i MASSACHUSETTS DEPARTMENT OF ELEMENTARY SECONDARY EDUCATION STANDARD APPLICATION FOR PROGRAM

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i MASSACHUSETTS DEPARTMENT OF ELEMENTARY SECONDARY EDUCATION STANDARD APPLICATION FOR PROGRAM Powered By Docstoc
					                MASSACHUSETTS DEPARTMENT OF ELEMENTARY & SECONDARY EDUCATION
                          STANDARD APPLICATION FOR PROGRAM GRANTS

                                                     FORM FR 1 (A)
                             (MTRS SUPPLEMENT TO THE FINAL FINANCIAL REPORT)

PART 1
A.   All sections of this report must be completed, and the report submitted, with Form FR1 (Final Financial Report), for
     any federal project containing funds budgeted for staff who are members of the Massachusetts Teachers’
     Retirement System (MTRS) and whose salaries are paid from the identified federal project.
B.   Complete and return as follows:
                             Massachusetts Department of Elementary & Secondary Education
                             Grants Management
                             350 Main Street
                             Malden, MA 02148

                             ATTENTION: Financial Analysis and Reporting

C.   Make any additional payments directly to the Massachusetts Teachers’ Retirement System. Do not make
     payments to the Department for the liability to MTRS.
(Do not complete items D through H if the information is the same as that on Form FR1 and this report is stapled to it.)


D.   Grant Recipient:
     (Legal Name of Agency
E.   Address:
     (Street,City/Town/Zip Code)
F.   Project Number:

G.   Name of grant program/
     Source of funds
H.   Name of person                        Name:
     Completing this report:               Title:
     (Print or Type)                       Phone Number:
PART II
A. Amount budgeted for MTRS as of December 31 of the applicable grant period. $
   (Obtain this figure from Line Item fou (4), Fringe Benefits, Subline 1,
   Massachusetts Teachers’ Retirement System, of the original grant application
   or subsequent approved amendment. (If zero, please indicate.)

B.   Multiply the figure on Line A by eighty per cent (.8). This should equal the      $
     payment directly made for you by the Department of Elementary and
     Secondary Education to the Massachusetts Teachers’ Retirement System. (If
     zero, please indicate.)
C.   Compute the actual liability to MTRS for this federal project, by multiplying the $
     combined total salaries paid under this project to staff who are members of
     MTRS by nine percent (.09).

D.   Subtract Line B from Line C and indicate the result of Line D. This should       $
     constitute The additional liability to be paid directly by you to the
     Massachusetts Teachers’ Retirement System. Do not pay this amount to
     the Department of Elementary and Secondary Education.




I certify that all the information contained in this report is true and correct.

1.   Signature of Authorized Representative:                         X

     (e.g. School Business Manager or Town Accountant)

2.   Typed or Printed Name:

3.   Title:

4.   Date Report Submitted:

     FR 1 (A)
MENT OF ELEMENTARY & SECONDARY EDUCATION
 PLICATION FOR PROGRAM GRANTS

     FORM FR 1 (A)
ENT TO THE FINAL FINANCIAL REPORT)



 d, and the report submitted, with Form FR1 (Final Financial Report), for
 ted for staff who are members of the Massachusetts Teachers’
 aries are paid from the identified federal project.


 partment of Elementary & Secondary Education
 nt




 e Massachusetts Teachers’ Retirement System. Do not make
ility to MTRS.
mation is the same as that on Form FR1 and this report is stapled to it.)
X




    Revised 3/2008

				
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