Get OMB SF 269 1999

Typed or Printed Name and Title Telephone Area code number and extension Signature of Authorized Certifying Official Date Report Submitted Previous Edition Usable NSN 7540-01-012-4285 This form was electronically produced by Elite Federal Forms Inc. Standard Form 269 REV 9-99 Prescribed by OMB Circulars A-102 and A-110. FINANCIAL STATUS REPORT Long Form Follow instructions on the back 1. Federal Agency and Organizational Element to Which Report is Submitted 2. Federal Grant or Other Identifying Number Assigned OMB Approval No* Page of 0348-0039 pages 3. Recipient Organization Name and complete address including ZIP code 4. Employer Identification Number 5. Recipient Account Number or Identifying Number 6. Final Report Yes 8. Funding/Grant Period See Instructions From Month Day Year 10. Transactions 9. Period Covered by this Report I Previously Reported a* II This Period III Cumulative Program income used in accordance with the deduction alternative d. Accrual Refunds rebates etc* c* Cash Total outlays b. 7. Basis No Net outlays Line a less the sum of lines b and c Recipient s share of net outlaws consisting of e. SBDC Network In-Kind Match f* SBDC Network Waived Indirect costs g. sharing alternative h. All SBDC Network Cash Match i. Total recipient share of net outlays Sum of lines e f g and h j. Federal share of net outlays line d less line i k. Total unliquidated obligations l* m* n* Total federal share sum of lines j and m o. Total federal funds authorized for this funding period p* Unobligated balance of federal funds Line o minus line n q. a* See Attached SBDC Network Schedule of All Indirect Costs. 11. Indirect Expense b. Rate c* Base d. Total Amount e. Federal Share 12. Remarks Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation* 13. Certification I certify to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents. FINANCIAL STATUS REPORT Long Form Follow instructions on the back 1. Federal Agency and Organizational Element to Which Report is Submitted 2. Federal Grant or Other Identifying Number Assigned OMB Approval No* Page of 0348-0039 pages 3. Recipient Organization Name and complete address including ZIP code 4. Federal Grant or Other Identifying Number Assigned OMB Approval No* Page of 0348-0039 pages 3. Recipient Organization Name and complete address including ZIP code 4. Employer Identification Number 5. Recipient Account Number or Identifying Number 6. Final Report Yes 8. Employer Identification Number 5. Recipient Account Number or Identifying Number 6. Final Report Yes 8. Funding/Grant Period See Instructions From Month Day Year 10. Transactions 9. Period Covered by this Report I Previously Reported a* II This Period III Cumulative Program income used in accordance with the deduction alternative d. Funding/Grant Period See Instructions From Month Day Year 10. Transactions 9. Period Covered by this Report I Previously Reported a* II This Period III Cumulative Program income used in accordance with the deduction alternative d. Accrual Refunds rebates etc* c* Cash Total outlays b. 7. Basis No Net outlays Line a less the sum of lines b and c Recipient s share of net outlaws consisting of e. .