UIPL6-99_Attach5.pdf

ETA Advisory File Text

ET HANDBOOK NO. XXX CHAPTER II - REPORTING APPENDIX II Page 1U.S. DEPARTMENT OF LABOR Employment and Training Administration Exp. Date 0xxxx-xxxx OMB Approval xxxx-xxxx WORKSHEET UI-3QUARTERLY UI CONTINGENCY REPORT StateFiscal YearQuarter Section A Program Staff Year Usage QuarterYear-to-Date Program Category a SY Worked b SY Paid c SY Paid 1. Claims Activities 2. Employer Activities 3. UI Performs 4. Support AS T 5. Trade Claims Activities 6. Other 7. Total Staff Years Section B Regular Contingency Entitlement Certification Standard Hours Quarterly Year-to-Date Yearly Claims Activity a Workload b MPU c 1. Initial Claims Regular EB and STC 2. Initial Claims Third Tier 3. Weeks Claimed Regular EB and STC 4. Weeks Claimed Third Tier 5. Interstate Weeks Claimed Regular and EB 6. Interstate Weeks Claimed Third Tier 7. Nonmonetary Deter. Regular EB and STC 8. Nonmonetary Deter. Third Tier 9. Appeals Regular EB and STC 10. Appeals Third Tier 11. Interstate Appeals Taken IB-101 12. Interstate Referrals 13. Multiclaimant Services 14. Monetary Redeterminations 15. Other Staff Years Specify 16. Total Staff Years Worked Earned Sum of Lines 1 through 15 17. Entitlement Staff Years Worked Line 16 - Base SY Worked 18. Entitlement Staff Years Paid Line 17 x Experienced Leave 19. PS PB Entitlement Line 18 x Regular Contingency PS PB Rate 20. Support Entitlement Line 19 x Contingency Support Percentage 21. Other Specify 22. Total Dollar Costs Line 18 Line 19 Line 20 23. Advance 24. Net Dollar Entitlement Line 22 - Line 23CERTIFICATION I certify to the best of my knowledge and belief that information provided herein is accurate and complete and wasobtained from agency accounting records. Signature Title Date ETA 2208A Page 2U.S. DEPARTMENT OF LABOR Employment and Training Administration Exp. Date xx xx xx OMB Approval xxxx-xxxx xxxx-xxxx WORKSHEET UI-3 Continued QUARTERLY UI CONTINGENCY REPORT StateFiscal YearQuarter Section C Trade Contingency Entitlement Certification Standard Hours Quarterly Year-to-Date Yearly Claims Activity a Workload b MPU c 1. Initial Claims 2. Weeks Claimed 3. Nonmonetary Determinations 4. Appeals 5. Trade Redeterminations 6. Other Staff Years Specify 7. Total Staff Years Worked Sum of Lines 1 through 6 8. Staff Years Paid Line 7 x Experienced Leave 9. PS PB Entitlement Line 8 x Trade PS Regular Contingency PB Rate 10. Support Entitlement Line 9 x Trade Support Percentage 11. Other Specify 12. Total Trade Dollar Costs Line 9 Line 10 Line 11 Section D SAVE Workload Certification Standard Hours Quarterly Year-to-Date Yearly Claims Activity a Workload b MPU c 1. Initial Claims 2. Other Staff Years Specify 3. Total Staff Years Worked Line 1 Line 2 4. Staff Years Paid Line 3 x Experienced Leave 5. PS PB Entitlement Line 4 x PS PB Rate 6. Support Entitlement Line 5 x SAVE Support Percentage 7. Other Specify 8. Total SAVE Dollar Costs Line 5 Line 6 Line 7 Section E Additional Benefits Contingency Entitlement Certification Standard Hours Quarterly Year-to-Date Yearly Claims Activity a Workload b MPU c 1. Initial Claims 2. Weeks Claimed 3. Nonmonetary Determinations 4. Appeals 5. Monetary Redeterminations 6. Other Staff Years Specify 7. Total Staff Years Worked Sum of Lines 1 through 6 8. Staff Years Paid Line 7 x Regular Contingency Experienced Leave 9. PS PB Entitlement Line 8 x Regular Contingency PS PB Rate 10. Support Entitlement Line 9 x Regular Contingency Support Percentage 11. Other Specify 12. Total AB Dollar Costs Line 9 Line 10 Line 11 Page 3Public Reporting Burden for the collection of this information is estimated to average 120 minutes per response including time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the Unemployment Insurance Service ETA U.S. Department of Labor Room S-4231 200 Constitution Avenue N. W. Washington D.C. 20210 and or Paper Reduction Project xxxx-xxxx .INSTRUCTIONS FOR THE UI-3 Please type or print legibly. The following general instructions explain how to use the form itself. General InstructionsThis form is designed so that application can be made for funds from one or more grant programs Regular UI Trade SAVE and Additional Benefits . The SAVE program is funded from base however it is included on the UI-3 in order to reimburseongoing operational costs related to the SAVE program. The electronic version of this form appears slightly different on the computer screen than the one included in theseinstructions which is provided for display only. States should submit their reports electronically. There is minimaldata entry necessary in the current UI-3s. Workloads MPUs Staff Years Worked Earned and Experienced Leave rates notoptional experienced leave rate of SAVE are all automatically entered. In addition the electronic version has a Comments section to explain entries in the Other Staff Years or Other lines but does not have a block forcertification by a State official. States are also urged to use the comment section for explanations of other lines. The Comments section is heavily relied upon during the review of the report. NOTE Throughout The UI-3 reports listed as Sections A B C D and E in these instructions States should enter zero 0 in any cell that must be manually entered but has no data no activity for the particular quarter being reported on.Minutes Per Unit. Minutes per unit MPUs based on the most recent cost model studies approved by the National Office foreach of the four broadband activities in Lines 1 through 4 in Sections B C and E and Lines 7 through 10 in Section B areallocated in the annual base budget and will be used in the contingency funding process. These budgeted MPU values varyfor each State from year to year however static MPU values have been established for the following functions IB Agent Weeks Claimed Line 5 and 6 Section B See page 9 IB Agent Appeals Line 11 Section B 20.0 Interstate Referrals Line 12 Section B 15.0 Redetermination Line 14 Section B and Line 5 Sections C and E promulgated in the yearly field memorandum for the allocations SAVE Line 1 Section D 6.5 Position Computation. Generally staff years earned are computed using a workload and minutes per unit formula whichdetermines the number of hours needed to process a given workload and dividing that number by the hours available in theperiod to be budgeted. This computation yields the number of staff required in the budget period to accomplish the workload. For a calendar quarter the formulae are expressed as follows Workload x MPU 60 x Quarter Hours Paid Staff Years Worked Earned. Staff Years Worked Earned x Experienced Leave Factor Staff Years Paid Earned. Experienced Leave Factor. The experienced leave factor is calculated by dividing the quarterly staff years paid used bythe quarterly staff years worked used for that program activity. Regular UI and Trade contingency have differentexperienced leave factors. See the explanation below for the method of calculating the SAVE experienced leave factor. Page 4 INSTRUCTIONS FOR THE UI-3 continued Personal Services Personnel Benefits PS PB Rate. Attachment II to the field memorandum for the yearly allocationscontains the approved annual Regular UI contingency PS PB rates. These are expressed as annual rates and must be convertedto a quarterly equivalent for use on the UI-3. A staff hour conversion factor should be used by determining the number ofstaff hours in the quarter as a ratio of staff hours in the year and applying this ratio to the annual rate. For the Tradeprogram States may use the average experienced personal services rate of staff working in Trade claims activities. Tradepersonnel benefits will be funded at the same rate as the Regular contingency program. States which have set up a SAVEproject code to capture staff years used may use the average experienced personal services rate of staff working in SAVEclaims activities and the Regular contingency personnel benefits rates. All other States should use the same rate as theRegular contingency program. Support. The support percentage may vary from one year to another and from one program to another. Therefore the totalsupport percentage will be promulgated in the field memorandum for the yearly allocations. Section A. Program Staff Year Usage Lines 1-7 Columns a through c Complete this section for current quarter and fiscal year-to-date. This section lists the UI categories to bereported. For each of Lines 1-7 in Section A enter quarterly staff years worked in Column a quarterly staffyears paid in Column b and year-to-date staff years paid in Column c . These lines should reflect total staffyears. No adjustment should be made for staff years financed with prior year carry-forward funds. Line 1 - Enter staff years for claims activities including initial claims weeks claimed eligibility reviews nonmonetary determinations appeals and multi-claimant services. Line 2 - Enter staff years for employer activities including wage records tax and tax travel. Line 3 - Enter staff years for UI Performs activities less AS T. Line 4 -Enter staff years for support activities for the UI and Trade programs including benefits and appeals travel benefit payment control UI support internal security interstate automation grants staff and administrativestaff and technical services AS T including QC and Trade AS T. Note The current CAS reports which SESAs mayuse to crosswalk CAS data to the UI-3 do not show AS T staff years worked in these programs. The SESA shouldestimate the AS T staff years worked by analyzing the percentage of AS T staff years paid charged to these programs. Line 5 - Enter staff years for claims activities under the Trade Adjustment Assistance TAA provisions of the Trade Act of 1974 as amended and the North American Free Trade Agreement NAFTA bridge program. Line 6 -Enter staff years for special funded activities not included in the above lines e.g. SAVE and for activitiesfunded with national activities funds excluding cooperative agreements . Line 7 -The sum of the staff years in Lines 1 through 6 for each column will automatically be entered here. Section B. Regular Contingency Entitlement Certification Lines 1-11 Column a Total workload in Section B will include data from the Regular UI Extended Benefit EB and Short-TimeCompensation STC programs and if enacted third tier programs e.g. FSB FSC and EUC . The following tableshows the source of data for total workloads Line 1 -Data will automatically be entered from the ETA 5159 Regular EB and STC report the sum of lines 101 102 and103 for columns 2 3 5 and 7 of the Regular and EB reports and the sum of columns 2 and 3 for line 101 of theSTC report. Line 2 -Data will automatically be entered from the ETA 5159 Third Tier report the sum of lines 101 102 and 103 forcolumns 2 3 5 and 7. Line 3 -Data will automatically be entered from the ETA 5159 Regular EB and STC reports the sum of lines 201 202 and203 for columns 9 and 12 of the Regular and EB reports and the workload in line 201 column 9 of the STC report. Page 5 Page 6 INSTRUCTIONS FOR THE UI-3 continued Line 4 -Data will automatically be entered from the ETA 5159 Third Tier report the sum of lines 201 202 and 203 forcolumns 9 and 12. Line 5 -Data will automatically be entered from the ETA 5159 Regular and EB reports the sum of lines 201 202 and 203for column 11. Line 6 -Data will automatically be entered from the ETA 5159 Third Tier report the sum of lines 201 202 and 203 forcolumn 11. Line 7 -Data will automatically be entered from the ETA 207 Regular and EB reports the sum of lines 101 103 and 105 forcolumn 1. Line 8 -Data will automatically be entered from the ETA 207 Third Tier report the sum of lines 101 103 and 105 forcolumn 1. Line 9 - Data will automatically be entered from the ETA 5130 Regular and EB reports the sum of columns 1 through 6 in line 100. Line 10 - Data will automatically be entered from the ETA 5130 Third Tier report the sum of columns 1 through 6 in line 100. Line 11 - States should enter IB Agent Appeals the sum of IB-101s sent to liable States.Line 12 - Data will automatically be entered from the ETA 5159 Regular and EB column 4 less column 5 in line 101. Line 13 - States should enter the number of multi-claimant appeals not appellants . Line 13 is automatically subtracted from line 9 before Staff Years Worked Earned are calculated on line 9. Line 14 - States should enter the number of monetary redeterminations. Reserved for future use. OMB Approval Numbers ETA 5159 1205-0010 expires 11 30 96 ETA 207 1205-0150 expires 8 31 97 ETA 5130 1205-0172 expires 8 31 95 Lines 1-12 Column b The appropriate MPU values will be entered automatically. Leave Line 13 Column b blank. Line 14 Column b A 50 MPU value will automatically be entered in column b . If another MPU value is necessary the defaulted MPUvalue can be overwritten. Lines 1-12 Column c Staff Years Worked Earned will be calculated by the system using the formula in the General Instructions. Line 13 Column c States should enter the number of Staff Years Worked Used for processing multi-claimant activities such as labordispute determinations for individual claimants or retroactive payments resulting from an appeal decision. Thetotal quarter-to-date multi-claimant staff years used extracted from the cost distribution report should beentered in column c line 13 Section B. Note the computer software automatically subtracts the workloadcount in column a line 13 from the workload count column a in line 9 before Staff Years Worked Earned arecomputed in column c line 9. Line 14 Column c Staff Years Worked Earned will be calculated by the system using the formula in the General Instructions. Reserved for future use. Line 15 - Reserved for future use. Page 7 Line 16 - The Total Staff Years Worked Earned will automatically be calculated from Lines 1 through 15 column c . Page 8 INSTRUCTIONS FOR THE UI-3 continued Line 17-Entitlement Staff Years Worked will automatically be calculated by subtracting Base Staff Years Worked for thegiven quarter from Staff Years Worked Earned Line 16 . Base Staff Years Worked will automatically becalculated and entered in the parentheses on line 17. Base Staff Years Worked will be calculated by dividingthe Hours per Staff Years Paid by the Hours per Staff Year Worked for the appropriate quarter from the UI-1 todetermine the budgeted leave factor the number of Claims Activity Staff Years Paid will be divided by thebudgeted leave factor for that quarter. States which have noted the breakout of quarterly hours in the remarkssection of their SF 424-A See instructions in the yearly field memorandum FM providing Resource PlanningTargets and Guidelines and the FM used to promulgate the Resource Allocations may override the defaulted BaseStaff Years Worked entered by the system with their own calculated Base Staff Years Worked. Line 18-Entitlement Staff Years Paid will automatically be calculated by the system by multiplying the experienced leavefactor by the data in Line 17 Column . The experienced leave factor will automatically be calculated bydividing the quarterly staff years paid by the staff years worked for claims activities as reported in Line 1 Section A. The experienced leave factor will automatically be entered in the parentheses on Line 18. If part-time or temporary staff do not earn leave the staff year entitlement in Line 18 will be equal to the entitlementin Line 17. Line 19-States should enter the Regular UI Contingency quarterly PS PB rate which will automatically be multiplied by thedata in Line 18. Line 20-States should enter the Regular UI Contingency Support percentage which will automatically be multiplied by thedata in Line 19. Line 21-States should enter other costs relating to special cases. Note these in the comments section. Line 22-Total dollar costs the sum of Lines 19 20 and 21 will automatically be calculated and input on line 22. Line 23-States should enter the amount of the advance received at the beginning of the quarter for quarterly above-baseclaims operations. Line 24-The net dollar entitlement line 23 will automatically be calculated by subtracting the data in line 23 from thedata in line 22 and entered here. Section C. Trade Contingency Entitlement Certification Lines 1-5 Column a - States should enter total workload data which will include data from the Regular and NAFTA Trade programs. Its source is State data. Column b - Trade broadband MPU values which will automatically be entered are identical to the Regularbroadband MPUvalues except for Trade weeks claimed which excludes the weighted MPU value for the Eligibility Review Program ERP from the Regular weeks claimed MPU value. The Trade Redetermination MPU value which should be manuallyentered is promulgated in the yearly field memorandum for the allocations. Column c - Staff Years Worked Earned will automatically be calculated by the system using the formula in the GeneralInstructions. Line 6-States should enter other staff years such as Trade Benefit Travel staff years worked used. Line 7-The sum of Lines 1 through 6 Column c will automatically be calculated and entered here. Line 8-The System will use the same formula to calculate Staff Years Paid as for Section B but will calculate the experienced leave factor by using Section A Line 5. If necessary this defaulted value can be overwritten. Line 9-States should enter the combined Trade PS and Contingency PB rate. The system will multiply this rate by the datain Line 8. Line 10-States should enter the Trade Contingency Support percentage. The system will use this data and multiply it bythe entry in Line 9. Page 9 INSTRUCTIONS FOR THE UI-3 continued Line 11-States should enter other costs relating to Trade Administration - such as precertification activities andnewspaper notices - in Line 11. Precertification activities are funded at a rate of up to 750 for each petitionfiled within the fiscal year. Notices in local newspapersfor special worker notifications are fully reimbursed. States should specify all such costs in the Comments section. Line 12-The system will automatically enter the sum of Lines 9 10 and 11 here. Section D. SAVE Entitlement Certification Line 1 Column a - States should enter the number of verifications made during the quarter. The source of this data is line 1of the Alien Claims Activity Report Form ETA 9016 OMB Approval Number 1205-0268 expiring November 30 1995 .Column b - The SAVE MPU value will automatically be entered. Column c - Staff Years Worked Earned will automatically be calculated using the formula in the General Instructions.Line 2- Reserved for future use. Line 3 -The sum of Lines 1 and 2 Column c will automatically be calculated. Line 4 -The experienced leave factor will automatically be entered in the parentheses on line 4. The system willautomatically multiply the experienced leave factor by the data in Line 3 to calculate Staff Years Paid. Stateswhich have set up a SAVE project code to capture staff years used may use the average experienced leave rate ofstaff working in SAVE claims activities. If this is done States may override the defaulted experience leavefactor automatically calculated and entered by the system and manually enter their calculated experience leavefactor. All other States should use the defaulted experience leave factor which is the same as for Section B.Line 5 -The PS PB quarterly rate will automatically be entered in the parentheses on line 5 and multiplied by the data inLine 4. States which have set up a SAVE project code to capture staff years used may use the PS PB rate of staffworking in SAVE claims activities. States may replace the defaulted rate with the manually calculated rate. Allother States should use the same formula as for Section B. Line 6 -States should enter the SAVE Support percentage in the parentheses on line 6. The system will automatically multiply it by the entry in Line 5. Line 7 -States should enter other costs relating to the SAVE program - such as computer access charges and equipment andphone leasing charges. The General Services Administration bills States which use the Immigration andNaturalization Service s INS computer data base to verify claimants immigration status. In addition someStates must lease phone lines and equipment in order to use the INS data base. These costs are fully reimbursed however States which are approved to use the ICON previously called the UI INTERNET system to obtain access tothe INS data base may not claim leased line and equipment costs. States should specify all such costs in the Comments section. Line 8 -The sum of Lines 5 6 and 7 will automatically be entered here. Section E. Additional Benefits AB Contingency Entitlement Certification NOTE Reporting of AB data is not required for statistical purposes but is necessary in order to calculate the properentitlement. Lines 1-5 Column a - States should enter the Total workload which will include data from the AB program. Its source is Statedata. Column b - AB broadband MPU values which will automatically be entered are identical to the Regular broadband MPUvalues. The AB Redetermination MPU value which should be manually entered is promulgated in the yearly fieldmemorandum for the allocations. Column c - Staff Years Worked Earned will automatically be calculated by the system using the formula in the GeneralInstructions. Page 10 Page 11 INSTRUCTIONS FOR THE UI-3 continued Line 6 - Reserved for future use. Line 7 -The sum of Lines 1 through 6 Column c will automatically be calculated and entered here. Line 8 -States should enter Staff Years Paid. States should use the same leave formula as for Section B. Line 9 -States should enter the Regular UI Contingency quarterly PS PB rate in the parentheses on line 9. The system willmultiply this rate by the data in Line 8. Line 10 - States should enter the Regular UI Contingency Support percentage in the parentheses on line 10. The system will use this data and multiply it by the entry in Line 9. Line 11 - Reserved for future use. Line 12 - The system will automatically enter the sum of Lines 9 10 and 11 here. ETA 2208A Page 12 INTERSTATE AGENT WEEKS CLAIMED MPU STATEMPUREGION IConnecticut6.47 Maine6.57 Massachusetts6.54 New Hampshire7.19 Rhode Island6.57 Vermont5.38 REGION IINew Jersey4.47 New York6.40 Puerto Rico6.48 Virgin Islands7.26 REGION IIIDelaware5.16 District of Columbia5.96 Maryland6.85 Pennsylvania6.89 Virginia7.12 West Virginia5.33 REGION IVAlabama6.54 Florida6.40 Georgia5.77 Kentucky6.26 Mississippi6.80 North Carolina4.42 South Carolina3.89 Tennessee6.63 REGION VIllinois6.82 Indiana6.71Michigan6.48 Minnesota6.51 Page 13 STATEMPUOhio6.59 Wisconsin6.63 REGION VIArkansas6.85 Louisiana6.80 New Mexico7.42 Oklahoma6.54 Texas6.51 REGION VIIIowa3.44 Kansas6.94 Missouri7.05 Nebraska8.06 REGION VIIIColorado6.00 Montana7.16 North Dakota7.69 South Dakota7.26 Utah7.80 Wyoming7.63 REGION IXArizona6.74 California6.44 Hawaii7.14 Nevada7.23 REGION XAlaska6.96 Idaho5.15 Oregon6.52 Washington6.65 Page 14 Page 15 FINANCIAL STATUS REPORT Long Form Please type or print legibly. The following general instructions explain how to use the form itself. You may need additional information to complete certain items correctly or to decide whether a specific item is applicable to this award. Usually such information will be found in the Federal agency s grant regulations or in the terms and conditions of the award e.g. how to calculate the Federal share the permissible uses of program income the value of in-kind contributions etc. . You may also contact the Federal agency directly. Item Entry Item Entry 1 2 and 3. Self-explanatory. 4. Enter the employer identification number assigned by the U.S. Internal Revenue Service. 5. Space reserved for an account number or other identifying number assigned by the recipient. 6. Check yes only if this is the last report for the period shown in item 8. 7. Self-explanatory. 8. Unless you have received other instructions from the awarding agency enter the beginning and ending dates of the current funding period. If this is a multi-year program the Federal agency might require cumulative reporting through consecutive funding periods. In that case enter the beginning and ending dates of the grant period and in the rest of these instructions substitute the term grant period for funding period. 9. Self-explanatory. 10. The purpose of columns I II and III is to show the effect of this reporting period s transactions on cumulative financial status. The amounts entered in column I will normally be the same as those in column III of the previous report in the same funding period. If this is the first or only report of the funding period leave columns I and II blank. If you need to adjust amounts entered on previous reports footnote the column I entry on this report and attach an explanation. 10a. Enter total gross program outlays. Include disbursements of cash realized as program income if that income will also be shown on lines 10c or 10g. Do not include program income that will be shown on lines 10r or 10s. For reports prepared on a cash basis outlays are the sum of actual cash disbursements for direct costs for goods and services the amount of indirect expense charged the value of in-kind contributions applied and the amount of cash advances payments made to subrecipients.For reports prepared on an accrual basis outlays are the sum of actual cash disbursements for direct charges for goods and services the amount of indirect expense incurred the value of in-kind contributions applied and the net increase or decrease in the amounts owed by the recipient for goods and other property received for services performed by employees contractors subgrantees and other payees and other amounts becoming owed under programs for which no current services or performances are required such as annuities insurance claims and other benefit payments. l0b. Enter any receipts related to outlays reported on the form that are being treated as a reduction of expenditure rather than income and were not already netted out of the amount shown as outlays on line 10a. 10c. Enter the amount of program income that was used in accordance with the deduction alternative. Note Program income used in accordance with other alternatives is entered on lines q r and s. Recipients reporting on a cash basis should enter the amount of cash income received on an accrual basis enter the program income earned. Program income may or may not have been included in an application budget and or a budget on the award document. If actual income is from a different source or is significantly different in amount attach an explanation or use the remarks section. 10d e f g h i and j. Self-explanatory. 10k. Enter the total amount of unliquidated obligations including unliquidated obligations to subgrantees and contractors. Unliquidated obligations on a cash basis are obligations incurred but not yet paid. On an accrual basis they are obligations incurred but for which an outlay has not yet been recorded. Do not include any amounts on line 10k that have been included on lines 10a and 10j. On the final report line 10k must be zero. FINANCIAL STATUS REPORT Page 16 Long Form 10l. Self-explanatory. 10m. On the final report line 10m must also be zero. 10n o p q r s and t. Self-explanatory. 11a. Self-explanatory. 11b. Enter the indirect cost rate in effect during the reporting period. 11c. Enter the amount of the base against which the rate was applied.11d. Enter the total amount of indirect costs charged during the report period. 11e. Enter the Federal share of the amount in 11d. Note If more than one rate was in effect during the period shown in item 8 attach a schedule showing the bases against which the different rates were applied the respective rates the calendar periods they were in effect amounts of indirect expense charged to the project and the Federal share of indirect expense charged to the project to date. PU.S.Governrnent Printing Office 1991--312-071 40223 SF 269 Rev. 4-88 Black Page 17 Page 18 Page 19INSTRUCTIONS FOR SF 270 Please type or print legibly. Items 1 3 5 9 10 11c l1e 11f 11g 11i 12 and 13 are self-explanatory specific instructions for other items are as follows Item Entry Item Entry 2. Indicate whether request is prepared on cash or accrued expenditure basis. All requests for advances shall be prepared on a cash basis. 4. Enter the Federal grant number or other identifying number assigned by the Federal sponsoring agency. If the advance or reimbursement is for more than one grant or other agreement insert N A then show the aggregate amounts. On a separate sheet list each grant or agreement number and the Federal share of outlays made against the grant or agreement. 6. Enter the employer identification number assigned by the U.S. Internal Revenue Service or the FICE institution code if requested by the Federal agency. 7. This space is reserved for an account number or other identifying number that may be assigned by the recipient. 8. Enter the month day and year for the beginning and ending of the period covered in this request. If the request is for an advance or for both an advance and reimbursement show the period that the advance will cover. If the request is for reimbursement show the period for which the reimbursement is requested. Note The Federal sponsoring agencies have the option of requiring recipients to complete items 11 or 12 but not both. Item 12 should be used when only a minimum amount of information is needed to make an advance and outlay information contained in item 11 can be obtained in a timely manner from other reports. 11. The purpose of the vertical columns a b and c is to provide space for separate cost breakdowns when a project has been planned and budgeted by program function or activity. If additional columns are needed use as many additional forms as needed and indicate page number in space provided in upper right however the summary totals of all programs functions or activities should be shown in the total column on the first page.11a. Enter in as of date the month day and year of theending of the accounting period to which this amount applies.Enter program outlays to date net of refunds rebates anddiscounts in the appropriate columns. For requests preparedon a cash basis outlays are the sum of actual cashdisbursements for goods and services the amount of indirectexpenses charged the value of in-kind contributions applied and the amount of cash advances and payments made tosubcontractors and subrecipients. For requests prepared onan accrued expenditure basis outlays are the sum of theactual cash disbursements the amount of indirect expensesincurred. and the net increase or decrease in the amountsowed by the recipient for goods and other property received and for services performed by employees contracts subgrantees and other payees. 11b. Enter the cumulative cash income received to date if requests are prepared on a cash basis. For requests prepared on an accrued expenditure basis enter the cumulative income earned to date. Under either basis enter only the amount applicable to program income that was required to be used for the project or program by the terms of the grant or other agreement.11d. Only when making requests for advance payments enterthe total estimated amount of cash outlays that will be madeduring the period covered by the advance.13 Complete the certification before submitting this request. STANDARD FORM 270 back REV 2-92 Page 20 Page 21INSTRUCTIONS STANDARD FORM 272 BACK Rev 2-92 Public reporting burden for this collection of Information Is estimated to average 120 minutes per response including time for reviewing instructions searching existingdata sources gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding the burden estimate orany other aspect of this collection of information including suggestions for reducing this burden to the Office of Management and Budget Paperwork Reduction Project 0348-0000 Washington DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE Of MANAGEMENT AND BUDGET SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. Please type or print legibly. Items 1 2 8 9 10 11d 11e 11h and 15 are self explanatory specific instructions for other items are as follows Item Entry Item Entry 3. Enter employer identification number assigned by the U.S. Internal Revenue Service or the FICE institution code. If this report covers more than one grant or other agreement leave Items 4 and 5 blank and provide the information on Standard Form 272-A Report of Federal Cash Transactions--Continued otherwise 4. Enter Federal grant number agreement number or other identifying numbers if requested by sponsoring agency. 5. This space reserved for an account number or other Identifying number that may be assigned by the recipient. 6. Enter the letter of credit number that applies to this report. If all advances were made by treasury check enter NA for not applicable and leave items 7 and 8 blank. 7. Enter the voucher number of the last letter-of-credit payment voucher Form TUS 5401 that was credited to your account. 11a. Enter the total amount of Federal cash on hand at the beginning of the reporting period including all of the Federal funds on deposit imprest funds and undeposited Treasury checks. 11b. Enter total amount of Federal funds received through payment vouchers Form TUS 5401 that were credited to your account during the reporting period. 11c. Enter the total amount of all Federal funds received during the reporting period through Treasury checks whether or not deposited. 11f. Enter the total Federal cash disbursements made during the reporting period including cash received from program income. Disbursements as used here also Include the amount of advances and payments less refunds to subgrantees or contractors the gross amount of direct salaries and wages including the employee s share of benefits if treated as a direct cost interdepartmental charges for supplies and services and the amount to which the recipient is entitled for indirect costs. 11g. Enter the Federal share of program income that was required to be used on the project or program by the terms of the grant or agreement.11i. Enter the amount of all adjustments pertaining to prior periods affecting the ending balance that have not been included in any lines above. Identify each grant or agreement for which adjustment was made and enter an explanation for each adjustment under Remarks. Use plain sheets of paper if additional space is required. 11j. Enter the total amount of Federal cash on hand at the end of the reporting period. This amount should include all funds on deposit imprest funds and undeposited funds line e less line h plus or minus line i . 12. Enter the estimated number of days until the cash on hand shown on line 11j will be expended. If more than three days cash requirements are on hand provide an explanation under Remarks as to why the draw down was made prematurely or other reasons for the excess cash. The requirement for the explanation does not apply to prescheduled or automatic advances. 13a. Enter the amount of interest earned on advances of Federal funds but not remitted to the Federal agency. If this includes any amount earned and not remitted to the Federal Sponsoring agency for over 60 days explain under Remarks. Do not report interest earned on advances to States. 13b. Enter amount of advance to secondary recipients included In item 11h. 14. In addition to providing explanations as required above give additional explanation deemed necessary by the recipient and for information required by the Federal sponsoring agency in compliance with governing legislation. Use plain sheets of paper if additional space Is required . Page 22