Attachment.
The sum of the cumulative cash disbursements on the FFR Attachment
must equal the amount entered on Line 10b, FFR.
Cash On Hand (Line 10a Enter the amount of Line 10a minus Line 10b. This amount represents
Minus Line 10b)
immediate cash needs. If more than three business days of cash are on
hand, the Federal agency may require an explanation
Revised 6/28/2010

FFR
Number

Reporting Item

Instructions

on Line 12, Remarks, explaining why the drawdown was made
prematurely or other reasons for the excess cash.
Federal Expenditures and Unobligated Balance: Do not complete this section if reporting on multiple
awards.
10d
Enter the total Federal funds authorized as of the reporting period end
Total Federal Funds
date.
Authorized
10e
Federal Share of
Enter the amount of Federal fund expenditures. For reports prepared on a
Expenditures
cash basis, expenditures are the sum of cash disbursements for direct
charges for property and services; the amount of indirect expense charged;
and the amount of cash advance payments and payments made to
subrecipients. For reports prepared on an accrual basis, expenditures are
the sum of cash disbursements for direct charges for property and services;
the amount of indirect expense incurred; and the net increase or decrease
in the amounts owed by the recipient for (1) goods and other property
received; (2) services performed by employees, contractors, subrecipients,
and other payees; and (3) programs for which no current services or
performance are required. Do not include program income expended in
accordance with the deduction alternative, rebates, refunds, or other
credits. (Program income expended in accordance with the deduction
alternative should be reported separately on Line 10o.)
10f

Federal Share of
Unliquidated Obligations

Unliquidated obligations on a cash basis are obligations incurred, but not
yet paid. On an accrual basis, they are obligations incurred, but for which
an expenditure has not yet been recorded. Enter the Federal portion of
unliquidated obligations. Those obligations include direct and indirect
expenses incurred but not yet paid or charged to the award, including
amounts due to subrecipients and contractors. On the final report, this line
should be zero unless the awarding agency has provided other
instructions.

Do not include any amount in Line 10f that has been reported in Line 10e.
Do not include any amount in Line 10f for a future commitment of funds
(such as a long-term contract) for which an obligation or expense has not
been incurred.
10g
Total Federal Share (Sum Enter the sum of Lines 10e and 10f.
of Lines 10e and 10f)
10h
Unobligated Balance of
Enter the amount of Line 10d minus Line 10g.
Federal Funds (Line 10d
Minus Line 10g)
Recipient Share: Do not complete this section if reporting on multiple awards.
10i
Enter the total required recipient share for reporting period specified in
Total Recipient Share
line 9. The required recipient share should include all matching and cost
Required
sharing provided by recipients and third-party providers to meet the level
required by the Federal agency. This amount should not include cost
sharing and match amounts in excess of the amount required by the
Federal agency (for example, cost overruns for which the recipient incurs
additional expenses and, therefore, contributes a greater level of cost
Revised 6/28/2010

FFR
Number

Reporting Item

Instructions

sharing or match than the level required by the Federal agency).
10j
Enter the recipient share of actual cash disbursements or outlays (less any
Recipient Share of
rebates, refunds, or other credits) including payments to subrecipients and
Expenditures
contractors. This amount may include the value of allowable third party
in-kind contributions and recipient share of program income used to
finance the non-Federal share of the project or program. Note: On the
final report this line should be equal to or greater than the amount of Line
10i.
10k
Remaining Recipient Share Enter the amount of Line 10i minus Line 10j. If recipient share in Line
to be Provided (Line 10i 10j is greater than the required match amount in Line 10i, enter zero.
Minus Line 10j)
Program Income: Do not complete this section if reporting on multiple awards.
10l
Total Federal Program
Enter the amount of Federal program income earned. Do not report any
Income Earned
program income here that is being allocated as part of the recipient's cost
sharing amount included in Line10j.
10m
Program Income Expended Enter the amount of program income that was used to reduce the Federal
share of the total project costs.
in Accordance With the
Deduction Alternative
10n
Program Income Expended Enter the amount of program income that was added to funds committed
in Accordance With the
to the total project costs and expended to further eligible project or
Addition Alternative
program activities.
10o
Enter the amount of Line 10l minus Line 10m or Line 10n. This amount
Unexpended Program
equals the program income that has been earned but not expended, as of
Income (Line 10l Minus
the reporting period end date.
Line 10m or Line 10n)
Indirect
Expense:
Complete
this information only if required by the awarding agency. Enter
11
cumulative amounts from date of the inception of the award through the end date of the reporting
period specified in line 9.
11a
Type of Rate(s)
State whether indirect cost rate(s) 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 base against which the rate(s) was applied.
11e
Amount Charged
Enter the amount of 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.
Remarks, Certification, and Agency Use Only
12
Remarks
Enter any explanations or additional information required by the Federal
sponsoring agency including excess cash as stated in line 10c.
13a
Typed or Printed Name and Enter the name and title of the authorized certifying official.
Title of Authorized
Certifying Official
13b
Signature of Authorized
The authorized certifying official must sign here.
Certifying Official
13c
Enter the telephone number (including area code and extension) of the
Telephone (Area Code,
individual listed in Line 13a.
Number and Extension)
13d
E-mail Address
Enter the e-mail address of the individual listed in Line 13a.
Revised 6/28/2010

FFR
Reporting Item
Number
13e
Date Report Submitted
(Month, Day, Year)
14
Agency Use Only

Instructions
Enter the date the FFR is submitted to the Federal agency using the
month, day, year format.
This section is reserved for Federal agency use.

Revised 6/28/2010