2012 2013 Semi Annual Financial Reporting Forms by 0m63vv

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									    Getting Started: Be sure to have a copy of your contract handy.

    GO TO: General Info tab
             Enter your agency information on the General Information tab
    Check                Your FEIN number follows the format: i.e. 63-6000000
                         Your contract number is entered exactly like it is on your contract


    GO TO: Budget Form
1            Enter your budget as it appeared in your RFP in the RFP Requested Budget column
2            Enter your new budget to accommodate the grant award amount in the Award Budget Column
             Repeat steps 1 and 2 for the Cash Match and In-Kind Budgets
             Mail Budget Form to DCANP before 9-2-2012

    GO TO: BR-1 Form
             Enter your revised budget in the appropriate columns.
             Repeat steps and for the cash match and In-kind budgets
             The deadline for budget revisions is June 30, 2013 for grants with August 1, 2013 start date.
             The deadline for budget revisions is August 1, 2013 for grants with October 1, 2013 start date.

    GO TO: PS-1 tab (Program Stipulations)
             Enter each of your program stipulations (see your contract for stipulations)
             Select if the stipulation is 'Pending" or "Completed" in the status column
             Enter an explanation if pending or when the stipulation was completed.

    GO TO: SFR Form
             Enter financial person's phone number if different from phone number entered on General Info tab
             Select the reporting period

    GO TO: SBE Form
             Enter expenditures, cash match and in-kind in the appropriate columns and rows
             Print or type authorized person's name, title and date
             Sign the expenditure report
    Check                That line items are not over allowable limits.

    GO TO:     GE-1
               Print

    GO TO:     CM-1
               Print

    GO TO:     IKM-1
               Print

    GO TO:     SP-1
               If a salaried personnel wages are charged to the DCANP grant fill in all yellow areas

    GO TO:     HP-1
               If hourly personnel wages are charged to DCANP grant fill in all yellow areas

    GO TO:     ICP-1
               If an independent contractor, professional service provider, and/or consultant provided services
               that are charged to DCANP grant fill in all yellow areas

    GO TO:     SFR Form
               Answer item 10
Print form and initial item 1-9 as appropriate. Only initial if the form is being submitted.
Alabama Department of Child Abuse and Neglect Prevention
Children's Trust Fund              2012-2013
                                           (Do not submit this page; fill-in all yellow boxes)
Fill-in the highlighted areas. This information will post to all necessary forms.
General Information Page

                  Agency Name: Type Your Agency Name                                FEIN # ##-#######
Fiscal Agency's Name if applicable: Fiscal Agent                             Contract #: Contract Suffix 2013-001
                 Program Name: Type Your Program Name                    Program Type: Non-School Based/After School




     Program Director's E-mail : Type Program Director's E-mail

               Program Director: Type Program Director Name                     Phone: Program Director's #
                        Address: 123 Street South

                  City, State Zip: Anywhere, AL 36103

               Financial Contact: Type Financial Contact Name                   Phone: Financial Contact's #

      Financial Contact's Email: Type Financial Contact's E-mail
            Select Grant Period: 10/1/2012 - 9/30/2013
                                               Budget Form
                          Alabama Department of Child Abuse and Neglect Prevention
                                                         Children's Trust Fund
     2012-2013 Budget Form                                                          Date Submitted to DCANP:             9/15/2012

                                                                                       Contract #: Contract Suffix 2013-001
     Agency Name:                Type Your Agency Name

     Program Name:               Type Your Program Name                             Program Type: Non-School Based/After School

     Address:                    123 Street South Anywhere, AL 36103
     Contact Person:             Type Program Director Name                                Phone:    Program Director's #
                                                                                           E-Mail:   Type Program Director's E-mail
     Financial Person:           Type Financial Contact Name                               Phone:    Financial Contact's #
                                                                                           E-Mail:   Type Financial Contact's E-mail


                                                                        RFP Cash
                                        RFP                               Match                       RFP In-Kind
                                      Requested                         Requested   Award Cash        Requested       Award In-Kind
             Line Items                Budget     Award Budget           Budget     Match Budget        Budget          Budget

 1 Accounting
 2 Audit/CPA Services
 3 Background Check
 4 Consultants
 5 Equipment
 6 Office Supplies
 7 Personnel/Salaries
 8 Personnel/Benefits
 9 Postage
10 Printing
11 Prof. Serv/Ind Cont
12 Program Materials
13 Space Rental
14 Staff Development
15 Telephone
16 Teleph: Cell/Pager
17 Transport/Travel
18 Utilities
19 Volunteer In-Kind
20
21
22
23
24
25
26

     Grand Total                  $          -     $          -     $         -   $          -    $          -    $               -
                                                  DCANP will not approve budget revisions after August 1, 2013.
                                                  Attach a brief statement summarizing each budget revision on your
                                                  letterhead.
     Authorizing Official Signature               For Office Use Only




     Print or Type Name


                                                  ______________________________________             ___________________
     Title                                        Field Director Approval                            Date



     Date
                                 Comments:




     Budget Form Rev. 04-2010
                      Alabama Department of Child Abuse and Neglect Prevention
                                                  Children's Trust Fund
                                                2012-2013 Budget Narrative




ADDRESS BUDGET FORM and BUDGET NARRATIVE TO:


DEPT OF CHILD ABUSE & NEGLECT PREVENTION
FY 2012-2013 BUDGET

P. O. BOX 4251
MONTGOMERY, AL 36103




       Line Items                                          BUDGET NARRATIVE
Accounting
Audit/CPA Services
Background Check
Consultants
Equipment
Office Supplies
Personnel/Salaries
Personnel/Benefits
Postage
Printing
Prof. Serv/Ind Cont
Program Materials
Space Rental
Staff Development
Telephone
Teleph: Cell/Pager
Transport/Travel
Utilities
Volunteer In-Kind
                      0
                      0
                      0
                      0
                      0
                      0
                      0

                          Please submit narrative on your agency letterhead if additional space is needed.
                                            BR
                  Alabama Department of Child Abuse and Neglect Prevention
                                  Children's Trust Fund
     2012-2013 Budget Revision Form                 Date Submitted to DCANP:                                 9/15/2012

     EXPENDITURES                                        EXPENDITURES                              EXPENDITURES
     Agency Name:              Type Your Agency Name                         Contract #: Contract Suffix 2013-001

     Program Name:             Type Your Program Name                      Program Type: Non-School Based/After School

     Address:        123 Street South Anywhere, AL 36103
     Contact Person: Type Program Director Name                                  Phone:    Financial Contact's #
                                                                                 E-Mail:   Type Program Director's E-mail
     Financial Person: Type Financial Contact Name                               Phone:    Financial Contact's #
                                                                                 E-Mail:   Type Financial Contact's E-mail
                               SEND this Budget Revision form SEPARATELY from your financial forms.
                                   Award        Revised         Revised      Revised         Revised         Revised
             Line Items            Budget      Budget - 1       Budget-2     Budget 3        Budget 4        Budget 5
 1   Accounting                            -
 2   Audit/CPA Services                    -
 3   Background Check                      -
 4   Consultants                           -
 5   Equipment                             -
 6   Office Supplies                       -
 7   Personnel/Salaries                    -
 8   Personnel/Benefits                    -
 9   Postage                               -
10   Printing                              -
11   Prof. Serv/Ind Cont                   -
12   Program Materials                     -
13   Space Rental                          -
14   Staff Development                     -
15   Telephone                             -
16   Teleph: Cell/Pager                    -
17   Transport/Travel                      -
18   Utilities                             -
19   Volunteer In-Kind                     -
20                         0               -
21                         0               -
22                         0               -
23                         0               -
24                         0               -
25                         0               -
26                         0               -
            #REF!
     Grand Total               $           -        0.00            0.00           0.00          0.00               0.00
                                               ATTACH BUDGET NARRATIVE FORM (see row 80 below)
                                               DCANP will not approve budget revisions after August 1, 2013.

     Authorizing Official Signature            For Office Use Only



     Print or Type Name


                                               ______________________________________      ___________________
     Title                                     Field Director Approval                     Date

     September 15, 2012
     Date
                               Comments:




     BR-1 Rev. 04-2010
                                       BR-1
              Alabama Department of Child Abuse and Neglect Prevention
                              Children's Trust Fund
2012-2013 Budget Narrative Form                 Date Submitted to DCANP:                      9/15/2012


EXPENDITURES                                   EXPENDITURES                          EXPENDITURES
Agency Name:              Type Your Agency Name
                                                                  Contract #: Contract Suffix 2013-001
Contact Person:                Type Financial Contact Name           Phone:      Financial Contact's #


     Line Items                                              NARRATIVE



Accounting

Audit/CPA Services

Background Check

Consultants

Equipment

Office Supplies

Personnel/Salaries

Personnel/Benefits

Postage

Printing

Prof. Serv/Ind Cont

Program Materials

Space Rental

Staff Development

Telephone

Teleph: Cell/Pager

Transport/Travel

Utilities

Volunteer In-Kind

                      0

                      0

                      0

                      0

                      0

                      0

                      0

Please submit narrative on your agency letterhead if additional space is needed.
                                            BR-2
                   Alabama Department of Child Abuse and Neglect Prevention
                                   Children's Trust Fund
     2012-2013 Budget Revision Form                   Date Submitted to DCANP:                                    9/15/2012

     CASH MATCH                                               CASH MATCH                                   CASH MATCH
     Agency Name:              Type Your Agency Name                              Contract #: Contract Suffix 2013-001

     Program Name:             Type Your Program Name                           Program Type: Non-School Based/After School

     Address:        123 Street South Anywhere, AL 36103
     Contact Person: Type Program Director Name                                       Phone:    Financial Contact's #
                                                                                      E-Mail:   Type Program Director's E-mail
     Financial Person: Type Financial Contact Name                                    Phone:    Financial Contact's #
                                                                                      E-Mail:   Type Financial Contact's E-mail
                               SEND this Budget Revision form SEPARATELY from your financial forms.
                                   Award          Revised            Revised      Revised         Revised         Revised
             Line Items            Budget        Budget - 1          Budget-2     Budget 3        Budget 4        Budget 5
 1   Accounting                            -
 2   Audit/CPA Services                    -
 3   Background Check                      -
 4   Consultants                           -
 5   Equipment                             -
 6   Office Supplies                       -
 7   Personnel/Salaries                    -
 8   Personnel/Benefits                    -
 9   Postage                               -
10   Printing                              -
11   Prof. Serv/Ind Cont                   -
12   Program Materials                     -
13   Space Rental                          -
14   Staff Development                     -
15   Telephone                             -
16   Teleph: Cell/Pager                    -
17   Transport/Travel                      -
18   Utilities                             -
19   Volunteer In-Kind                     -
20                         0               -
21                         0               -
22                         0               -
23                         0               -
24                         0               -
25                         0               -
26                         0               -
            #REF!
     Grand Total               $           -   $       -      $        -   $         -      $        -    $               -
                                               ATTACH BUDGET NARRATIVE FORM (see row 80 below)
                                               DCANP will not approve budget revisions after August 1, 2013.

     Authorizing Official Signature            For Office Use Only



     Print or Type Name


                                               ______________________________________           ___________________
     Title                                     Field Director Approval                          Date

     September 15, 2012
     Date
                               Comments:




     BR-1 Rev. 04-2010
                                       BR-2
              Alabama Department of Child Abuse and Neglect Prevention
                              Children's Trust Fund
2012-2013 Budget Narrative Form                  Date Submitted to DCANP:                       9/15/2012


CASH MATCH                                        CASH MATCH                              CASH MATCH
Agency Name:              Type Your Agency Name
                                                                    Contract #: Contract Suffix 2013-001
Contact Person:                 Type Financial Contact Name            Phone:                 -


     Line Items                                               NARRATIVE



Accounting

Audit/CPA Services

Background Check

Consultants

Equipment

Office Supplies

Personnel/Salaries

Personnel/Benefits

Postage

Printing

Prof. Serv/Ind Cont

Program Materials

Space Rental

Staff Development

Telephone

Teleph: Cell/Pager

Transport/Travel

Utilities

Volunteer In-Kind

                      0

                      0

                      0

                      0

                      0

                      0

                      0

Please submit narrative on your agency letterhead if additional space is needed.
                                            BR-3
                   Alabama Department of Child Abuse and Neglect Prevention
                                   Children's Trust Fund
     2012-2013 Budget Revision Form                   Date Submitted to DCANP:                                   9/15/2012

     IN-KIND MATCH                                          IN-KIND MATCH                               IN-KIND MATCH
     Agency Name:              Type Your Agency Name                             Contract #: Contract Suffix 2013-001

     Program Name:             Type Your Program Name                                       Non-School Based/After School
                                                                                Program Type:

     Address:        123 Street South Anywhere, AL 36103
     Contact Person: Type Program Director Name                                      Phone:    Financial Contact's #
                                                                                     E-Mail:   Type Program Director's E-mail
     Financial Person: Type Financial Contact Name                                   Phone:    Financial Contact's #
                                                                                     E-Mail:   Type Financial Contact's E-mail
                               SEND this Budget Revision form SEPARATELY from your financial forms.
                                   Award          Revised            Revised      Revised        Revised         Revised
             Line Items            Budget        Budget - 1          Budget-2     Budget 3       Budget 4        Budget 5
 1   Accounting                            -
 2   Audit/CPA Services                    -
 3   Background Check                      -
 4   Consultants                           -
 5   Equipment                             -
 6   Office Supplies                       -
 7   Personnel/Salaries                    -
 8   Personnel/Benefits                    -
 9   Postage                               -
10   Printing                              -
11   Prof. Serv/Ind Cont                   -
12   Program Materials                     -
13   Space Rental                          -
14   Staff Development                     -
15   Telephone                             -
16   Teleph: Cell/Pager                    -
17   Transport/Travel                      -
18   Utilities                             -
19   Volunteer In-Kind                     -
20                         0               -
21                         0               -
22                         0               -
23                         0               -
24                         0               -
25                         0               -
26                         0               -
            #REF!
     Grand Total               $           -   $       -      $        -   $         -      $        -    $              -
                                               ATTACH BUDGET NARRATIVE FORM (see row 80 below)
                                               DCANP will not approve budget revisions after August 1, 2013.

     Authorizing Official Signature            For Office Use Only



     Print or Type Name


                                               ______________________________________          ___________________
     Title                                     Field Director Approval                         Date

     September 15, 2012
     Date
                               Comments:




     BR-1 Rev. 04-2010
                                       BR-3
              Alabama Department of Child Abuse and Neglect Prevention
                              Children's Trust Fund
2012-2013 Budget Narrative Form                  Date Submitted to DCANP:                       9/15/2012


IN-KIND MATCH                                     IN-KIND MATCH                         IN-KIND MATCH
Agency Name:              Type Your Agency Name
                                                                    Contract #: Contract Suffix 2013-001
Contact Person:                 Type Financial Contact Name            Phone:                 -


     Line Items                                               NARRATIVE



Accounting

Audit/CPA Services

Background Check

Consultants

Equipment

Office Supplies

Personnel/Salaries

Personnel/Benefits

Postage

Printing

Prof. Serv/Ind Cont

Program Materials

Space Rental

Staff Development

Telephone

Teleph: Cell/Pager

Transport/Travel

Utilities

Volunteer In-Kind

                      0

                      0

                      0

                      0

                      0

                      0

                      0

Please submit narrative on your agency letterhead if additional space is needed.
         Alabama Department of Child Abuse and Neglect Prevention
Organization Name: Type Your Agency Name                                        Contract #: Contract Suffix 2013-001

                                                       PS-1
                                             Program Stipulations
                                     (Complete Separate Page for each Program)
                                   (Do not exceed more than one page per program)

1. Give the status of any recommendations or stipulations that were made for your program by the DCANP Board of Directors for
Program Year 2012-2013. (Do not include this page if you did not have any stipulations in your grant award letter)
                                   Reporting Period:              Final
        Number                Status                    Stipulation                Explanation or Quarter Completed



           1            Pending




           2



           3



           4



           5



           6



           7



           8



           9



          10


PS-1 Rev. 04-2010
                                                                SFR-1                                                                  ~

                            2012-2013 Semi-Annual Financial Report Cover Sheet
                                                       (Copy all pages as needed)



Agency Name:           Type Your Agency Name

                           If applicable, Fiscal Agency's Name: Fiscal Agent

Program Name:          Type Your Program Name                              Program Type: Non-School Based/After School

Agency Address: 123 Street South Anywhere, AL 36103

                Contract Number: Contract Suffix 2013-001                                         Contract Amount: $               -

Contact Person: Type Program Director Name                                          Phone: Program Director's #

Financial Person: Type Financial Contact Name                                       Phone: Financial Contact's #

                   REPORT PERIOD:                      Final                        Semi-Annual Expenditures: $                    -
                                               April 1 - September 30           Report Due:  October 15, 2013

                      Date Submitted:         September 15, 2012                           Expenditures to Date:   $               -

Check off and include the following:                                                                                     Initial

1. SFR Form
DCANP Quarterly Financial Report Cover Sheet

SBE Budget Expenditures Form
All forms below are included and documentation is attached to each and included with SBE form.

3. GE-1 Form
DCANP charged items are listed on the GE-1 Form and documentation is attached.

4. CM-1 and IKM-1 Form
Cash Match & In-Kind Match charged items are listed and documentation is available on site.
Do not forward documentation to DCANP; keep documentation on site.

5. SP-1 Form
Salaried employees are listed and documentation is attached.

6. HP-1 Form
Hourly employees are listed and documentation is attached.

7. ICP-1 Form
Independent contractor, consultants, and professionals are listed and documentation is attached

8. If partial amounts are charged to DCANP, then amount charged is noted with formula,
highlighted and totaled. (example bill = $100.00 but only $50.00 is charged to DCANP)

9. PS-1 Form
Program stipulations are documented and addressed.

10. Have previous reported expenditures, cash-match, or In-kind match been changed ?                               YES

   If Yes, identify the quarter, line item, original amount, new amount and give an explanation




                                                                            For Office Use Only
                                                                            Date Received

SFR Rev. 04-2010
Alabama Department of Child Abuse and Neglect Prevention                                                                            SBE
Children's Trust Fund
2012-2013 Semi-Annual Budget Expenditures Reporting Form

Agency Name:              Type Your Agency Name                                                                                           Reporting Period:           Final
Program Name:             Type Your Program Name                                                                                                  Program Type: Non-School Based/After School

If applicable, Fiscal Agency's Name:                    Fiscal Agent                                                                                 Contract #:      Contract Suffix 2013-001
Address:                  123 Street South   Anywhere, AL 36103                                                                                            FEIN: ##-#######

Financial Contact:        Type Financial Contact Name                        Phone: Financial Contact's #                                                E-mail: Type Financial Contact's E-mail
Program Director:         Type Program Director Name                    Phone: Program Director's #                                                E-mail: Type Program Director's E-mail
                                                    DCANP Grant (Attach Form CGE-1)                                              Cash Match (CM-1)              In-Kind Match (IKM-1)
            A                  B              C                 D           E              F                G            H                I               J                L            M            N
                                                                                                                  Cash                                                 In-Kind
                           DCANP                                        Total          Balance       % Expended
                                                                                                                 Match                                                  Match
                          Approved       Mid-Year          Final       DCANP           Per Line          by                          Mid-Year           Final                  Mid-Year           Final
     Line Items                                                                                                 Approved                                              Approved
                           Budget                                      Expenes           Item         Line Item
                                                                                                                 Budget                                                Budget
                            DCANP          DCANP          DCANP          DCANP          DCANP          DCANP        Cash Match      Cash Match       Cash Match         In-Kind       In-Kind     In-Kind
                          Expenditures   Expenditures   Expenditure    Expenditures   Expenditures   Expenditures   Expenditures    Expenditures     Expenditures        Match         Match       Match
                                                            s                                                                                                         Expenditure   Expenditure Expenditure
Accounting                         -                                              -            -                             -                                                -
Audit/CPA Services                 -                                              -            -                             -                                                -
Background Check                   -                                              -            -                             -                                                -
Consultants                        -                                              -            -                             -                                                -
Equipment                          -                                              -            -                             -                                                -
Office Supplies                    -                                              -            -                             -                                                -
Personnel/Salaries                 -                                              -            -                             -                                                -
Personnel/Benefits                 -                                              -            -                             -                                                -
Postage                            -                                              -            -                             -                                                -
Printing                           -                                              -            -                             -                                                -
Prof. Serv/Ind Cont                -                                              -            -                             -                                                -
Program Materials                  -                                              -            -                             -                                                -
Space Rental                       -                                              -            -                             -                                                -
Staff Development                  -                                              -            -                             -                                                -
Telephone                          -                                              -            -                             -                                                -
Teleph: Cell/Pager                 -                                              -            -                             -                                                -
Transport/Travel                   -                                              -            -                             -                                                -
Utilities                          -                                              -            -                             -                                                -
Volunteer In-Kind                  -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                      0            -                                              -            -                             -                                                -
                                                                                  -            -                             -                                                -


           Grand Total           -             -           -                  -              -          #DIV/0!              -                -               -                -            -            -
I certify that no costs claimed in the above expenditures is allocated or included as a cost of any
other Federally or DCANP funded program, and the local portion was paid from matchable funds.
                                                                                                                                                                      % Cash Match of Expenditures           =   #DIV/0!
                                                                                                                                                                    % In-Kind Match of Expenditures          =   #DIV/0!
                                                                                                                                                                      % Total Match of Expenditures          =   #DIV/0!
Signature                                               Title




Print or Type Name                                      Date

SBE-1 Rev. 04-2010
                                                           GE-1
                                           Grant Expenditure Documentation Form
A DCANP Grant Expenditure is a cash payment made by the organization for salaries, services, or products that support the DCANP funded program and that
are paid by the funds received from the DCANP grant. Expenditures charged to the DCANP Grant and paid with DCANP grant funds must be proven and documented
by the organization according to the compliance standards for each line item listed below.


                              Complete and submit this form, attach supporting documentation, and initial the QFR-1 form.


             Organization Name:                              Type Your Agency Name
                Reporting Period:                                          Final                             Contract #Contract Suffix 2013-001



Budget Line-Item Category                                           Eligible Documentation                                           Amount                  No entry necessary

Accounting                                Copy of Invoice & Cancelled Check                                                                          -       Check to ensure inf

Audit/CPA Services                        Copy of Invoice & Cancelled Check                                                                          -

Background Check                          Copy of Invoice & Cancelled Check                                                                          -
                                          Copy of Invoice on Letterhead, Contract,ICP-1 Form & Cancelled
Consultants                               Check                                                                                                      -

Equipment                                 Copy of Itemized Invoice or Receipt & Cancelled Check                                                      -

Office Supplies                           Copy of Itemized Invoice or Receipt & Cancelled Check                                                      -

Personnel/Salaries                        Copy of Paycheck/Print-Out & SP-1 and/or HP-1 Forms                                                        -

Personnel/Benefits                        Copy of Paycheck Benefit Stub/Print-Out & SP-1 and/or HP-1 Forms                                           -

Postage                                   Copy of Receipt & Cancelled Check                                                                          -

Printing                                  Copy of Itemized Invoice or Receipt, Sample, & Cancelled Check                                             -

Prof. Serv/Ind Cont                       Copy of Invoice on Letterhead, ICP-1 Form & Cancelled Check                                                -

Program Materials                         Copy of Itemized Invoice or Receipt & Cancelled Check                                                      -

Space Rental                              Copy of Invoice on Letterhead & Cancelled Check                                                            -

Staff Development                         Copy of Invoice & Cancelled Check                                                                          -

Telephone                                 Copy of Bill w/Formula & Cancelled Check                                                                   -

Teleph: Cell/Pager                        Copy of Bill w/Formula & Cancelled Check                                                                   -

Transport/Travel                          Copy of Mileage Form, other Receipts & Cancelled Checks                                                    -

Utilities                                 Copy of Bill w/Formula & Cancelled Check                                                                   -

Volunteer In-Kind                         Copy of Proof of Billing and Payment                                                                       -

                                       0 Copy of Proof of Billing and Payment                                                                        -

                                       0 Copy of Proof of Billing and Payment                                                                        -

                                       0 Copy of Proof of Billing and Payment                                                                        -

                                       0 Copy of Proof of Billing and Payment                                                                        -

                                       0 Copy of Proof of Billing and Payment                                                                        -

                                       0 Copy of Proof of Billing and Payment                                                                        -

                                       0 Copy of Proof of Billing and Payment                                                                        -


                                                                                                     Total                                           -
GE-1 Rev. 04-2010
No entry necessary

Check to ensure information is correct
                                                            CM-1
                                                Cash Match Documentation Form
A Cash Match is a cash payment made by the organization for salaries, services, or products that support the DCANP funded program. The Source of a
Cash Match must be clearly stated. Expenditures charged to Cash Match must not include dollars from the DCANP grant, the State of Alabama General Fund,
or the State of Alabama Education Trust Fund. If an organization is unsure of the eligibility or documentation of a Cash Match, please contact your DCANP
Field Director for assistance. Cash Match documentation must meet compliance standards for each line item listed below.
                                  Complete and submit this form, keep documentation on site, and initial the QFR-1 form


             Organization Name:                             Type Your Agency Name
                Reporting Period:                                         Final                                   Contract #Contract Suffix 2013-001


Budget Line-Item Category                           Eligible Documentation (Maintained On-Site)                                   Cash Match Amount

Accounting                               Copy of Invoice & Cancelled Check                                                                                  -

Audit/CPA Services                       Copy of Invoice & Cancelled Check                                                                                  -

Background Check                         Copy of Invoice & Cancelled Check                                                                                  -
                                         Copy of Invoice on Letterhead, Contract,ICP-1 Form & Cancelled
Consultants                              Check                                                                                                              -

Equipment                                Copy of Itemized Invoice or Receipt & Cancelled Check                                                              -

Office Supplies                          Copy of Itemized Invoice or Receipt & Cancelled Check                                                              -

Personnel/Salaries                       Copy of Paycheck/Print-Out & SP-1 and/or HP-1 Forms                                                                -
                                         Copy of Paycheck Benefit Stub/Print-Out & SP-1 and/or HP-1
Personnel/Benefits                       Forms                                                                                                              -

Postage                                  Copy of Receipt & Cancelled Check                                                                                  -

Printing                                 Copy of Itemized Invoice or Receipt, Sample, & Cancelled Check                                                     -

Prof. Serv/Ind Cont                      Copy of Invoice on Letterhead, ICP-1 Form & Cancelled Check                                                        -

Program Materials                        Copy of Itemized Invoice or Receipt & Cancelled Check                                                              -

Space Rental                             Copy of Invoice on Letterhead & Cancelled Check                                                                    -

Staff Development                        Copy of Invoice & Cancelled Check                                                                                  -

Telephone                                Copy of Bill w/Formula & Cancelled Check                                                                           -

Teleph: Cell/Pager                       Copy of Bill w/Formula & Cancelled Check                                                                           -

Transport/Travel                         Copy of Mileage Form, other Receipts & Cancelled Checks                                                            -

Utilities                                Copy of Bill w/Formula & Cancelled Check                                                                           -

Volunteer In-Kind                        Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -

                                       0 Copy of Proof of Billing and Payment                                                                               -


                                                                                                         Total                                              -
CM-1 Rev. 04-2010
No entry necessary

Check to ensure information is correct.
canp
                                                            IKM-1
                                              In-Kind Match Documentation Form
An In-Kind Match is defined as services or products provided by the organization or to the organization in the form of a donation that supports the DCANP funded
program. Typical examples include an accountant who donates their services to the organization. If an organization is unsure of the eligibility of an in-kind
match, please contact your DCANP Field Director for assistance. In-Kind Match charged to the DCANP Grant must be proven and documented by the organization
according to the compliance standards for each line item listed below.
                                   Complete and submit this form, keep documentation on site, and initial QFR-1 form.


             Organization Name:                              Type Your Agency Name
                Reporting Period:                                         Final                                   Contract # Contract Suffix 2013-001



Budget Line-Item Category                           Eligible Documentation (Maintained On-Site)                                             Amount

Accounting                                Invoice on Letterhead & Donor Acknowledgement                                                                     -

Audit/CPA Services                        Invoice on Letterhead & Donor Acknowledgement                                                                     -

Background Check                          Invoice on Letterhead & Donor Acknowledgement                                                                     -
                                          Invoice on Letterhead, Contract, ICP-1 Form & Donor
Consultants                               Acknowledgement                                                                                                   -

Equipment                                 Itemized Invoice or Receipt & Donor Acknowledgement                                                               -

Office Supplies                           Itemized Invoice or Receipt & Donor Acknowledgement                                                               -

Personnel/Salaries                        Copy of Paycheck/Print-Out & SP-1/HP-1 Forms                                                                      -

Personnel/Benefits                        Copy of Paycheck Benefit Stub/Print-Out & SP-1/HP-1 Forms                                                         -

Postage                                   Itemized Invoice or Receipt & Donor Acknowledgement                                                               -

Printing                                  Itemized Invoice or Receipt & Donor Acknowledgement                                                               -

Prof. Serv/Ind Cont                       Invoice on Letterhead, ICP-1 Form & Donor Acknowledgement                                                         -

Program Materials                         Itemized Invoice or Receipt & Donor Acknowledgement                                                               -

Space Rental                              Invoice on Letterhead & Donor Acknowledgement                                                                     -

Staff Development                         Invoice on Letterhead & Donor Acknowledgement                                                                     -

Telephone                                 Copy of Bill w/Formula                                                                                            -

Teleph: Cell/Pager                        Copy of Bill w/Formula                                                                                            -

Transport/Travel                          Copy of Mileage Sheet, Receipt & Donor Acknowledgement                                                            -

Utilities                                 Copy of Bill w/Formula                                                                                            -

Volunteer In-Kind                         Sign-In-Sheets                                                                                                    -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -

                                       0 Itemized Invoice or Receipt & Donor Acknowledgement                                                                -
                     Total   -
IKM-1 Rev. 04-2010
No entry necessary.

Check to ensure information is correct.
                                                     SP-1
                                      Salaried Personnel Reporting Form

Organization Name: Type Your Agency Name                                           Contract #: Contract Suffix 2013-001
Include only salaried employees who perform duties for the DCANP funded program of your agency/organization
and who receive employee benefits and/or have taxes withheld from their paycheck. Independent contractors,
professional service providers, and consultants are not to be included on this reporting form.

Name:                                                                 Reporting Period:             Final

Title:

         Experience and Education Level:                              Job Description (include duties related to DCANP
                                                                      funded program):




                             Report Totals                                                **Annual Totals

                         Gross     Benefits
                                                                                      Total
                         Salary      Paid                               Hours                   Total Annual
         Hours charged                           Total Cost this                     Annual                     Total Annual
                       charged to charged to                           worked                   Benefits Paid
          to DCANP                                   Period                          Gross                          Cost
                       DCANP this DCANP this                          each week                 to Employee
                                                                                     Salary
                         period     period
                             Charge to DCANP                             ** (DCANP salary + All other sources of income)

                   20                                        -                20                                          -
                               Cash-Match
                                                             -
                              In-Kind Match
                                                             -




         SP-1 Rev. 04-2010
                                                 HP-1
                                Hourly Personnel Budget Reporting Form

Organization Name: Type Your Agency Name                                        Contract #: Contract Suffix 2013-001
Include only employees who are paid by the hour, receive employee benefits and/or have taxes withheld from their
paycheck, and who perform duties for the DCANP funded program of your agency/organization. Independent
contractors, professional service providers, and consultants are not to be included on this reporting form.

Name:                                                                  Reporting Period:                 Final

Title:                                                                 Rate of Pay/hour:

         Experience and/or Education Level:                            Job Description (include duties related to DCAN
                                                                       funded program):




                             Report Totals                                             **Annual Totals

                                Benefits                                                       Total
           Hours      Wages                                            Hours       Total
                                  Paid                                                        Annual
         charged to charged to                   Total Cost this       worked     Annual
                               charged to                                                     Benefits
         DCANP this DCANP this                       Period             each      Gross
                               DCANP this                                                     Paid to
           period     period                                            week      Salary
                                 period                                                      Employee
                             Charge to DCANP                           ** (DCANP salary + All other sources of income)

                   20                                        -
                               Cash-Match
                                                             -
                              In-Kind Match
                                                             -




         HP-1 Rev. 04-2010
       HP-1
sonnel Budget Reporting Form

                                               Contract Suffix 2013-001
ur, receive employee benefits and/or have taxes withheld from their
NP funded program of your agency/organization. Independent


                                                            Final



                         Job Description (include duties related to DCANP




                                         **Annual Totals



                                                              Total Annual
                                                                  Cost


                          ** (DCANP salary + All other sources of income)
                                                                          -
                                         ICP-1
                Independent Contractors, Professional Service Providers,
                        & Consultants Budget Reporting Form
Organization Name:          Type Your Agency Name                            Contract #: Contract Suffix 2013-001
Only independent contractors, professional service providers, and/or consultants who provide services to
the DCANP funded program are to be included on this reporting form.
Section 1
      Name:                                                           Reporting Period:             Final

  Company:                                                                Amount of Fees:

                                                                         Contract Amount:

Specify how contractor/professional is paid                   Education and/or Experience of individual/professional:
(I. E. per session taught, total contract, etc…):




Description of services provided to grantee for DCANP funded program:




Section 2.
                                                    Report Totals
           # hours
   individual/professional
                                Total dollars paid to the     Does contractor/professional provides services on other
worked providing services to
                                individual/company for         contracts for your agency/program that is not DCANP
           agency/
  organization this period.  services provided this period.                           related?
     charged to DCANP

                    Charge to DCANP
          20                                                              Yes
                                                                          20                             No
                        Cash-Match                                              If so, please explain.




                       In-Kind Match



IMPORTANT If the organization has a contract with the professional, independent contractor, and/or consultant that
includes the information requested in Section 1 of this form, then the agency/organization must attach the contract
to this form and skip the completion of Section 1. Information in Section 2 must be provided.
ICP-1 Rev 04-2010
Contract Suffix 2013-001

								
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