Standard Form 425: Federal Financial Report

1 Federal Agency and Organizational Element to Which Report is Submitted: Enter the name of the Federal agency and organizational element identified in the award document or as instructed by the agency.

2 Federal Grant or Other Identifying Number Assigned by Federal Agency: For a single award, enter the grant number assigned to the award by the Federal agency. For multiple awards, report this information on the FFR Attachment. Do not complete this box if reporting on multiple awards.

3 Recipient Organization: Enter the name and complete address of the recipient organization including zip code.

4a UEI: Enter the recipient organization's Unique Entity Identifier (UEI) or Central Contract Registry UEI.

4b EIN: Enter the recipient organization's Employer Identification Number (EIN).

5 Recipient Account Number or Identifying Number: Enter the account number or any other identifying number assigned by the recipient to the award. This number is for the recipient's use only and is not required by the Federal agency.

6 Report Type: Mark appropriate box.

The submission of interim FFRs will be on a quarterly, semi-annual, or annual basis, as directed by the Federal agency. A final FFR shall be submitted at the completion of the award agreement.

7 Basis of Accounting (Cash/Accrual): Specify whether a cash or accrual basis was used for recording transactions related to the award(s) and for preparing this FFR.

Accrual basis of accounting refers to the accounting method in which expenses are recorded when incurred. For cash basis accounting, expenses are recorded when they are paid.

8 Project/Grant Period, From: Indicate the period established in the award document during which Federal sponsorship begins and ends. Do not complete this line if reporting on multiple awards.

Some agencies award multi-year grants for a project period that is funded in increments or budget periods (typically annual increments). Throughout the project period, agencies often require cumulative reporting for consecutive budget periods. Under these circumstances, enter the beginning and ending dates of the project period not the budget period.

Reporting Period End Date: Enter the ending date of the reporting period. For quarterly, semi-annual, and annual interim reports, use the reporting period end dates 3/31, 6/30, 9/30, or 12/31. For final FFRs, the reporting period end date shall be the end date of the project or grant period.

Transactions: Enter cumulative amounts from date of the inception of the award through the end date of the reporting period specified in line 9. Use Lines 10a through 10c, Lines 10d through 10o, or Lines 10a through 10o, as specified by the Federal agency, when reporting on single grants.

10a Cash Receipts: Enter the cumulative amount of actual cash received from the Federal agency as of the reporting period end date.

10b Cash Disbursements: Enter the cumulative amount of Federal fund disbursements (such as cash or checks) as of the reporting period end date.

Cash On Hand (Line 10a Minus Line 10b): Enter the amount of Line 10a minus Line 10b.

Federal Expenditures and Unobligated Balance: Do not complete this section if reporting on multiple awards.

10d Total Federal Funds Authorized: Enter the total Federal funds authorized as of the reporting period end date.

10e Federal Share of Expenditures: Enter the amount of Federal fund expenditures.

10f Federal Share of Unliquidated Obligations: 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 expenditure has not yet been recorded. Enter the Federal portion of unliquidated obligations. On the final report, this line should be zero unless the awarding agency has provided other instructions.

Total Federal Share (Sum of Lines 10e and 10f): Enter the sum of Lines 10e and 10f.

Unobligated Balance of Federal Funds (Line 10d Minus Line 10g): Enter the amount of Line 10d minus Line 10g.

Recipient Share: Do not complete this section if reporting on multiple awards.

10i Total Recipient Share Required: Enter the total required recipient share for reporting period specified in line 9.

10j Recipient Share of Expenditures: Enter the recipient share of actual cash disbursements or outlays (less any rebates, refunds, or other credits) including payments to subrecipients and contractors.

Remaining Recipient Share to be Provided (Line 10i Minus Line 10j): Enter the amount of Line 10i minus Line 10j. If recipient share in Line 10j is greater than the required match amount in Line 10i, enter zero.

Program Income: Do not complete this section if reporting on multiple awards.

10l Total Federal Program Income Earned: Enter the amount of Federal program income earned.

10m Program Income Expended in Accordance With the Deduction Alternative: Enter the amount of program income that was used to reduce the Federal share of the total project costs.

10n Program Income Expended in Accordance With the Addition Alternative: Enter the amount of program income that was added to funds committed to the total project costs and expended to further eligible project or program activities.

Unexpended Program Income (Line 10l Minus Line 10m or Line 10n): Enter the amount of Line 10l minus Line 10m or Line 10n.

11 Indirect Expense: Complete this information only if required by the awarding agency.

11a Type of Rate(s): State whether indirect cost rate(s) is Provisional, Predetermined, Final, or Fixed.

11b Rate: Enter the indirect cost rate(s) in effect during the reporting period. 11c Period From; Period To: Enter the beginning and ending effective dates for the rate(s).

Amount Charged: Enter the amount of indirect costs charged during the time period specified. (Multiply 11b. x 11d.)

12 Remarks (Remarks, Certification, and Agency Use Only): Enter any explanations or additional information required by the Federal sponsoring agency including excess cash as stated in line 10c.

Certification: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award.

13a Typed or Printed Name and Title of Authorized Certifying Official: Enter the name and title of the authorized certifying official.

Telephone: Enter the telephone number (including area code and extension) of the individual listed in Line 13a. E-mail Address: Enter the e-mail address of the individual listed in Line 13a.

13e Date Report Submitted (Month, Day, Year): Enter the date the FFR is submitted to the Federal agency using the month, day, year format.

Standard Form 425 is the Federal Financial Report. Use Line 12, Remarks, to provide any information deemed necessary to support or explain FFR data.

13b Signature of Authorized Certifying Official: The authorized certifying official must sign here.

1) Quarterly and semi-annual interim reports shall be submitted no later than 30 days after the end of each reporting period. Annual reports shall be submitted no later than 90 days after the end of each reporting period. Final reports shall be submitted no later than 90 days after the project or grant period end date.

Report Submissions 1) Recipients will be instructed by Federal agencies to submit the Federal Financial Report (FFR) to a single location, except when an automated payment management reporting system is utilized. In this case, a second submission location may be required by the agency.

I am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise.