2012 2013 Quarterly Financial Reporting Forms by 1M8a92Y0

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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
                         You selected the correct grant period

    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 9-2-2013

    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, 2012 start date.
             The deadline for budget revisions is August 1, 2013 for grants with October 1, 2012 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 the quarter the stipulation was completed. i.e. 1st Qtr, 2nd Qtr etc.

    GO TO: QFR Form
             Enter financial person's phone number if different from phone number entered on General Info tab
             Select the reporting period
             Enter the date the report will be submitted to DCANP

    GO TO: QBE 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 an 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:     QFR 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: Community Awareness




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

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

                  City, State Zip: Anywhere, AL 36103

              Financial Contact: Type Financial Contact's Name                      Phone: Financial Contact's #
     Financial Contact's E-mail: 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 DCAP:              10/3/2012

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

     Program Name:                Type Your Program Name                                Program Type: Community Awareness

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

                                                                            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                      $          -     $          -     $         -   $           -   $            -  $               -
                                                      DCAP 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. 07-2009
                      Alabama Department of Child Abuse and Neglect Prevention
                                               Children's Trust Fund
2012-2013 Budget Narrative
SEND TO DCAP BY 10/15/2013

ADDRESS BUDGET FORM and BUDGET NARRATIVE TO:




DEPT OF CHILD ABUSE & NEGLECT PREVENTION
FY 2011-2012 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
                                           BR-1
                  Alabama Department of Child Abuse and Neglect Prevention
                                  Children's Trust Fund
     2012-2013 Budget Revision Form                 Date Submitted to DCANP:                               10/3/2012

     EXPENDITURES                                      EXPENDITURES                                 EXPENDITURES
     Agency Name:            Type Your Agency Name

     Program Name:           Type Your Program Name                      Program Type:      Community Awareness
     Address:        123 Street South Anywhere, AL 36103                   Contract #:   Contract Suffix 2013-001
     Contact Person: Type Program Director's Name                             Phone:     Program Director's #
                                                                               E-Mail    Type Program Director's E-mail
     Financial Person: Type Financial Contact's Name                          Phone:     Financial Contact's #
                                                                               E-Mail    Type Financial Contact's E-mail
                             SEND this Budget Revision form SEPARATELY from your financial forms.
                                           Revised            Revised      Revised         Revised         Revised
             Line Items      Award 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                                       -
21                                       -
22                                       -
23                                       -
24                                       -
25                                       -
26                                       -

     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

     October 3, 2012
     Date
                             Comments:




     BR-1 Rev. 07-2009
                                      BR-1
             Alabama Department of Child Abuse and Neglect Prevention
                              Children's Trust Fund
2012-2013 Budget Narrative Form                 Date Submitted to DCANP:                   10/3/2012


EXPENDITURES                               EXPENDITURES                            EXPENDITURES

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

DCANP Grantee Training
                                            BR-2
                   Alabama Department of Child Abuse and Neglect Prevention
                                   Children's Trust Fund
     2012-2013 Budget Revision Form                   Date Submitted to DCANP:                                  10/3/2012

     CASH MATCH                                             CASH MATCH                                    CASH MATCH
     Agency Name:            Type Your Agency Name

     Program Name:           Type Your Program Name                           Program Type:      Community Awareness
     Address:        123 Street South                                          Contract #:    Contract Suffix 2013-001
     Contact Person: Type Program Director's Name                                 Phone:      Program Director's #
                                                                                   E-Mail     Type Program Director's E-mail
     Financial Person: Type Financial Contact's Name                              Phone:      Financial Contact's #
                                                                                   E-Mail     Type Financial Contact's E-mail
                             SEND this Budget Revision form SEPARATELY from your financial forms.
                                                Revised            Revised      Revised         Revised         Revised
             Line Items      Award 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                                       -
21                                       -
22                                       -
23                                       -
24                                       -
25                                       -
26                                       -

     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

     October 3, 2012
     Date
                             Comments:




     BR-2 Rev. 07-2009
                                       BR-2
              Alabama Department of Child Abuse and Neglect Prevention
                              Children's Trust Fund
2012-2013 Budget Narrative Form                  Date Submitted to DCANP:                    10/3/2012


CASH MATCH                                     CASH MATCH                              CASH MATCH

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

DCANP Grantee Training
                                            BR-3
                   Alabama Department of Child Abuse and Neglect Prevention
                                   Children's Trust Fund
     2012-2013 Budget Revision Form                   Date Submitted to DCANP:                                  10/3/2012

     IN-KIND MATCH                                        IN-KIND MATCH                                IN-KIND MATCH
     Agency Name:            Type Your Agency Name

     Program Name:           Type Your Program Name                           Program Type:      Community Awareness
     Address:        123 Street South                                          Contract #:    Contract Suffix 2013-001
     Contact Person: Type Program Director's Name                                 Phone:      Program Director's #
                                                                                   E-Mail     Type Program Director's E-mail
     Financial Person: Type Financial Contact's Name                              Phone:      Financial Contact's #
                                                                                   E-Mail     Type Financial Contact's E-mail
                             SEND this Budget Revision form SEPARATELY from your financial forms.
                                                Revised            Revised      Revised         Revised         Revised
             Line Items      Award 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                                       -
21                                       -
22                                       -
23                                       -
24                                       -
25                                       -
26                                       -

     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

     October 3, 2012
     Date
                             Comments:




     BR-3 Rev. 07-2009
                                       BR-3
              Alabama Department of Child Abuse and Neglect Prevention
                              Children's Trust Fund
2012-2013 Budget Narrative Form                  Date Submitted to DCANP:                    10/3/2012


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's 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

DCANP Grantee Training
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:           4th Quarter
         Number                Status                    Stipulation                Explanation or Quarter Completed



           1             Pending




           2



           3



           4



           5



           6



           7



           8



           9



          10

PS-1 Rev. 07-2009
                                                         QFR-1
                       2012-2013 Quarterly 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: Community Awareness

Agency Address: 123 Street South Anywhere, AL 36103

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

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

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

                  REPORT PERIOD:                 4th Quarter             Quarterly Expenditures: $                 -
                                                 May 1 - July 31            Report Due: July 31, 2013

                      Date Submitted:          October 3, 2012              Expenditures to Date:   $              -

Check off and include the following:                                                                     Initial

1. QFR-1 Form
DCANP Quarterly Financial Report Cover Sheet

2. QBE-1 Budget Expenditures Form
All forms below are included and documentation is attached to each and included with QBE-1 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 ?                NO

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




                                                                         For Office Use Only
                                                                         Date Received

QFR-1 Rev. 07-2009
Alabama Department of Child Abuse and Neglect Prevention
Children's Trust Fund                                                                                                                       QBE-1
2012-2013 Quarterly Budget Expenditures Reporting Form                                                                                                                 Reporting Period:                      4th Quarter
                                                                                                                                                                          Program Type: Community Awareness
Agency Name:              Type Your Agency Name
                                                                                                                                                                                 Contract #: Contract Suffix 2013-001
Program Name:             Type Your Program Name
                                                                                                                                                                                     FEIN: ##-#######
If applicable, Fiscal Agency's Name:                Fiscal Agent

Address:                  123 Street South   Anywhere, AL 36103

Contact Person: Type Financial Contact's Name                       Phone: Financial Contact's #                                                                                    E-mail: Type Financial Contact's E-mail

Contact Person: Type Program Director's Name      Phone: Program Director's #                                                                                                    E-mail: Type Program Director's E-mail
                          DCANP Grant (Attach Form CGE-1)                                               Cumulative Totals                                        Cash Match (CM-1)                                   In-Kind Match (IKM-1)
            A                  B             C              D         E           F                G                H                I          J            K           L            M              N          O          P         Q           R           S
                                                                                                                                    %                                                                         In-Kind
                                                                                                TOTAL
                             DCANP         1st        2nd           3rd        4th         EXPENDITURES FOR      REMAINING      Expended Cash Match         1st        2nd          3rd            4th         Match      1st       2nd       3rd          4th
    Line Items              Approved     Quarter     Quarter       Quarter    Quarter        DCANP FUNDED        FUNDS PER       by Line  Approved        Quarter     Quarter      Quarter        Quarter    Approved   Quarter    Quarter   Quarter      Quarter
                             Budget                                                            PROGRAM            LINE ITEM       Item     Budget                                                             Budget
                            DCANP          DCANP       DCANP       DCANP       DCANP            DCANP              DCANP          DCANP     Cash Match Cash Match Cash Match Cash Match Cash Match        In-Kind     In-Kind     In-Kind     In-Kind     In-Kind
                          Expenditures   Expenditure Expenditure Expenditure Expenditure      Expenditures       Expenditures   Expenditure Expenditure Expenditure Expenditure Expenditure Expenditure    Match       Match       Match       Match       Match
                                             s           s           s           s                                                  s           s           s           s           s           s       Expenditure Expenditure Expenditure Expenditure Expenditures
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

QBE-1 Rev. 07-2009
                                                           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:                                     4th Quarter                            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. 07-2009
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:                                    4th Quarter                                  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. 07/2009
No entry necessary

Check to ensure information is correct.
                                                            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:                                     4th Quarter                                 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. 07-2009
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:         4th Quarter

Title:

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




                             Report Totals                                              **Annual Totals

                          Gross     Benefits
                                                                                    Total
            Hours         Salary      Paid                            Hours                   Total Annual
                                                Total Cost this                    Annual                     Total Annual
          charged to    charged to charged to                        worked                   Benefits Paid
                                                    Period                         Gross                          Cost
           DCANP        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. 07-2009
                                                 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:             4th Quarter

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. 07-2009
       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


                                                        4th Quarter



                         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:         4th Quarter

  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 07-2009
Contract Suffix 2013-001

								
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