Education Trust Fund of Alabama - DOC

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					                                                                                                                                             FY 2010

                                    ALABAMA CATASTROPHIC TRUST FUND FOR SPECIAL EDUCATION
                                       CLAIM FOR REIMBURSEMENT/REPORT OF EXPENDITURES
                                                        CFSE FORM 10

Submit one copy with original signature of LEA Superintendent to:

Alabama State Department of Education
Administrative and Financial Services
LEA Financial Assistance
5141 Gordon Persons Building
Post Office Box 302101
Montgomery, AL 36130-2101

CLAIM FOR REIMBURSEMENT/REPORT OF EXPENDITURES must be submitted on or before the 10th day of each month. This report must be
submitted monthly with substantiating documentation attached. Final claim for reimbursement must be marked final and received by SDE no later
than November 1, 2010.

Enter official title (name) of the LEA on behalf of which the Claim for Reimbursement is being made and the three digit identification number (System
Code) assigned to the LEA by the State Department of Education. Claims should be numbered consecutively and the applicable number entered in
space provided. State the amount of the approved Catastrophic Funds and percentage and the required Match Funds and percentage. For the period
covered by claim, specify month.

PAGE 1

I.       Catastrophic Fund Budget and Expenditures

         A.     Column 1: Itemize in detail all items of expense being budgeted/expended in accordance with LEA's approved Application for
                Financial Assistance through the Catastrophic Trust Fund. These funds should be included in your Systemwide Budget.

         A.     Column 2: Refer to the Financial Planning, Budgeting and Reporting System for Alabama Public Schools for the appropriate 27 digit
                Account Code for each type of expenditure made.

         B.     Column 3: CATASTROPHIC BUDGET - Complete with Approved Budget figures in accordance with LEA's approved Application
                for Financial Assistance through the Catastrophic Trust Fund.

         C.     Column 4: Complete with expenditure amounts for the month being reported and attach substantiating documentation.
                Documentation shall include copies of payroll, schedule of employee paid benefits, time sheets to account for 100% of time worked,
                itemized, paid invoices/bills with copy of Purchase Order, signed material receipts and copy of checks showing date items of expense
                were paid.

         D.     Column 5: Complete with cumulative expenditure to date. Total of Expenditures This Period plus Cumulative Expenditures To Date
                from previous Claim For Reimbursement/Report of Expenditures.
II.      Match Fund Budget and Expenditures

         A. Column 6: Match - Approved Budget - Enter the latest approved budget in effect.

         B. Column 7: Match - Refer to the Financial Planning, Budgeting and Reporting System for Alabama Public Schools for the appropriate 27
            digit Account Code for each type of expenditure made. A Special Use Code of 0031 must be used for the required match.

         C. Column 8: Match - Match Budget - Complete with Approved Match Budget figures in accordance with LEA's approved Application for
            Financial Assistance through the Catastrophic Trust Fund.

         D. Column 9: Match - Complete with expenditure amounts for the month being reported.

         E. Column 10: Match - Complete with cumulative expenditure to date. Total of Expenditures This Period plus Cumulative Expenditures To
            Date from previous Claim For Reimbursement/Report of Expenditures.

III.     SIGNATURE OF CHIEF SCHOOL FINANCIAL OFFICER

         Original signature of CSFO is required. Stamped or xeroxed signatures are not acceptable.

IV.      SIGNATURE OF LEA SUPERINTENDENT

         Original signature of LEA Superintendent is required. Stamped or xeroxed signatures are not acceptable.


PAGE 2

         NARRATIVE: Complete on Final Claim for Reimbursement only. Attach additional sheets if needed. Describe in detail what was achieved.




CFSE10INST                                                                2

				
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