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Form Fa 399 State of Florida

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Form Fa 399 State of Florida Powered By Docstoc
					Adult Education and Family Literacy
     Regional Adult Literacy Centers New

   Computer Generated
             2002-2003
   Performance-Based
 Project Report Program




                        Division of Workforce Development
            Bureau of Program Innovation & Implementation
                       2002-2003 Performance Report Form Instructions
  I. There are 12 types of worksheets to this 2002-2003 Performance Form: a cover page, three pages of
     instructions, the DOE 100A Budget Page, the DOE 103 Budget Page, the Schedule & Performance
     Worksheet, the Performance-Based Achievement Report, Schedule of Deliverables (two pages),
     Invoice Worksheet, Invoice, one page of Definitions, three pages of the DOE 411 Amendment Form and
     the FA 399. These worksheets are like files and each worksheet is identified by the tab at the bottom of the
     screen. This will keep all records for each project together.
 II. The DOE 100A is required for the submission of the proposal. Fill out all areas shaded blue. Only the
     total amount requested is required on this page. Repeated information will be generated by the computer
     on subsequent worksheets. The project number (shaded yellow) cannot be entered until the project has
     been approved.

 III. The DOE 103 Budget Page required for submission of the proposal will need function codes (only for
      districts), object codes, budget description and budget amount. Provide all information for salaries,
      purchased services, capital outlay, and expenses. Include in the description, what, who and program
      each item is for.

 IV. The worksheets: Schedule & Performance and Schedule of Deliverables are used in the preparation of
     a new project or new continuation project and to set up the form for project management, reporting and
     invoicing if needed.
    A. Schedule & Performance
       1. The Performance Goals and Total Project Budget Per Core Measure (shaded blue) are to be filled
          out. Do not use words, only number amounts for the core measures and budgets. This can aid in
          the development of the project proposal and would include whatever core measures are being
          addressed in that particular project. Core Measure #1, Educational Gains should be addressed as
          the total number of LCPs or Educational Gains rather than the number of students. Also for Core
          Measure #2, enter the total number of Participants that are Placed in Employment and/or Higher
          Education; Retentions in Employment; or Completion of a higher educational program. In Core
          Measure #3, enter the total number of both GED and High School diplomas.

        2. All areas shaded in yellow are for data achieved during the period of the project. Information will be
           automatically inserted in other worksheets as required and all calculations will be done by the
           computer for you. The achievements are divided into separate (ABE, GED & High School)
           components for record keeping purposes both for reporting to the state and federal agencies and for
           monitoring and managing projects.

        3. It has become increasingly important to keep accurate records for enrollment. We need figures for
           enrollment of all students in programs covering 0-8.9 and all students 9-12. Also, we need the total
           enrollment for those students institutionalized. (Students in any facility, correction, medical or
           special institution)

        4. For any core measure not to be addressed, delete the calculation code (#DIV/0!) under "Unit Cost
           per Core Measure." (Delete this code only on this worksheet) This will enable the calculations
           on the other worksheets to be correct.

    B. Schedule of Deliverables
        1. When the Schedule & Performance blue shaded areas are completed, the computer will fill out
           sections A & B on the Schedule of Deliverables. Go to the Schedule of Deliverables worksheet and
           enter in the projected goal of enrollment.




11/15/2010                                        Page 2 of 32                                        Instructions
        2. For all Local Educational Agencies, once the DOE 100A and the Schedule & Performance blue
           shaded areas are completed, the Schedule of Deliverables necessary for the project proposal is
           complete. All that is necessary is to print out a copy and insert it with the budget pages in your
           proposal.
        3. Because Community-Based Organizations (CBOs) are required to invoice and provide a
           schedule of Deliverables, more information is required on this worksheet, Section C. You would
           need to decide what you plan to accomplish, on the amount and how often you intend to invoice for
           payment. Enter in the Goal blue shaded area what you plan to achieve for each date you intend to
           invoice. If the dates provided do not match, you can change these dates. But only change it for
           Core Measure #1. Changing the date there will automatically change it everywhere else. You do
           not have to invoice and have a goal for each month. You can leave some dates blank. The Amount
           per goal will be calculated for you.

        4. You will need to provide the objective for each core measure addressed. Please have only one unit
           cost per core measure to ensure that the data can be measured throughout the state.

        5. You will also need to provide the products to be delivered for each core measure addressed. You
           will notice that once you have filled out the blue shaded areas of your goals, the computer will
           calculate how much each invoice will come to for each date selected. The computer will add up
           each core measure for that date.

        6. You are now ready to print this page to insert into your proposal.

 V. The worksheets: Achievement and Invoice Worksheets will for the most part be automatically filled out by
    the computer based upon the figures you entered on the Schedule & Performance Worksheet (the areas in
    yellow).

    A. Achievement
       1. The Performance-Based Achievement Report will give you the totals of all core measures per
          period, percentages of performance and the amount of money earned to date and how much
          needed to meet the deliverables.

        2. This report should be either e-mailed or mailed to your regional representative at least on or by
           January 30, 2003, for the mid-year report and on or by July 10, 2003, for the final report. The FA
           399 is to be sent to the Comptroller's Office, with a copy to your regional representative, on or by
           August 20, 2003.


    B. Invoice Worksheet
       1. No data entry is required on this worksheet.
       2. The Invoice Worksheet will provide information about the amount of money earned for each core
          measure for each entry, quarter and to date. Also, it will provide information of the total that would
          be earned for all core measures per entry, quarter and to date. From this you can determine how
          much can be invoiced if your agency is a community-based organization (CBO). This information
          can be used on the invoice form.


 VI. The Invoice
        1. Take the total from the Invoice Worksheet that you are requesting and enter it on this Invoice page.
        2. Enter all the information indicated by the yellow shaded areas:
           a.    Invoice Number.
           b.    Invoice Date.
           c.    Total amount requested for this invoice.
           d.    Description of Deliverables that this Invoice is for.



11/15/2010                                        Page 3 of 32                                        Instructions
        3. If you need to invoice, print and mail with supporting documentation to Grants Management with a
           copy to your regional representative.

VII. The DOE 411 Amendment Form contains three pages; a cover form, a sheet of instructions, and the
     budget page. Fill in the yellow shaded areas, the computer will do the calculations for you. Print and
     submit this form for your amendment. If and when you need another amendment, click on edit at the top of
     the program for a pull down menu. Choose move or copy sheet. This will give you a screen with a list of all
     the worksheets. Highlight the DOE 411. Check copy at the bottom of the screen and hit enter. This will
     give you a new copy with a 2 added to the worksheet title. You can click on this tab, change the
     amendment number at the top. If the previous amendment changed the total budget amount, change the
     budget total at the bottom. Print and submit. Using the amendment form in the reporting program will keep
     all information about this project in one place; Budget, Deliverables, Reports, and Amendments.

VIII. The final FA 399 is to be sent to the Comptroller's office and a copy to your regional representative on or by
      8/20/03. Fill in all yellow shaded areas. All funds must be encumbered by the end of the project period of
      6/30/03 and disbursed within 45 days of the end of the project period or by 8/14/03.




11/15/2010                                          Page 4 of 32                                         Instructions
                              FLORIDA DEPARTMENT OF EDUCATION                                                      TAPS Number
                                    PROJECT APPLICATION                                                               3B017

Please return to:                                   A) Program Name:                                     DOE USE ONLY
                                             Adult Education & Family
Florida Department of Education                                                             Date Received:
Bureau of Grants Management
                                                     Literacy
Room 325 B, Turlington Building
                                      Regional Adult Literacy Centers
326 West Gaines Street
Tallahassee, Florida 32399-0400
                                            NEW Competitive

Telephone: (850) 488-3473
                                          For Project Year 2002-2003
SunCom: 278-3473
                         B) Name and Address of Eligible Recipient:                            Project Number (DOE Assigned)




 C) Total Funds Requested:              F)
                                                                           Agency Contact Information
       $                          0     Contact Name:                                    Mailing Address:



                                        Telephone Number:                                   SunCom Number:
           DOE USE ONLY

       Total Approved Project:          Fax Number:                                         E-mail Address:

       $


                                                          CERTIFICATION



I,                                                                  , (Please Type Name) do hereby certify that all facts, figures, and
representations made in this application are true, correct and consistent with the statement of general assurances and specific
programmatic assurances for this project. Furthermore, all applicable statutes, regulations, and procedures; administrative and
programmatic requirements; and procedures for fiscal control and maintenance of records will be implemented to ensure proper
accountability for expenditure of funds on this project. All records necessary to substantiate these requirements will be available for
review by appropriate state and federal staff. I further certify that all expenditures will be obligated on or after the effective date and
prior to the termination date of the project. The appropriate disbursements will only be reported only as appropriate to this project,
and will not be used for matching funds on this or any special project, where prohibited.
Further, I understand that it is the responsibility of the agency head to obtain from its governing body the authorization for
the submission of this application.



E)
                         Signature of Agency Head




 DOE 100A
 Rev. 03/02                                                 Page 5 of 32                       Charlie Crist, Commissioner
                               Instructions for Completion of DOE 100A

A.      If not pre-printed, enter name of the program for which funds are being requested.

B.      Enter name and mailing address of eligible recipient. Recipient is the public or non-public entity
        receiving funds to carry out the purpose of the project.
C.      Enter the total amount of funds requested for this project.

D.      Enter requested information for agency contact. Agency contact is the person responsible for
        responding to all questions regarding information included in this application.

E.      The original signature of the appropriate agency head is required. The agency head is the
        school district superintendent, university or community college president, state agency
        commissioner or secretary, or the president/chairman of the Board for other eligible applicants.


*       Note: Applications signed by agency officials other than the appropriate agency head identified above
        must have a letter signed by the appropriate agency head, or documentation citing action of the
        governing body delegating authority of the person to sign on behalf of said official. Attach the letter or
        documentation to the DOE 100A when the application is submitted.




    DOE 100A
    Rev. 03/02                                     Page 6 of 32                Charlie Crist, Commissioner
DOE 100A
Rev. 03/02   Page 7 of 32   Charlie Crist, Commissioner
A)    0                                                                TAPS Number
     Name OF Eligible Recipient:
                                                                          3B017
B)     0
     Project Number: (DOE USE ONLY)


                  FLORIDA DEPARTMENT OF EDUCATION
                       BUDGET NARRATIVE FORM
     (1)                                  (2)                    (3)              (4)
                                                                 FTE
 OBJECT                       ACCOUNT TITLE AND NARRATIVE      POSITION
                                                                             AMOUNT




                                                               C) TOTAL           $0




 DOE 101
 Rev. 03/02                                     Page 8 of 32
                                                                                                     Charlie Crist, Commissioner




                                                       Instructions
                                                   Budget Narrative Form
This form should be completed based on the instructions outlined below, unless instructed otherwise in the Request for
Proposal (RFP) or Request for Application (RFA).

 A.     Enter Name of Eligible Recipient.

 B.     (DOE USE ONLY)
 COLUMN 1
 OBJECT: SCHOOL DISTRICTS:
          Use the three digit object codes as required in the Financial and Program Cost Accounting and
          Reporting for Florida Schools Manual.

                  COMMUNITY COLLEGES:
                  Use the first three digits of the object codes listed in the Accounting Manual for Florida's Public
                  Community Colleges.

                  UNIVERSITIES AND STATE AGENCIES:
                  Use the first three digits of the object codes listed in the Florida Accounting Information Resource
                  Manual.
                  OTHER AGENCIES:
                  Use the object codes as required in the agency's expenditure chart of accounts.

 COLUMN 2 - ALL APPLICANTS:
 ACCOUNT TITLE:                 Use the account title that applies to the object code listed in accordance with the agency's
                                accounting system.

 NARRATIVE:              Provide a detailed narrative for each object code listed. For example:
  u     SALARIES - describe the type(s) of positions requested. Use a separate line to describe each type of position.
  u     OTHER PERSONAL SERVICES - describe the type of service(s) and an estimated number of hours for each type of position. OPS is
        defined as compensation paid to persons, including substitute teachers not under contract, who are employed to provide temporary services
        to the program.
  u     PROFESSIONAL/TECHNICAL SERVICES - describe services rendered by personnel, other than agency personnel employees, who
        provide specialized skills and knowledge.
  u     CONTRACTUAL SERVICES AND/OR INTER-AGENCY AGREEMENTS - provide the agency name and description of the service(s) to be
        rendered.
  u     TRAVEL - provide a description of each type of travel to be supported with project funds, such as conference(s), in district or out of district,
        and out of state. Do not list individual names. List individual position(s) when travel funds are being requested to perform necessary
        activities.
  u     CAPITAL OUTLAY - provide the type of items/equipment to be purchased with project funds.
  u     INDIRECT COST - provide the percentage rate being used. Use the currently approved rate. (Reference the DOE Green Book for additional
        guidance regarding indirect cost.


 COLUMN 3 - MUST BE COMPLETED FOR ALL SALARIES AND OTHER PERSONAL SERVICES.
        FTE - Indicate the Full Time Equivalent (FTE based on a 40 hour workweek) number of positions to be funded. Determine
        FTE by dividing the standard number of weekly hours (40) for the position into the actual work hours to be funded by the
        project.

 COLUMN 4
        AMOUNT -         Provide the budget amount requested for each object code.

 C.     TOTAL -          Provide the total for Column (4) on the last page. Must be the same amount as requested on the DOE - 100
      DOE 101            A or B.
      Rev. 03/02                                                      Page 9 of 32
                             Charlie Crist, Commissioner




DOE 101
Rev. 03/02   Page 10 of 32
4)
OUNT




$0




       DOE 101
       Rev. 03/02   Page 11 of 32
uest for




           DOE 101
           Rev. 03/02   Page 12 of 32
DOE 101
Rev. 03/02   Page 13 of 32
                                  PERFORMANCE-BASED SCHEDULE AND PERFORMANCE REPORT
                                                    (For all Local Educational Agencies and Community-Based Organizations)


  Agency:     0                                                                                                                                 1st Half 2nd Half         Total to Date
  Project Contact Person:               0                                      Total Number of People Served to Date                                                                 0
  Project Number                        0
  Telephone / FAX                       0                   0
  E-Mail:                               0
  Total Project Amount                  $0                                            Regional Adult Literacy Centers NEW Competitive
           Core Measures                Performance     Total Project                                                          Total Achieved Per Reporting Period
                                       Goals 2002-2003 Budget per Core ***Unit Cost per Core




                                                                                                              August




                                                                                                                                                                              June
                                                                                                                                                                                         Total To




                                                                                                                       Sept




                                                                                                                                                                        May
                                                                                                       July




                                                                                                                                    Nov

                                                                                                                                          Dec




                                                                                                                                                            Mar
                                                                                                                                                      Feb
                                                                                                                                                Jan




                                                                                                                                                                  Apr
                                                                                                                              Oct
                                                          Measure            Measure
                                                                                                                                                                                          Date


1. Direct Client Interventions                                                       #DIV/0!                                                                                                0
                                                                                                               0                    0                 0                 0


2. Indirect Client Interventions                                                     #DIV/0!                                                                                                0
                                                                                                               0                    0                 0                 0

3. Enhancement of Coordination
and Collaboration Among Service                                                      #DIV/0!                                                                                                0
Providers                                                                                                      0                    0                 0                 0


4. Support of Volunteer Initiatives                                                  #DIV/0!                                                                                                0
                                                                                                               0                    0                 0                 0




NOTE:       *Full project payment is conditional upon meeting the performance requirements and encumbering expenses by the end of the project period. The total project amount
            will be the lesser of the two figures.

            **The Performance-Based Achievement Report is to be sent to your regional representative on or by 1/30/03 for the mid your report and 7/10/03 for the final report.
            The final FA399 is to be sent to the Comptroller's office and a copy to your regional representative on or by 8/20/03.
            ***For any core measures not addressed, delete the calculation code (#DIV/0!) under "Unit Cost per Core Measure" ON THIS PAGE ONLY.

            ****Enrollment includes all students who receive 12 hours or more of service.




      11/15/2010                                                                                                                                            Schedule & Performance
                    PERFORMANCE-BASED REPORT SCHEDULE OF DELIVERABLES
                                (To be submitted by all applicants)
                          Regional Adult Literacy Centers NEW Competitive
A.
 Agency:    0                                                         Telephone/SunCom:            0
 Contact Person:         0                                            FAX Number:     0
 Projected Number of People To Be Served in 2002-2003:                Project Number:              0

B.
                    (Column #1)                            (Column #2)              (Column #3)             (Column #4)
                       Areas                               Performance               Total Grant             Unit Cost
                                                              Goals                    Budget                 Per Area
                                                            2002-2003                 Per Area               2002-2003
 1. Direct client interventions                                  0                       $0                   #DIV/0!
 2. Indirect client interventions                                0                       $0                   #DIV/0!
 3. Enhancement of coordination and
 collaboration among service providers
                                                                 0                       $0                   #DIV/0!

 4. Support of volunteer initiatives                             0                       $0                   #DIV/0!

C.                                            (For Community-Based Organizations)
                                  Goal         Date       Amount      Goal      Date    Amount     Goal    Date    Amount
 Projected Amount for Area                  7/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
 #1                                         8/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
                                            9/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
 Total Goal   0                            10/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
 Objective for Area #1

 Products Delivered for Areas
 #1


                                  Goal         Date       Amount      Goal      Date    Amount     Goal    Date    Amount
 Projected Amount for Area                  7/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
 #2                                         8/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
                                            9/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
 Total Goal   0                            10/30/2002     #DIV/0!             #######   #DIV/0!           ######   #DIV/0!
 Objective for Area #2

 Products Delivered for Area
 #2


                                  Goal         Date       Amount      Goal      Date    Amount   Goal  Date        Amount
 Projected Amount for Area                  7/30/2002     #DIV/0!             #######    #DIV/0!      ######        #DIV/0!
 #3                                         8/30/2002     #DIV/0!             #######    #DIV/0!      ######        #DIV/0!
                                            9/30/2002     #DIV/0!             #######    #DIV/0!      ######        #DIV/0!
 Total Goal   0                            10/30/2002     #DIV/0!             #######    #DIV/0!      ######        #DIV/0!

 Objective for Area #3

 Products Delivered for Area
 #3



                                  Goal         Date       Amount       Goal     Date    Amount   Goal    Date     Amount
                                            7/30/2002        #DIV/0!          #######    #DIV/0!        ######      #DIV/0!
Projected Amount for Area #4
     11/15/2010                             8/30/2002    Page 15 of 32
                                                             #DIV/0!          #######       Schedule of ######
                                                                                         #DIV/0!        Deliverables#DIV/0!
  Agency:    0                                                            Telephone/SunCom:          0
  Contact Person:       0                                                 FAX Number:     0
  Projected Number of People To Be Served in 2002-2003:                   Project Number:            0
Projected Amount for Area #4

B.                                           9/30/2002        #DIV/0!          #######     #DIV/0!        ######      #DIV/0!
  Total Goal    0                           10/30/2002        #DIV/0!          #######     #DIV/0!        ######      #DIV/0!
Objective for Area #4


Products Delivered for Area #4




                Total Deliverable Amount Per Invoice (For Community-Based Organizations Only)
   Date             Amount                Date             Amount      Date         Amount              Date        Amount
7/30/2002           #DIV/0!            10/30/2002          #DIV/0!   ######          #DIV/0!         4/30/2003      #DIV/0!
8/30/2002           #DIV/0!            11/29/2002          #DIV/0!   ######          #DIV/0!         5/30/2003      #DIV/0!
9/30/2002           #DIV/0!            12/30/2002          #DIV/0!   ######          #DIV/0!         6/30/2003      #DIV/0!
                                              Total Deliverable Amount Per Project Year                #DIV/0!


Notes:
         1.    All applicants must fill out Sections A & B of this Performance-Based Schedule of Deliverables. Community-
               Based Organizations must fill out Section C.

          2. You may choose the timeline for scheduling for payment. Dates may be changed to fit your needs and some
             can be left blank.
          3. The objective must be measurable and specific to the core measure being addressed.
          4. When professional development is an objective, one of the deliverables shall be the instrumentation and report
             on transfer of learning assessment from persons who attended the professional development. This reporting
             shall include post-training data in two areas: The extent of use of practices learned by participants and an
             evaluation of gains and practices learned.

          5. Only one figure is to be used per core measure no matter how many objectives and/or products are being
             addressed.
          6. Full payment is conditional upon meeting the performance requirements of the deliverable. Payments for partial
             performance will be based on unit cost.
          7. Use the next worksheet to submit your Invoice. Full payment is conditional upon meeting the performance
             requirements of the deliverable. Payments for partial performance will be based on unit cost.
          8. A Performance-Based Achievement Report is to be sent to your regional representative on or by 1/30/03 for the
             mid-year report and 7/10/03 for the final report.
           9 The final FA 399 is to be sent to the Comptroller's office and a copy to your regional representative on or by
             8/20/03.
         10. The boxes for each objective and product will expand, but be sure to spread the area by pulling the row down in
             order to view each line. Put your cursor on the row line under the number. Hold down the left button and drag
             until all the words appear.




     11/15/2010                                           Page 16 of 32                        Schedule of Deliverables
                                                    Regional Adult Literacy Centers NEW Competitive
                                                    PERFORMANCE-BASED ACHIEVEMENT REPORT
                                                    (For all Local Educational Agencies and Community-Based Organizations)
Agency:     0                                                                    Project Period   2002-2003              Project Number                                   0
Contact:    0                                                                                                               1st Half                                     2nd Half      Total to Date
Telephone:                       0                                               Total Number of People Served to Date          0                                           0                  0
FAX:                             0
E-Mail:              0
Total Project Amount             $0
                                                                                                     Total Achieved
                                        Unit Cost    Total Budget
                        Goals 2001-                                                                                                                           Total Earned Per Core     Total Amount
Types of Gains                          Per Core       Per Core




                                                                                  Sept
                                                                                                                                                      To




                                                                    July




                                                                                                                                         May
                                                                            Aug




                                                                                               Nov

                                                                                                       Dec




                                                                                                                   Feb

                                                                                                                             Mar

                                                                                                                                   Apr



                                                                                                                                               Jun
                                                                                                             Jan
                                                                                         Oct
                           2002                                                                                                                                      Measure              Allowed
                                        Measure        Measure                                                                                       Date

                                                                    0        0    0       0    0       0     0     0         0     0     0     0
1. Direct Client
                             0           #DIV/0!      $         -                                                                                     0             #DIV/0!               #DIV/0!
Interventions
                                                                            0                  0                   0                     0

                                                                    0        0    0       0    0       0     0     0         0     0     0     0
2. Indirect Client
                             0           #DIV/0!      $         -                                                                                     0             #DIV/0!               #DIV/0!
Interventions
                                                                            0                  0                   0                     0
3. Enhancement of
Coordination and                                                    0        0    0       0    0       0     0     0         0     0     0     0
Collaboration                0           #DIV/0!      $         -                                                                                     0             #DIV/0!               #DIV/0!
Among Service                                                               0                  0                   0                     0
Providers

                                                                    0        0    0       0    0       0     0     0         0     0     0     0
4. Support of
                             0           #DIV/0!      $         -                                                                                     0             #DIV/0!               #DIV/0!
Volunteer Initiatives
                                                                            0                  0                   0                     0
                     Total Budgeted     $                       -          Total Amount Earned and Total Amount Allowed                                           #DIV/0!                 #DIV/0!




                                 Percentage of        Achievement Beyond Achievement Short of                          Amount Earned Above
   Core Measures                                                                                                                                              Amount Earned Short of Total Award
                                  Goals Met             Goal Predicted      Goal Predicted                                 Total Award

1. Direct Client
                                      #DIV/0!                   0                                0                       $                                -   $                                        -
Interventions


2. Indirect Client
                                      #DIV/0!                   0                              0                         $                                -   $                                        -
Interventions
      11/15/2010                                                                         Page 17 of 32                                                                                Achievement
                                            Regional Adult Literacy Centers NEW Competitive
                                            PERFORMANCE-BASED ACHIEVEMENT REPORT
                                            (For all Local Educational Agencies and Community-Based Organizations)
3. Enhancement of
Coordination and               #DIV/0!                    0                         0              $                        -   $                                   -
Collaboration Among
4. Support of Volunteer
                               #DIV/0!                    0                         0              $                        -   $                                   -
Initiatives


    Note: The mid-year report is required on or before 1/30/03 and the final or end of project report is required on or before 7/10/03. Send it to your regional
          representative. It can be either e-mailed, faxed or mailed.




     11/15/2010                                                             Page 18 of 32                                                             Achievement
Total to Date
        0




 Total Amount
   Allowed



   #DIV/0!



   #DIV/0!




   #DIV/0!




   #DIV/0!


   #DIV/0!




f Total Award


                -


                -
                11/15/2010   Page 19 of 32   Achievement
          -


          -


egional




          11/15/2010   Page 20 of 32   Achievement
                                    Regional Adult Literacy Centers NEW Competitive
                            PERFORMANCE-BASED INVOICE WORKSHEET(For Community-Based Organizations)
Agency:     0                                                                 Telephone/SunCom Number(s):                    0
Contact:             0                                                        FAX Number:              0
Total Number of People Served to Date 0                                       E-Mail:       0
Project Number:           0                                                   Project Amount:              $0
Areas of Service     Goal   Achieved To   Unit Cost       Payment Schedule For Each Core Measure           Total Grant           Declining       Total Payment to
                               Date                                                                        Budget Per            Balance               Date
                                                      1st Qtr.     2nd Qtr.     3rd Qtr.        4th Qtr.    Measure
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
1. Direct Client                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                      0         0         #DIV/0!                                                          $             -       #DIV/0!             #DIV/0!
Interventions                                         #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!

                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
2. Indirect Client                                    #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                      0         0         #DIV/0!                                                          $             -       #DIV/0!             #DIV/0!
Interventions                                         #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
3. Enhancement                                        #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
of Coordination
and                                                   #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                      0         0         #DIV/0!                                                          $             -       #DIV/0!             #DIV/0!
Collaboration                                         #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
Among Service
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
Providers
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
4. Support of
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
Volunteer             0       #REF!       #DIV/0!                                                          $             -       #DIV/0!             #DIV/0!
Initiatives                                           #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                                                      #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!
                                                                                                                Total Payments to Date               #DIV/0!
                               July        Aug         Sept        1st Qtr.    October     November        December              2nd Qtr.
Payment Schedule              #DIV/0!     #DIV/0!     #DIV/0!      #DIV/0!     #DIV/0!      #DIV/0!         #DIV/0!              #DIV/0!
Total of All Areas           January      February    March        3rd Qtr.      April           May            June             4th Qtr.
                             #DIV/0!       #DIV/0!    #DIV/0!      #DIV/0!      #DIV/0!         #DIV/0!        #DIV/0!           #DIV/0!             #DIV/0!




      11/15/2010                                                                                                                             Invoice Worksheet
                                                                                Department of Education


                                       Invoice for Payment
                                  Performance-Based Programs
                        Regional Adult Literacy Centers NEW Competitive
   Project Number: 0                             Invoice Date:                      Invoice Number:
   Agency: 0
                                                        Telephone
   Contact: 0                                           :         0

                                                        E-Mail: 0
             Adult Education & Family Literacy


   TOTAL AMOUNT REQUESTED FOR THIS INVOICE                          $



   Description of Deliverables:




                                                       Mail to: Grants Management
                                                                 Rm. 325B Turlington Building
                                                                 325 W. Gaines Street
                                                                 Tallahassee, Florida 32399-0400


11/15/2010                                                                                            Invoice
     IV: The Invoice
            1.       Take the total from the Invoice Worksheet that you are requesting and enter on this
                     Invoice page.
             2.     Enter all the information indicated by the yellow shaded areas:
                    a.    Invoice Number.
                    b.    Invoice Date.
                    c.    Total amount requested for this invoice.
                    d.    Description of the Deliverables that this Invoice is for.
             3.     If you need to invoice, print and mail this page with supporting documentation to
                    Grants Management with a copy to your regional representative.




11/15/2010                                                                                            Invoice
                                                     FLORIDA DEPARTMENT OF EDUCATION

                                                              PROJECT AMENDMENT
                                                            (See Instructions on Reverse)

1. TO:                            3.   DISTRICT/AGENCY NO.       6.   AMENDMENT             9. REQUIRED SIGNATURES:
   Grants Management                                                  NUMBER:
   Rm. 325B Turlington Building   4.   PROJECT NAME:             7.   AMENDMENT TYPE:
   325 W. Gaines Street
   Tallahassee, Florida 32399-                                            PROGRAM             PROJECT COORDINATOR          Date
                                   Regional Adult Literacy
   0400                                                                   BUDGET
                                       Centers NEW
2. FROM:                          5.   PROJECT NUMBER:           8.   DATE SUBMITTED:
   0                                                                                          FINANCE OFFICER              Date
   0
   0
                                                0
   0
PHONE: 0                                                                                      SUPERINTENDENT/AGENCY HEAD   Date

10. NARRATIVE: (Describe the project amendment submitted for approval.)




 DOE 411                                                         DOE Page 24 of 32
                                                                      GENERAL INSTRUCTIONS*
Prior approval of Project Amendments to the approved project application will be required for:
  A. Program Amendments
      1. Any change to the approved project application in objectives or workscope, type of target groups served, selection criteria, project evaluation scope, or to
      add any personnel position not described in the approved project.
      2. No prior approval shall be required for other program amendments.
  B. Budget Amendments
      1. If budget revisions to the approved Project Budget Summary and Disbursement Report which increase the total project amount.
      2. Budget revisions to the approved Project Budget Summary and Disbursement Report which are necessary to implement a program amendment requiring
      prior approval. NOTE: Budget schedules submitted as part of the discretionary project applications will not be subject to budget amendments.
      3. No prior approval shall be required for other budget revisions.
Submit two copies, one containing original signatures, to the appropriate division program office. No additional cover memorandum or letter of transmittal is
required.
Complete page one for both program and budget amendments as follows:
      1. Provide the complete address of the division program office to which the amendment will be sent.
      2. Provide the complete address and phone number of the school district or other agency staff member preparing the amendment.
 3. - 5. Indicate the district/agency name, project name, and project number.
 6. - 8. Record the amendment number which this amendment represents in item 6. Mark the type of amendment being submitted in item 7. Both a program and
         budget amendment may be submitted on the same form under one amendment number. In item 8., indicate the date this amendment was submitted.

     9. The signatures of the Project Coordinator, Finance Officer, and Superintendent or Agency Head are required for both program and budget amendments.

    10. Provide sufficient narrative to describe and justify the type of amendment being requested. For program amendments and budget amendments being
        submitted to implement program amendments, reference the specific pages of the approved project application which will be amended. For budget
        amendments describe the type of budget revisions requested.

Prepare budget amendments to the approved Project Budget Summary and Disbursement Report as follows:
  1. - 4. List only the budget lines of the approved Project Budget Summary and Disbursement Report which are to be amended. Add new budget lines being
          submitted for approval.
 5. - 7. For each budget line to be amended, indicate whether the amount will be increased or decreased in column (5) or (6) and record the adjusted budget
         submitted for approval.
     8. Record the total project amount currently approved. This amount should be the same as the total amount of the approved Project Budget Summary and
        Disbursement Report unless a budget amendment to increase the total project amount has been approved previously by the Florida Department of
        Education.
     9. Record the total project amount resulting from this amendment. This amount should be equal to item (8) unless a net increase to the total project amount
        currently approved is being requested in this amendment in columns (5) and (6).
MULTI-YEAR PROJECTS: SPECIAL INSTRUCTIONS*

Amendments of approved multi-year project applications for each new budget period shall require:
  A) Submission of DOE 411, Project Amendment Form, with page 1 completed according to the instructions provided above and page 3 left blank; and
  B) Submission of Project Budget Summary and Disbursement Report for the new budget period.
All assurances, terms, and conditions of the project award continue to be in effect for the new budget period.
   DOE 411                                                              DOE Page 25 of 32
PROJECT NUMBER                                       BUDGET AMENDMENT                                           AMENDMENT NUMBER
             0                                                                                                         0
                             List only the budget lines of the approved budget which are to be amended .

       (1)            (2)               (3)                           (4)                     (5)             (6)             (7)
    FUNCTION        OBJECT           ACCOUNT                       APPROVED                INCREASE        DECREASE        ADJUSTED
     NUMBER         NUMBER             NAME                         BUDGET                                                  BUDGET
                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                                                                               $0

                                                                TOTAL
                                                                INCREASE/                       $0              $0
                                                                DECREASE

(8) TOTAL PROJECT AMOUNT                                                             (9) TOTAL PROJECT AMOUNT RESULTING FROM
CURRENTLY APPROVED                                                                   THIS BUDGET AMENDMENT
            $0                                                                                             $0




  DOE 411                                                DOE Page 26 of 32
DOE 411   DOE Page 27 of 32
cope, or to




nt requiring


nsmittal is




ogram and
tted.

ments.

ents being
For budget




ines being

ted budget

mmary and
artment of

ect amount




               DOE 411   DOE Page 28 of 32
R


 7)
USTED
DGET
$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0




        DOE 411   DOE Page 29 of 32
(A)                      0
      District/Agency Name                                   FLORIDA DEPARTMENT OF EDUCATION                       (F) Agency Number
                   Regional Adult Literacy
(B)   Program Name Centers NEW Competitive                                                                         (G) Grant Number
                                                                PROJECT DISBURSEMENT REPORT
(C)   Effective Approval Date                                                                                      (H) Project Code

(D)   Termination Date                                                                                             (I)   Agency Project Number
                                                                    Interim Report             Final Report
(E)   Total Project Dollars   $0                                                                                   (J) Contact Person     0            Phone 0

   (1)            (2)                                   (3)                                     (4)                   (5)               (6)                   (7)
Account or     Account or                             Name of                                 Budget        Total Disbursed to Date Undisbursed          Nonreported
 Func. No      Object No.                             Account                                 Amount            As of / / .          Balance            Disbursements
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
                                                                                                                                              $0
         ALL PROGRAMS               (8)   COLUMN TOTALS (Complete on last page only)                     $0                      $0           $0                         $0
                                    (9)   FEDERAL PROGRAM INCOME
  FEDERAL PROGRAMS ONLY            (10)   TOTAL FEDERAL FUNDS                                            $0                                       $0
  COMPLETE ROWS (9) & (10),        (11)   PROGRAM INCOME FOOTNOTE

(12) CERTIFICATION: (Complete on last page only)
I hereby certify that I have reviewed this disbursement report and that all items shown above are in accordance with applicable law and regulations and have
been classified properly according to this district's/agency's current chart of accounts. All records necessary to substantiate these items are available for review
by state and federal monitoring staff. I further certify that as a disbursement report, all disbursements: were obligated for after the project approval date and prior
to the termination date; have not been reported previously; and were not used for matching funds on this or any special project. Further, that I certify all inventory
items included have been entered properly on the inventory records required by Florida Statutes.

DOE 399            Report Number                Certified Correct                                                        Date   /   /   . DOE Audited by:
Rev. 02/02                                                          Finance Officer or Authorized Representative                          Use Date:      /       /   .
                                                                          DOE Page 1 of 2
                                                                  PROJECT DISBURSEMENT REPORT
                                                                          INSTRUCTIONS
DISBURSEMENT REPORT
 Complete Items (A) through (J).   Mark (X), in the box provided below the title, to indicate that this is an interim or a final report (a final report closes out the project).
                                   Submit an original and one copy by the due date specified on the DOE 200 to: Comptroller's Office, Florida Department of Education, 325 West Gaines,
                                   Room 944, Tallahassee, Florida 32399-0400, (850) 487-2460, Suncom 277-2460.
                                   Do not submit monthly disbursement reports unless instructed to do so by the Comptroller's Office or the state grant program.
 COLUMNS
        (1)                        SCHOOL DISTRICTS ONLY:
        FUNCTION                   Use the three-digit object codes as required in the Financial and Program Cost Accounting and Reporting for Florida Schools Manual.

             (2)                   SCHOOL DISTRICTS:
             OBJECT                Use the three-digit object codes as required in the Financial and Program Cost Accounting and Reporting for Florida Schools Manual.

                                   COMMUNITY COLLEGES:
                                   Use the five-digit object codes as required in the Accounting Manual for Florida's Public Community Colleges.

                                   UNIVERSITIES AND STATE AGENCIES:
                                   Use the six-digit object codes as required in the Florida Accounting Information Resource Manual.


                                   OTHER AGENCIES:
                                   Use the object codes as required in the agency's expenditure chart of accounts.

             (3)                   ALL APPLICANTS:
             DESCRIPTION           Provide a specific description of the type of expenditures.

             (4)
             AMOUNT                For each function and object code indicate the budget amount requested.

             (5)                   Complete by reporting total project disbursements as of the date indicated at the top of the column.

             (6)                   Complete by subtracting Column (5) from Column (4).

             (7)                   Complete by reporting all disbursements not previously reported.
LINES
             (8)                   Complete line on Last page ONLY.

             (9)                   In Columns (5) and (6), report as FEDERAL PROGRAM INCOME the income from user fees and from the sale of equipment or other tangible personal

             (10)                  Complete by subtracting line (9) from line (8) in column (5) and adding line (9) to line (8) in column (6)

             (11)                  A footnote should be added to indicate the source of the FEDERAL PROGRAM INCOME.
ITEM
             (12)                  The Finance Officer or authorized representative must certify and date the project disbursement report on the last page.



DOE-399
Rev. 02/02   DOE Page 2 of 2

				
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Description: Form Fa 399 State of Florida document sample