No Cost Extension Form

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					                                                                                                                                                       1330 West Peachtree Street
                                                                                                                                                                         Suite 100
                                                                        FINAL ACCOUNTING REPORT                                                             Atlanta, Georgia 30309
                                                                                                                                                                tel (404) 965-7521
                                                                                                                                                                fax (404) 872-9559
                                                          Please return this form via email to: research@arthritis.org                                        John A. Hardin, MD
                                                                                                                                                           Chief Scientific Officer


    Award Recipient's Name                                                                                 Institution
    Fiscal Year                                                                                            Award Type
    Award Period (to/from)                                                                                 Award Title
                                                                                                          AF Account #

               Description                  Current Award              Approved Carryover            Current Award             Actual Payments             Unexpended
                                            Period Budget                (previous year)            Period Expenses               Received                   Balance


1 Salaries & Fringe Benefits                                                                                                                                                -

2 Permanent Equipment                                       -                               -                          -                           -                        -

3 Expendable Supplies                                                                                                                                                       -
  Other Expenses itemize
  expense $1,000 or more.
4 Current expenses only)                                                                                                                                                    -

5 Total Direct Cost                                         -                               -                          -                           -                        -
6 Total Indirect Cost (not
  permitted for Postdoctoral
  Fellowship or Doctoral
  Dissertation Award)

7 Total Cost                                $               -      $                        -      $                   -      $                    -      $                 -
    Upon completion remaining funds must be returned to the Arthritis Foundation with 60 days, unless a no-cost extension has been requested and approved.
    If you wish to request a no-cost extension, please complete the NO-Cost Extension section below and return the form 30 days prior to the end of the award.
8
                                         COMPLETE THIS SECTION TO REQUEST A NO-COST EXTENSION
                             No-cost extensions may be granted for a maximum of 12 months after the end of the award.
    A no-cost extension gives the award recipient extra time to complete the scope and objectives of the project without additional funds being provided. Requests may not be
     made for the sole purpose of spending remaining funds. Requests for no-cost extensions are included as part of the Final Financial Report, therefore all sections of the
         form must be completed and submitted at least 30 days after/follwing to the end of the award. They may be granted at the discretion of the Arthritis Foundation.
                                                  Explain how funds will be used in the next funding period:




    Note: Any missing checks should be reported immediately. They cannot be reissued after 6 months past the end of the award period.



    Signature of Financial Officer                                                                Date


    Type Name and Official Title

                              If you have questions, please contact Alicia DeLeon at adeleon@arthritis.org or 404-65-7636
1330 West Peachtree Street
                 Suite 100t
     Atlanta, Georgia 30309
         tel (404) 965-7521
         fax (404) 872-9559


      John A. Hardin, MD
    Chief Scientific Officer

				
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