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WA Commission Financial Reporting and Invoicing System
Welcome to the WA Commission's financial reporting and invoicing system. This system uses an excel based form as the invoice, called the WA
Commission Periodic Expense Report (PER) Form. This excel workbook includes an index with instructions, 12 PER invoices for each month of the
program year, 4 quarterly summary worksheets that total the quarters, a projection worksheet (located within the September worksheet to the right of the
WA PER), a closeout form worksheet (used to closeout the grant at program year-end), and a signature form to sign the WA PERs.
REPORTING REQUIREMENTS
Program requirements, including requirements on match, are located in the AmeriCorps regulations, modified by 2008 appropriations language, and
summarized below.
1 SINGLE MATCH DESCRIPTION OVERVIEW:
The appropriations language includes an important change in how AmeriCorps State and National programs match federal funds.
It replaces the regulatory 15% minimum member support and 33% minimum program operating match with a single overall minimum match of 24% for the
first three-year funding period. Starting with the second three-year cycle, match gradually increases every three years to 50% by year ten, according to the
minimum overall share chart found in 45 CFR 2521.60 (below). Current grantees remain where they are in terms of match requirements. For example, a grantee
entering the sixth year of funding will be required to match at 34% as specified in the chart.
Minimum grantee share is 24%. Starting in Year 4, overall grantee share of total program costs increases gradually to 50% by the tenth year of
funding and any year thereafter.
SINGLE MATCH CHART
45 CFR 2521.60
Single
Number of Years as an Match
AmeriCorps Subgrantee: Requirement
Years 1-3 24%
Year 4 26%
Year 5 30%
Year 6 34%
Year 7 38%
Year 8 42%
Year 9 46%
Year 10+ 50%
Single match compliance includes all Section I (Operational), Section II (Member Support), and Section III (Administrative) match funding combined.
Total match will be calculated on the far right column under "Total Match," which includes all cash and in-kind, in each monthly worksheet.
WCNCS Staff will review for compliance during each billing period. The number of years you have been a subgrantee should be stated in your
approved budget. Please contact WCNCS staff if you have questions on this.
2 INPUT AWARDED BUDGET INTO PERIODIC EXPENSE REPORT (PER) FOR AUGUST OR SEPTEMBER (Column 1)
If an AmeriCorps subgrantee has an August start date, please input your budget in the August10 PER Worksheet. If an AmeriCorps program has a
September start date or later , please input your budget in the September10 PER Worksheet. From the October10 PER worksheet onward, this
information should automatically feed into the BUDGET TOTAL column. Your approved budget can be found in eGrants as part of the awarded
AmeriCorps State grant application that you submitted. Go into your eGrants account. Go to the drop down menu and click on Budget. Your
approved budget should be listed.
3 INPUT CURRENT EXPENDITURES FOR EACH MONTHLY BILLING PERIOD (Column 2)
The CURRENT EXPENDITURES column should be highlighted in green since it includes all the funding you are charging to your AmeriCorps State
grant as well as the match share you are spending during each monthly billing period. This includes all cash and in-kind support including any "other
federal" funding that is utilized for match support. Remember, with any "other federal" funding claimed as match, you must receive permission to
utilize that funding for matching your AmeriCorps State grant award from the other federal agency providing this funding.
4 YEAR-TO-DATE (Column 3):
The YEAR TO DATE column gives the total expenditures to date from your AmeriCorps State grant award as well as match share. This information
will automatically calculate from the data you had input into your awarded budget as well as all current expenditures.
5 BUDGET VERSES YEAR-TO-DATE ACTUAL (Column 4)
The BUDGET VS YEAR TO DATE ACTUAL column just gives you a running balance between your total funding awarded and the total expenditures to
date. All negative balances will be reviewed by WCNCS staff. Any Budget Sections (I, II, and III) cannot maintain a negative balance and still be in
compliance.
6 SUBMIT A COPY OF YOUR MONTHLY PERIODIC EXPENSE REPORT FOR PAYMENT
Please submit a copy of your monthly PER along with a signed/dated State A-19 Invoice Voucher and monthly report. An A-19 copy can be found in
one of the bottom tabs of this Excel file.
7 WHEN TO REQUEST A BUDGET MODIFICATION:
You must contact the WCNCS staff if you know that any Budget Sections will encounter a negative balance. WCNCS staff will help you initiate a
Budget Modification. If circumstances arise where subgrantees must move an amount equalling 10% or higher of their total budget, this may
require permission by the Corporation and a amendment will need to be approved in eGrants. Negative balances appearing in your grantee share will
show the WCNCS and Corporation that you are spending additional program income that was not initially approved. This may ultimately lead to a
deduction to your AmeriCorps grant award in an amount that is equal to the total of any additional program expenditures that were not initally
approved.
A Budget Modification Form worksheet is attached in this file if you scroll to the right using the bottom tabs. Please input your approved budget
in the left column, and the modified budget in the center column. The budget totals must be the same.
As in previous years, AmeriCorps State subgrantees cannot move funding from Section II (Member Support) to other Sections of their budgets.
Attempts to do so will impact future AmeriCorps grant submissions and will adversely impact subsequent continuations and competition.
8 FINANCIAL STATUS REPORT (FSR) and FEDERAL FINANCIAL REPORT (FFR)
All federal grants will be converting to the FFR format effective in October 2008. A "draft" FFR is attached in one of the bottom tabs in this Excel file..
1
WCNCS Periodic Expense Report Form (PER)
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 8/1/10 8/31/10 8/7/12 AmeriCorps Carry Organization's Name - Program Name & Award # 9/1/2007 TO 8/31/2008 8/7/12
Program Year Period of Claim Legal Host Name Program Year
Forward Calc.
Column 1 Column 2 Column 3 Column 4
4 Worksheet
5 Budget Total Current Expenditures Year-To-Date Budget versus YTD Actual Total
YTD Projected
Budget Item Grantee Grantee Grantee Grantee Budget Item Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Projected & Budget
CNCS CNCS CNCS CNCS BUDGET CNCS Carryover
Cash In-kind Cash In-kind Cash In-kind Cash In-kind Actual
I. PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - - - - - - - CNCS Budget A Personnel Exp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Fringe Benefits - - - - - - 0 B Fringe Benefits 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C.1 Staff Travel - - - - - - 10% Budget C.1 Staff Travel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C.2 Member Travel - - - - - - 0 C.2 Member Travel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Equipment - - - - - - SINGLE MATCH D Equipment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Supplies AWARDED Supplies
E - - - - - - E 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F Consultants - - - - - - #DIV/0! #DIV/0! F Consultants 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
G.1 Staff Training - - - - - - 3 G.1 Staff Training 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CURRENT SINGLE
G.2 Member Training - - - - - - MATCH G.2 Member Training 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
H Evaluation - - - - - - #DIV/0! #DIV/0! H Evaluation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Other Op. - - - - - - CNCS Admin Other Op. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
I I
- - - - - - <5.26% CNCS Meetings 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #DIV/0! Subtotal I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II. MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE MATCH
A Living Allowance 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
>= 34% FICA
Member Support - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B FICA B Work Comp
- - - - #DIV/0! #DIV/0! 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Work Comp - - - - YTD CNCS Admin Health Care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
<=5.26%
Health Care - - - - Other 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C C
Other:MbrDvlpmnt - - - - #DIV/0! #DIV/0! Other:MbrDvlpmnt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Subtotal II $ - $ - 0.00 0.00 - - - - Subtotal II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III. ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - - - - - - - - <5.26% A Admin Grantee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Indirect - - - - - - - #DIV/0! #DIV/0! B Indirect 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CNCS Current
Subtotal III Admin <5.26%
$ - $ - $ - 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Subtotal III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL $ - $ - $ - 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 #DIV/0! #DIV/0! TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. - 1. -
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments: TOTAL PROJECTED CARRYOVER 0
Report Submitted by Phone number Date
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Payment to Subgrantee (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
Budget Modification
Authorized Signature Phone number Date Approved By:
6 Check Total
Date
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of each
month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
(Currently set at GREATER THAN OR EQUAL TO 34% but could be up to 50% or higher) You need to UPDATE CELL "T24 and U26"
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Any negative balances, including match share, will be red flagged and reimbursements may be on hold until these negative balances are addressed.
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
and co-signed/dated by WCNCS staff upon final approval.
Step 6
6 Sign WCNCS Expense Form
Email WCNCS Staff indicating that the PER and FSR are complete when it is due bi-annually.
Inform the accounts receivable person in your organization the break out of the WCNCS Expense Report request.
Please call your Program Officer with any further questions.
1
WCNCS Periodic Expense Report Form (PER)
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 9/1/10 9/30/10 8/7/12 AmeriCorps Carry Organization's Name - Program Name & Award # 9/1/2007 TO 8/31/2008 8/7/12
. Program Year Period of Claim Legal Host Name Program Year
Forward Calc.
Worksheet
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual Total
YTD Projected
Budget Item Grantee Grantee Grantee Grantee Budget Item Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Projected & Budget
CNCS CNCS CNCS CNCS BUDGET CNCS Carryover
Cash In-kind Cash In-kind Cash In-kind Cash In-kind Actual
I. PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - CNCS Budget A Personnel Exp 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Fringe Benefits $ - $ - $ - - - - - - - 0 B Fringe Benefits 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C.1 Staff Travel $ - $ - $ - - - - - - - 10% Budget C.1 Staff Travel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C.2 Member Travel $ - $ - $ - - - - - - - 0 C.2 Member Travel 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
D Equipment $ - $ - $ - - - - - - - SINGLE MATCH D Equipment 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Supplies AWARDED Supplies
E $ - $ - $ - - - - - - - E 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
F Consultants $ - $ - $ - - - - - - - #DIV/0! ###### F Consultants 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
G.1 Staff Training $ - $ - $ - - - - - - - 3 G.1 Staff Training 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - MATCH G.2 Member Training 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
H Evaluation $ - $ - $ - - - - - - - #DIV/0! ###### H Evaluation 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Other Op. $ - $ - $ - - - - - - - CNCS Admin Other Op. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
I I
- - - - - - - - - <5.26% CNCS Meetings 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! ###### Subtotal I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
II. MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE MATCH
A Living Allowance 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
>= 34% FICA
Member Support - - - - - - - - 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B FICA B Work Comp
$ - $ - - - - - - - #DIV/0! ###### 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Work Comp $ - $ - - - - - - - Health Care 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
YTD CNCS Admin <=5.26%
Health Care $ - $ - - - - - - - Other 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C C
Other:MbrDvlpmnt $ - $ - - - - - #DIV/0! ###### Other:MbrDvlpmnt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Subtotal II 0 0 - - - - - - Subtotal II 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
III. ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26% A Admin Grantee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! ###### B Indirect 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
CNCS Current
Subtotal III Admin <5.26%
0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Subtotal III 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 #DIV/0! ###### TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0 1. 0
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments: TOTAL PROJECTED CARRYOVER 0
Report Submitted by Phone number Date
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Payment to Subgrantee (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
Paid to Date
0 0 Budget Modification
Authorized Signature Phone number Date Approved By:
6 Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUALto 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Any negative balances, including match share, will be red flagged and reimbursements may be on hold until these negative balances are addressed.
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
and co-signed/dated by WCNCS staff upon final approval.
Step 6
6 Sign WCNCS Expense Form
Email WCNCS staff indicating that the PER and FSR are complete if it is quarter end.
Inform the accounts receivable person in your organization the break out of the WCNCS Expense Report request.
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 10/1/10 10/31/10 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash In-kind Cash In-kind Cash In-kind Cash In-kind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - 10% Budget
3
C.2 Member Travel $ - $ - $ - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - SINGLE MATCH
Supplies AWARDED
E $ - $ - $ - - - - - - -
F Consultants $ - $ - $ - - - - - - - #DIV/0! #DIV/0!
G.1 Staff Training $ - $ - $ - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - #DIV/0! #DIV/0!
I Other Op. $ - $ - $ - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #DIV/0!
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE MATCH
>= 34%
Member Support $ - $ - - - - -
B FICA $ - $ - - - - - #DIV/0! #DIV/0!
Work Comp $ - $ - - - - - YTD CNCS Admin <=5.26%
Health Care $ - $ - - - - -
C
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #DIV/0!
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #DIV/0!
CNCS Current
Subtotal III 0 0 0 - - - - - - - - - Admin <5.26%
TOTAL 0 0 0 - - - - - - - - - #DIV/0! #DIV/0!
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Payment to Subgrantee (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 11/1/10 11/30/10 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - SINGLE MATCH
Supplies AWARDED
E $ - $ - $ - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - -
Other:MbrDvlpmnt $ - $ - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - #DIV/0! #####
CNCS
Current Admin
Subtotal III $ - $ - $ - - - - - - - - - - <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Payment to Subgrantee (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
7
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of each
month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 12/1/10 12/31/10 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - #DIV/0! ######
G.1 Staff Training $ - $ - $ - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - #DIV/0! ######
I Other Op. $ - $ - $ - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! ######
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE MATCH
>= 34%
Member Support $ - $ - - - - - - -
B FICA $ - $ - - - - - - #DIV/0! ######
Work Comp $ - $ - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! ######
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0!######
CNCS
Current Admin
Subtotal III $ - $ - $ - - - - - - - - - - <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! ######
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Payment to Subgrantee (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 8/1/10 12/31/10 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Quarter-To-Date Aug.-Dec. Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget 3
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance 0 0 - - - - - - YTD SINGLE
MATCH
>= 34%
Member Support 0 0 - - - - - -
B
FICA 0 0 - - - - - - #DIV/0! #####
Work Comp 0 0 - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
0 0 - - - - - -
Other:MbrDvlpmnt 0 0 - - - - - - #DIV/0! #####
Subtotal II 0 0 - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee 0 0 0 - - - - - - - - - <5.26%
B Indirect 0 0 0 - - - - - - - - - #DIV/0! #####
C CNCS
Current
Subtotal III 0 0 0 - - - - - - - - - Admin <5.26%
TOTAL 0 0 0 - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Paid to Date
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines. $ -
0 0
6 Authorized Signature Phone number Date
Check Total
Paid in Quarter 1
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month.
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
1
WCNCS Periodic Expense Report Form (PER)
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 1/1/11 1/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - -
F Consultants $ - $ - $ - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - >= 34%
B FICA $ - $ - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - -
Other:MbrDvlpmnt $ - $ - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
C CNCS Current
Subtotal III Admin <5.26%
$ - $ - $ - - - - - - - - - -
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds 6
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
and co-signed/dated by WCNCS staff upon final approval.
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 2/1/11 2/28/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
C
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
BACK OUT the $116.84 from Dec review.
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 3/1/11 3/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp - - - - - - - - - CNCS Budget
B Fringe Benefits - - - - - - - - - 0
C.1 Staff Travel - - - - - - - - - - - 10% Budget
3
C.2 Member Travel - - - - - - - - - - - 0
D Equipment - - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies - - - - - - - - - - -
F Consultants - - - - - - - - - - - #DIV/0! #####
G.1 Staff Training - - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training - - - - - - - - - - - MATCH
H Evaluation - - - - - - - - - - - #DIV/0! #####
I Other Op. - - - - - - - - - - - CNCS Admin
- - - - - - - - - - - - <5.26%
Subtotal I - - - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance - - - - - - YTD SINGLE
MATCH
Member Support - - - - - - - - >= 34%
B FICA - - - - - - - #DIV/0! #####
Work Comp - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
- - - - - - -
Other:MbrDvlpmnt - - - - - - - - #DIV/0! #####
Subtotal II - - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee - - - - - - - - - - - - <5.26%
B Indirect - - - - - - - - - - - - #DIV/0! #####
CNCS
C
Current
Subtotal III - - - - - - - - - - - - Admin <5.26%
TOTAL - - - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
67 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 1/1/11 3/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Quarter-To-Date Jan.-Mar. Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
3
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
>= 34%
Member Support $ - $ - - - - - - -
B
FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
C CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Paid to Date
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines. $ -
0 0
6 Authorized Signature Phone number Date
Check Total
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month.
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Check the budget versus actual for significant variances
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 4/1/11 4/30/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - 10% Budget
3
C.2 Member Travel $ - $ - $ - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
C
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 5/1/11 5/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - -
F Consultants $ - $ - $ - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - >= 34%
B FICA $ - $ - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - -
Other:MbrDvlpmnt $ - $ - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
C Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles,
OMB Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 6
5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 6/1/10 6/30/10 8/7/12 9/1/2007 8/31/2008
Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
3
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
C
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By: Brian Lock
Check Total
Date 6/18/2010 $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, cash match, and in-kind match columns "H" thru "J"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 65 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 4/1/11 6/30/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Quarter-to Date April - June Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
>= 34%
Member Support $ - $ - - - - - - -
B
FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Paid to Date
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines. $ -
0 0
7 Authorized Signature Phone number Date
Check Total
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month.
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, YW-YouthWorks, cash match, and in-kind match columns "I" thru "L"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
6
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 7/1/11 7/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget 3
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
7 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, YW-YouthWorks, cash match, and in-kind match columns "I" thru "L"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
5
6
Step 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 8/1/11 8/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
6 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, YW-YouthWorks, cash match, and in-kind match columns "I" thru "L"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
5
6
Step 5 6 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 9/1/11 9/30/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
3
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
7 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, YW-YouthWorks, cash match, and in-kind match columns "I" thru "L"
Step 3 An overall match is required based on the number of years you have received funding - response should read "OK"
3 Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
5
Step 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 10/1/11 10/31/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
5 Budget Total Current Expenditures Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
3
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
$ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
Member Support $ - $ - - - - - - - >= 34%
B FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00 Comments:
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines.
0 0 Budget Modification Paid to Date
7 Authorized Signature Phone number Date Approved By:
Check Total
Date $ -
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month. Budget Modification
Approved By:
Date
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, YW-YouthWorks, cash match, and in-kind match columns "I" thru "L"
Step 3 An overall match is required based on the number of years you have received funding - response should read "OK"
3 Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
5
Step 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
WCNCS Periodic Expense Report Form (PER) 1
Organization's Name - Program Name & Award # 2 9/1/10 8/31/11 7/1/11 9/30/11 8/7/12 9/1/2007 8/31/2008
. Program Year Period of Claim
56 Budget Total Quarter-to Date July - September Year-To-Date 4 Budget versus YTD Actual
Budget Item Grantee Grantee Grantee Grantee
CNCS CNCS CNCS CNCS BUDGET
Cash Inkind Cash Inkind Cash Inkind Cash Inkind
1 PROGRAM OPERATING COSTS
A Personnel Exp $ - $ - $ - - - - - - - - - - CNCS Budget
B Fringe Benefits $ - $ - $ - - - - - - - - - - 0
C.1 Staff Travel $ - $ - $ - - - - - - - - - - 10% Budget
C.2 Member Travel $ - $ - $ - - - - - - - - - - 0 3
D Equipment $ - $ - $ - - - - - - - - - - SINGLE MATCH
AWARDED
E Supplies $ - $ - $ - - - - - - - - - -
F Consultants $ - $ - $ - - - - - - - - - - #DIV/0! #####
G.1 Staff Training $ - $ - $ - - - - - - - - - - 3
CURRENT SINGLE
G.2 Member Training $ - $ - $ - - - - - - - - - - MATCH
H Evaluation $ - $ - $ - - - - - - - - - - #DIV/0! #####
I Other Op. $ - $ - $ - - - - - - - - - - CNCS Admin
CNCS Meetings $ - $ - $ - - - - - - - - - - <5.26%
Subtotal I $ - $ - $ - - - - - - - - - - #DIV/0! #####
II MEMBER COSTS
A Living Allowance $ - $ - - - - - - - YTD SINGLE
MATCH
>= 34%
Member Support $ - $ - - - - - - -
B
FICA $ - $ - - - - - - - #DIV/0! #####
Work Comp $ - $ - - - - - - - YTD CNCS Admin
Health Care <=5.26%
C
$ - $ - - - - - - -
Other:MbrDvlpmnt $ - $ - - - - - - - #DIV/0! #####
Subtotal II $ - $ - - - - - - -
III ADMINISTRATIVE ~ INDIRECT COSTS CNCS Admin
A Admin Grantee $ - $ - $ - - - - - - - - - - <5.26%
B Indirect $ - $ - $ - - - - - - - - - - #DIV/0! #####
CNCS
Current
Subtotal III $ - $ - $ - - - - - - - - - Admin <5.26%
TOTAL $ - $ - $ - - - - - - - - - - #DIV/0! #####
TOTAL PROGRAM $ - $ - $ - $ -
AmeriCorps Funds Grantee Funds
1. Grant Amount (linked to budget above) 1. 0.00 1. 0.00
2. Expenditures to Date (Before this report) 2. 0.00 2. 0.00
3. Grant Balance Available (line 1 less line 2) 3. 0.00 3. 0.00
4. Current Period Expenditures (linked above) 4. 0.00 4. 0.00
5. Grant Balance Remaining 5. 0.00 5. 0.00
6. Amount of This Request (current expenses) 6. 0.00
Effective with 2010 Budget WCNCS Staff will review appropriate single match depending on your funding year
Final Claim: Yes No Yes No
Paid to Date
Certification: I certify that the amounts shown above are accurate and do not exceed the grant award. All grant expenditures have been recorded and reported according to generally accepted accounting principles, OMB
Circulars, & CNCS grant guidelines. 0.00
0 0
6 Authorized Signature Phone number Date
Check Total
0.00
Email or mail your completed and signed WCNCS Expense Report to your Commission Program Officer by the 15th of
each month.
INSTRUCTIONS
1
Step 1 Update/verify start date and end date for the reporting period in cell P3 & Q3
Step 2 2 Key in current expenses for Federal CNCS, YW-YouthWorks, cash match, and in-kind match columns "I" thru "L"
Step 3 3 An overall match is required based on the number of years you have received funding - response should read "OK"
Set at GREATER THAN OR EQUAL to 24% but could be up to 50% or higher)
If any of check percentages read "NO", please provide the WCNCS a justification on why.
Step 4 4 Check the budget versus actual for significant variances
Note - budget amounts for Federal CNCS funds from Section II can not be re-budgeted to other sections without permission
The corporation allows budget changes of up to 10% cumulative of the total budget within line items of Section I and III
(Cell T28 displays 10% of the budget)
Step 5 5 Check total awarded Budget. Any Budget Modifications will need pre-approval by the WCNCS. A budget modification will be signed/dated by the Subgrantee,
Step 6 6 Sign WCNCS Expense Form
Please call your Program Officer with any further questions.
FEDERAL FINANCIAL REPORT
(Follow form instructions)
1. Federal Agency and Organizational Element 2. Federal Grant or Other Identifying Number Assigned by Federal Agency Page ___ of ___ pages
(To report multiple grants use FFR Attachment)
to Which the Report is Submitted
Corporation for National Service
3. Recipient Organization (Name and complete address and zip code)
4a. DUNS Number 4b. EIN 5. Recipient Account or Identifying Number (to report 6. Final Report 7. Basis
multiple grants use FFR attachment)
Yes No Cash Accrual
8. Project Grant Period 9. Reporting Period End Date
From: (Month, Day, and Year) (Month, Day, Year)
To: (Month, Day, and Year)
10. Transactions: Cumulative
(Use lines a-c for single or multiple grant reporting)
Federal Cash
a. Cash Receipts $ -
b. Cash Disbursements $ -
c. Cash on Hand (line a minus b) $ -
(Use lines d-q for single grant reporting)
Federal Expenditures and Unliquidated Balance:
d. Total Federal funds authorized $ -
e. Federal share of expenditures $ -
f. Federal share of unliquidated obligations $ -
g. Total federal share (sum of lines e and f) $ -
h. Unobligated balance of Federal funds (line d minus g) $ -
Recipient Share:
i. Total Recipient Share required $ -
j. Recipient share of expenditures $ -
k. Recipient share of unliquidated obligations $ -
l. Total recipient share (sum of lines j and k) $ -
m. Remaining recipient share to be provided (line i minus l) $ -
Program Income:
n. Total Federal program income earned $ -
o. Program income expended in accordance with the deduction alternative $ -
p. Program income expended in accordance with the addition alternative $ -
q. Unexpended program income (line n minus line o or line p) $ -
11. Indirect Type of Rate (Place "X" in appropriate box)
Expense
Provisional Predetermined Final Fixed
12. Remarks - Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
13. Certification: I certify to the best of my knowledge and belief that this report is correct and complete and that all expenditures and unliquidated
obligations are for the purposes set forth in the award documents.
a. Typed or Printed Name and Title of Authorized Certifying Official c. Telephone (Area Code, number and extension)
d. Email Address
b. Signature of Authorized Certifying Official e. Date Report Submitted (Month, Day, Year)
14. Agency Use Only
Prescribed by OMB A-102 and A-110 OMB Approval Number
FEDERAL FINANCIAL REPORT ATTACHMENT
1. Federal Agency and Organizational Element to which Report is Submitted (Box 1 on Page 1) 2. Recipient Organization (Box 3 on Page 1)
3a. DUNS Number (Box 4a on Page 1) 4. Reporting Period End Date (Box 9 on Page 1)
(Month, Day, Year)
Page ___ of ___
3b. EIN Number (Box 4b on Page 1)
List Information below for each grant covered by this report. Use additional pages if more space is required.
Federal Grant Number Recipient Account Number Cumulative Cash Disbursement
TOTAL (Should correspond to the amount on Line 10b on Page 1)
Prescribed by OMB A-102 and A-110
OMB Approval Number
FORM STATE OF WASHINGTON AGENCY USE ONLY
A-19-1A INVOICE VOUCHER AGENCY NO. LOCATION CODE P.R. OR AUTH. NO.
(Rev. 6/95)
AGENCY NAME
INSTRUCTIONS TO VENDOR OR CLAIMANT : Submit this form to claim payment for materials or services. Show complete
WA Commission for National and Community Service, P.O. detail for each item.
Box 43113,
Olympia, WA 98504-3113
Vendor's Certificate. I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for
materials, merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered
have been provided without discrimination because of age, sex, marital status, race, creed, color, national origin, handicap,
religion, or Vietnam era or disabled veterans status.
VENDOR OR CLAIMANT (Warrant is to be payable to)
BY
(SIGN IN BLUE INK)
(TITLE) (DATE)
FEDERAL I.D. NO. OR SOCIAL SECURITY NO. (For Reporting Personal Services Contract Payments to I.R.S. RECEIVED BY DATE RECEIVED
DATE DESCRIPTION QUANTITY UNIT UNIT PRICE AMOUNT FOR AGENCY USE
CNCS Grant #
WCNCS Grant #: K???
Time Period: August 1 - 31, 2010
PREPARED BY TELEPHONE NUMBER DATE AGENCY APPROVAL DATE
DOC. DATE PMT DUE DATE CURRENT DOC. NO. REF. DOC NO. VENDOR NUMBER VENDOR MESSAGE USE TAX UBI NUMBER
REF TRANS M MASTER SUB SUB ORG WORK COUNTY CITY/ SUB PROJ
DOC CODE O FUND APPN INDEX OBJ SUB INDEX CLASS TOWN PROJECT PROJ PHAS AMOUNT INVOICE NUMBER
SUF D INDEX PROGRAM OBJ BUDGET
INDEX ALLOC UNIT MOS
ACCOUNTING APPROVAL FOR PAYMENT DATE WARRANT TOTAL WARRANT NUMBER
REQUEST FOR CONTRACT BUDGET REVISION
From: TO:
Washington State Commission for National And Community Service
Program Name: P.O. Box 43113
Program Address: Olympia, WA 98504-3113
Contract Number: Date:
Federal Tax Id #:
Contact Person: Phone Number:
Current Program Budget Totals Budget Modifications Requested Budget Modifications Approved
Please insert current approved Program Budget Please insert Proposed Budget Changes and detail For Commission use only
SECTION I. Program SECTION I. Program SECTION I. Program Operating
Operating Costs Operating Costs Costs
A. Personnel Expenses A. Personnel Expenses A. Personnel Expenses
B. Personnel Fringe Benefits B. Personnel Fringe Benefits B. Personnel Fringe Benefits
C. Travel C. Travel C. Travel
Staff Travel Staff Travel Staff Travel
Member Travel Member Travel Member Travel
C. Travel Subtotal: $ - C. Travel Subtotal: $ - C. Travel Subtotal: $ -
D. Equipment $ - D. Equipment D. Equipment
E. Supplies E. Supplies E. Supplies
F. Contractual and Consultant Services $ - F. Contractual and Consultant Services $ - F. Contractual and Consultant Services
G. Training G. Training G. Training
Staff Training Staff Training Staff Training
Member Training Member Training Member Training
G. Training Subtotal: $ - G. Training Subtotal: $ - G. Training Subtotal: $ -
H. Evaluation $ - H. Evaluation H. Evaluation
I. Other Program Operating Costs I. Other Program Operating Costs I. Other Program Operating Costs
Travel to CNCS Sponsored Meetings Travel to CNCS Sponsored Meetings Travel to CNCS Sponsored Meetings
I. Other Subtotal: $ - I. Other Subtotal: $ - I. Other Subtotal: $ -
SECTION I. TOTAL $ - SECTION I. TOTAL #VALUE! SECTION I. TOTAL #VALUE!
SECTION II. Member Costs SECTION II. Member Costs SECTION II. Member Costs
A. Living Allowance A. Living Allowance A. Living Allowance
Full-Time (1700 hours) Full-Time (1700 hours) Full-Time (1700 hours)
Half-Time (900 hours) Half-Time (900 hours) Half-Time (900 hours)
Reduced Half-Time (675 hours) Reduced Half-Time (675 hours) Reduced Half-Time (675 hours)
Quarter-time (450 hours) Quarter-time (450 hours) Quarter-time (450 hours)
Minimum time (300 hours) Minimum time (300 hours) Minimum time (300 hours)
2nd Year of 2 Year Part-Time 2nd Year of 2 Year Part-Time 2nd Year of 2 Year Part-Time
A. Living Allowance Subtotal: $ - A. Living Allowance Subtotal: $ - A. Living Allowance Subtotal: $ -
B. Member Support Costs B. Member Support Costs B. Member Support Costs
FICA for Members FICA for Members FICA for Members
Workers Compensation Workers Compensation Workers Compensation
Health Care Health Care Health Care
B. Member support $ - B. Member support $ - B. Member support $ -
SECTION II. TOTAL $ - SECTION II. TOTAL $ - SECTION II. TOTAL $ -
SECTION III. Administrative Costs SECTION III. Administrative Costs SECTION III. Administrative Costs
A. Corporation Fixed Percentage A. Corporation Fixed Percentage A. Corporation Fixed Percentage
Corporation Fixed Amount Corporation Fixed Amount Corporation Fixed Amount
Commission Fixed Amount (N/A) N/A Commission Fixed Amount (N/A) N/A Commission Fixed Amount (N/A) N/A
B. Federally Approved Indirect Cost $ - B. Federally Approved Indirect Cost $ - B. Federally Approved Indirect Cost
Rate $ - Rate $ - Rate $ -
SECTION III. TOTAL #VALUE! SECTION III. TOTAL #VALUE! SECTION III. TOTAL #VALUE!
Budget Totals #VALUE! Budget Totals #VALUE! Budget Totals #VALUE!
Number of Members Number of Members Number of Members
Average Cost per Member #VALUE! Average Cost per Member #VALUE! Average Cost per Member #VALUE!
Justification For Budget Revision
Please detail reasons for revision here. (Include reason for revision and adverse consequences if revision is denied. Note: Funds in category A are restricted. Use additional
AUTHORIZED SIGNATURE PRINTED NAME AND TITLE DATE
COMMISSION USE ONLY
WCNCS APPROVAL: DATE:
WA Commission for National and Community Service
Electronic Signature Authorization Form
Electronic signatures are a method of signing a record, through electronic means, that identifies or
authenticates a particular person as the source of the record. This also indicates the person's approval of the
information contained in the record.
This form documents the name of the authorized signer and the electronic signature that will be used to
authenticate a reimbursement request using a ServeMinnesota Expense Report Form (SERF).
AUTHORIZATION INFORMATION
Fiscal Host Name:
Program Name:
Primary Authorized Signer:
Name:
Title:
Email:
Phone:
Electronic Signature:
(Must contain 8-digits including letters and numbers)
Signature:
Date:
Alternate Authorized Signer:
Name:
Title:
Email:
Phone:
Electronic Signature:
(Must contain 8-digits including letters and numbers)
Signature:
Date:
Please return this form to:
Brian Lock, WCNCS (GA Building, Suite G4), PO Box 43113, Olympia, WA 98504-3113
WA Commission Closeout Form
There are three closeout certifications listed below; signing this document certifies that the sub grantee has met all the closeout requirements
and has reported all the equipment and inventory on hand according to the policies below.
Grant #:
Grantee Name:
Program Name:
ATTACHMENT C
EQUIPMENT INVENTORY
Items of Equipment with a Current Fair Market Value of $5,000 or More and Purchased with Federal Grant Funds
Is this program continuing beyond the expiration date of the CNCS grant? YES NO
If the above answer is YES, does the grantee request to continue use of all or part of the equipment? YES NO
(If yes, identify all such equipment below by marking it with a double**)
Does the grantee request the use of the equipment on other federally supported activities? YES NO
Title Holder/ Funding Item Description Equipment Serial # Location/Site and Acquisition Estimated Current Fair Disposition Date
Source (Grantee/ Condition* Date/Cost Market Value
CNCS)
* E-Excellent VG-Very Good G-Good F-Fair P-Poor
If grantee does not request continued use of items of equipment, the Corporation will issue disposition instructions upon receipt of the inventory.
ATTACHMENT D
INVENTORY OF RESIDUAL SUPPLIES
Unused/Residual Supplies Purchased with Federal Funds with an Aggregate Fair Market Value Exceeding $5,000
(If the estimated Fair Market Value is less than $5,000, title rests in the grantee and no inventory is necessary)
Items Description Location/Site Current Fair Final Authorized Disposition/ Date
Market Value
$0
$0
$0
$0
$0
*Total must exceed $5,000 *Total $0
If grantee does not request continued use of items of equipment, the Corporation will issue disposition instructions upon receipt of the inventory.
ATTACHMENT E
CERTIFICATION OF SUB GRANT CLOSEOUT
I certify that our agency has completed all closeout actions; accomplished all program and financial requirements; secured all reports; and
reconciled all funding with respect to sub grants we have awarded under the above referenced grant.
Signature or E-signature Title
Typed Name Date
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