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HIV/AIDS Programs: Caring for the Underserved

 

Ryan White HIV/AIDS Program Part A Manual

 

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III. Reporting Requirements
  2. Budget, Contracting, and Fiscal Reports
      Introduction
    A. Required Program and Contractor Budget/Fiscal Reports
    B. Purpose and History of Reports
      1. Final Program Budget
      2. Consolidated List of Contracts Report
      3. Contractor Budget Packages
      4. Financial Status Report
Introduction

Grantees are required as a Condition of Award to provide certain program budget and fiscal reports and detailed contractor/provider budget packages each year. Below is a description of these reports, their purpose, and reporting deadlines for each. The latter part of this chapter provides detailed instructions on how to prepare each individual report or report package, using the standard forms and reporting formats provided by HRSA.

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A. Required Program and Contractor Budget/Fiscal Reports

1. Part A: Final Part A Program Budget

This report is a revision of the planned Part A budget submitted by the grantee with the grant application, before Congress has appropriated funds for the Part A program that fiscal year. The actual grant amount awarded depends upon the appropriation level each year. Therefore, it is necessary for grantees to revise their planned budget to reflect the actual amount of funds awarded and the program priorities established for that fiscal year.

2. Part B: Consolidated List of Contracts (CLC)

The CLC identifies each Part A-funded contract provider, the contract amount, and the service/activity to be provided under that contract. This summary information helps HRSA monitor and track the use of grant funds for compliance with program and grants policies and requirements.

3. Part C: Contract/Provider Budget Package

Contract/provider budget packages include a Contract Review Certification and a categorical budget with a narrative justification for each contract and subcontract. In addition, the attached Summary of Other AIDS Funding Sources must be included for each contractor/provider (not each individual contract).

4. Part D: Financial Status Report (FSR)

The standard form (SF) 269 is used by grantees to report their actual expenditures for a budget period (after the end of the fiscal year).

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B. Purpose and History of Reports

HRSA monitors and tracks:

  • How grantees plan to use funds each fiscal year
  • How grantees contract to carry out those plans, and
  • Actual grant expenditures.

HRSA requirements for submitting Part A program and contractor budgets and expenditure reports are guided by grants policies established by the U.S. Department of Health and Human Services (HHS), Public Health Service (PHS), and Office of Management and Budget (OMB) Circulars.

Budget and contractor information is also used by HRSA to address:

  • Compliance with PHS grants policies and OMB requirements
  • Ryn White funding requirements and restrictions
  • Inquiries from the Congress, HHS, and OMB regarding Part A-funded grantees’ and providers’ use of program funds.
Budget, Contractor and Financial Report Deadlines
Report Due Date
Final Part A Planned Budget
(Final Budget on SF 424A)
45 days after Notice of Grant Award (NGA)
Consolidated List of Contractors (CLC) 180 days after NGA

Contractor/Provider Budget Packages

  • Contract Review Certification
  • Contractor/Subcontractor Budgets with justification
  • Summary of AIDS funding sources for each contractor
180 days after NGA
Final Financial Status Report
(FSR on SF 269)
90 days after the end of the fiscal year

To assist grantees in submitting these reports on time, the HRSA/HAB Grants Management Branch (GMB) includes copies of the standard forms and reporting formats with instructions when the Notice of Grant Award (NGA) and Conditions of Award (CoA) are mailed to grantees each fiscal year. Also included is a diskette containing the report formats developed specifically by HAB (e.g., the Consolidated List of Contractors [CLC]).

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1. Final Program Budget

A categorical Final Program Budget must be submitted for each Part A award. It must be based on priorities established by the planning body, reflect the amount of Part A funds awarded for that fiscal year (FY) only, and be prepared using applicable Cost Principles and HAB/DSS program policies.

There are two components in a Final Program Budget:

  • Standard Form (SF) 424-A. Budget Information—Non-construction Programs (attached at the end of this section). This form must be revised and resubmitted with the Final Part A Program Budget to reflect budget allocations based on the actual amount of funds awarded to the EMA/TGA with respect to the following five major program budget categories:
    • Grantee Administration
    • Grantee Clinical Quality Management, and
    • Services.
  • Narrative Justification. A categorical budget and narrative justification is required for:
    • Grantee Administration, and
    • Grantee Clinical Quality Management

Categorical budgets for services to be provided to clients are not required with the Final Program Budget, since in most EMAs/TGAs the contracting process will still be under way.

The budget narrative is the descriptive information used to explain and justify the amounts budgeted within each program budget category. It must include specific information about who, what, where, when, and why. All costs identified in Section B of SF 424-A of the budget must be described and justified, including those listed in the "other" category.

Instructions for Preparing SF 424-A and Narrative Justification

This information supplements instructions that accompany the SF 424-A: Budget Information—Non-construction Programs. It provides guidance on preparing the categorical budget and narrative justification for each program budget category, and guidance on the types of cost (called “Object Class Categories”) within each budget category.

1. SF 424-A.

This form has two sections, which must be completed for a one-year budget period.

  1. Section A is used to report summary budget information.

  2. Section B is used to provide a detailed breakdown of budget costs in "Object Class Categories" for each program budget category. Allowable costs and how those costs may be allocated by States and local governments receiving PHS grants is set forth in 45 CFR Part 92. Cost principles prescribed for grant recipients are contained in Office of Management and Budget (OMB) Circular A-87 for State and local governments.

  3. Because there are five major program budget categories, grantees will need to complete two pages of the SF 424-A. Page one should be used to report the amounts budgeted for Grantee Administration and Clinical Quality Management activities in the columns listed in Section B. Page two should be used to report in Section B the amounts budgeted for services that will be provided to clients and program budget totals in column 5.

2. Guidance on Program Budget Categories.

A budget and narrative must be included for funds allocated to Grantee Administration and Clinical Quality Management. Line 6.f., Contractual, will include the funds that are to be used for services for clients and also costs such as consultants or contractors secured for the purpose of conducting business for the program areas of Grantee Administration and Clinical Quality Management. For example, if any/all Object Class Categories for the Grantee Administration and Clinical Quality Management areas are performed by contractors, then those costs should appear on line 6.f. The categorical budget for these contracts will appear in the narrative justification.

Important: Grantees are reminded that the amount available in the aggregate for first-line entities to spend on administrative costs is subject to a 15 percent cap. This cap is calculated by subtracting the grantee's administrative costs (up to 10 percent) and the grantee's Clinical Quality Management costs (up to 5 percent or $3 million, whichever is less) from the total grant amount, and multiplying the difference by 15 percent.*

  1. Grantee Administrative Costs. These are funds to be used by the grantee for routine grant administration and monitoring activities. Such activities include development of the Part A application, receipt and disbursal of program funds, the development and establishment of reimbursement and accounting systems, preparation of routine programmatic and financial reports, and costs associated with assuring compliance with grant conditions and audit requirements.

    Grantee administrative costs may include activities associated with the grantee's contract award procedures, including the development of requests for proposals, contract proposal review activities, and negotiation and award of contracts, as well as the development and implementation of grievance procedures.

    In addition, grantee administrative funds may be used for post-award activities such as monitoring of contracts, written documentation of on-site visits, reporting on contracts, and funding reallocation activities.

    Grantee administrative costs should address expenses related to participation in the Statewide Coordinated Statement of Need (SCSN). Grantee administrative costs cannot exceed 10 percent of the grantee's award, as mandated by Ryan White legislation.

Grantee administrative costs may also include program support, which includes activities that are not service-oriented, administrative in nature, or grantee Clinical Quality Management activities, but which contribute to or help to improve service delivery. Such activities include capacity development, technical assistance, program or services evaluation (including outcomes evaluation), and assessment of service-delivery patterns. These activities must be established as priorities by the planning council and linked to the findings of a comprehensive needs assessment. Activities must meet all other criteria of priority setting in accordance with the Ryan White legislation.

Grantee adminstrative costs may also support the operation of the planning council may also be covered under grantee administrative costs. They must be identified as a priority by the planning council. Costs for each planning council support activity should be listed separately, with a budget justification for each activity. Planning council support includes the "reasonable and necessary" activities listed below.

  • Staff support (i.e., clerical and professional expenses required by the planning council for the performance of required planning council activities, including routine planning council administrative activities).

  • Costs incurred by planning council members as a result of their participation on the planning council and required planning council activities, in accordance with Chapter 7: Allowable and Unallowable Costs of the Public Health Service (PHS) Grants Policy Statement. The PHS Grants Policy Statement includes costs that occur as a result of participating in a planning council meeting/activity, such as transportation, meals, babysitting fees, and lost wages. Allowable costs are further described in the letter on reimbursable costs for members of consumer/provider boards from the HRSA/HAB Associate Administrator.*

  • Local travel specifically related to legislative mandates of the planning council. All travel costs must be fully justified in the budget narrative.

  • Out-of-town travel for planning council members to and from HRSA/HAB-sponsored technical assistance meetings. However, no international travel is allowed.

  • Activities associated with publicizing the planning council's activities and programs for HIV-infected/affected populations and subpopulations, and for efforts to substantively enhance community participation in planning council activities.

  • Administration of planning council grievance procedures for decisions related to funding, as required by the Ryan White legislation.

  • Needs assessment and other methods for obtaining input on community needs and priorities, such as public meetings, focus groups, and ad hoc panels for the purpose of assisting the planning council in setting service priorities, in accordance with the Ryan White legislation.

  • Development of a comprehensive plan for the organization and delivery of HIV-related services, in accordance with the Ryan White legislation.

  • Assessment of the efficiency of the administrative mechanism in rapidly allocating funds within the EMA/TGA, in accordance with the Ryan White legislation.

  • Participation in the development of the Statewide Coordinated Statement of Need (SCSN), in accordance with the Ryan White legislation.

  1. Clinical Quality Management Activities. The grantee may allocate a portion of Part A funds awarded to the EMA/TGA to support Clinical Quality Management programs that assist direct-service medical providers in assuring that funded services adhere to established HIV clinical practice standards and Public Health Services (PHS) Guidelines.

  • Clinical Quality Management programs must include strategies for improving HIV-related primary medical care (including health-related supportive services) and use available demographic, clinical, and health care utilization information to monitor HIV-related illnesses and trends in the local epidemic.

  • Grantees are allowed to allocate up to 5 percent of the total grant award or $3 million (whichever is less) for Clinical Quality Management activities.

  1. Service Costs. Service costs are the proposed expenditures for services to be provided to clients based upon the priorities established by the planning council. The total amount to be awarded for services through grants, contracts, and any memoranda of understanding or other agreements should be entered on line 6f of column 1 on page 2 of the SF 424-A. Further contract information is not needed with the Final Program Budget, but will be submitted later with the Consolidated List of Contractors and Contractor Budget Packages described in Parts B and C of this chapter.

3. Funding Restrictions

Part A funds are subject to certain requirements, restrictions, and limitations based on specific Ryan White provisions. This includes, for example, the requirement to use a proportion of Ryan White funds to provide services to women, infants, children and youth, and a prohibition on the use of funds to purchase land.

4. Object Class Categories (Section B, lines 6a through 6k)

Below are guidelines for budgeting costs associated with each Object Class for each program budget category on the SF 424-A, and for preparing the narrative justification.

  • Personnel. Enter the total amount of Part A funds budgeted for personnel costs for each budget category where applicable. In the accompanying narrative justification for each position within each budget category, provide:

    • Job title

    • Last name of the employee

    • Brief description of the duties and responsibilities of the employee as they relate to the Part A-funded work

    • Annual salary

    • Percentage of time to be devoted to and paid for by the Part A grant, and

    • Amount to be charged to the grant.

If the position is vacant, state that and provide an estimated date when it will be filled. Do not assume that the job title (e.g., nurse, caseworker) adequately describes the job responsibilities, but do not submit job descriptions or qualifications for the position. Complete the same information as for positions that are filled.

  • Fringe Benefits. Provide the aggregate amount of fringe benefit across all positions within each budget category on line 6b of the SF 424-A. It is not necessary to provide the calculations for arriving at the amount of fringe benefit.

  • Travel. Provide the aggregate amount of travel costs within each budget category on line 6c of the SF 424-A. All travel must directly benefit and be specific to the work supported by this grant. In the accompanying narrative, list all travel relative to each budget category that is anticipated to occur during the budget/contract period. Be specific about who will travel, where, when, and why the travel is necessary.

    • Travel outside the EMA/TGA should be calculated using per diem rates, and allocated as follows for each individual traveling: air fare, ground transportation, lodging, per diem, and a total. Grantees should limit the use of Part A funds for travel to HRSA-sponsored technical assistance and other grantee meetings that may be identified in the Part A Application Guidance for that fiscal year.

    • Grantees should budget for expenses related to the support of persons living with HIV/AIDS (PLWHA), including travel to HRSA-sponsored technical assistance or grantee meetings as identified above.

    • All travel for contractors must be local and directly related to the services provided under the specific contract. Budgeting for international travel for the grantee, planning council, or contractor is not allowed.

  • Equipment. Provide the aggregate amount of equipment costs within each budget category on line 6d of the SF 424-A. In the accompanying narrative for each budget category, list only the equipment that is being purchased with grant funds. Be specific in describing what equipment is being purchased, who will use it, and why it is necessary to purchase it.  A purchase versus lease analysis should be done for large dollar items. Cost sharing must be applied if equipment will be used for other than Part A activities.
  • Supplies. Provide the aggregate amount of supply costs within each budget category on line 6e of the SF 424-A. In the accompanying narrative for each budget category, a general description must be provided for the types of items classified as supplies. Computer software should be included in this category.
  • Contractual. Enter the aggregate amount of contractual costs within each budget category on line 6f of the SF 424-A. This includes the total amount of funds to be used  for contracts across budget categories, including:

    Grantee Administration, Grantee Clinical Quality Management activities, Planning Council Support, Program Support budgets on page 1 of the SF 424-A (line 6f in columns 1, 2, 3, and 4, respectively), and

    Services for clients on page 2 of the SF 424-A (line 6f in column 1). 

  • The total amount budgeted for all contract arrangements under each budget category, on page 2 of the SF 424-A (line 6f in column 5).
  • Construction. Part A funds may not be used for construction by either grantees or contractors/subcontractors.
  • Other. Provide the aggregate amount of other costs within each budget category on line 6h of the SF 424-A. In the accompanying narrative for each budget category, be specific in describing each item listed in terms of what it is, who will benefit, and why it is necessary.  This category should include items such as rent, printing of brochures, telephone, postage, utilities, training, interpreter fees, insurance, and equipment maintenance (items that are not included in supplies or equipment and are not included in the base for the indirect cost rate). Grantees must provide a cost and descriptive justification of each item listed. The items of cost must be distributed between direct program costs and direct administrative costs.
  • Total Direct Charges. This is the sum of costs for each program budget category. For each category, enter the sum of lines 6a through 6h on line 6i of columns 1 through 4 on page 1, and columns 1 and 4 on page 2, of the SF 424-A.
  • Indirect Costs. Use line 6j to report total allowable indirect costs for each program budget category. For grantees, indirect costs are allowable only within the 5 percent restriction/cap for grantee administration. For contractors and subcontractors, indirect costs are allowable only (1) with a Federally-approved indirect cost rate in accordance with applicable Cost Principles; and (2) in accordance with legislative limitations of administration.
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2. Consolidated List of Contracts Report

Part A grantees must submit a Consolidated List of Contracts (CLC) using the format provided by HRSA each fiscal year as a Condition of Award. The diskette containing the CLC format in both Microsoft Excel and Word is sent to all grantees with their Notice of Grant Award and must be used to prepare and submit an electronic copy of the CLC. Insert additional lines in the Excel spreadsheet or Word document as needed. 

The CLC is submitted together with the budget packages for all contracts and subcontracts awarded by the grantee that year. This includes contracts awarded for Grantee Administration or Clinical Quality Management activities, as well as contracts/subcontracts for Services to be provided to clients.

The CLC must include the following information for each contractor/subcontractor.

  1. The full name of the contractor/subcontractor as it appears on the Contract Review Certification and as reported on the Ryan White Program Data Report.

  2. The full address of the contractor/subcontractor (no post office box numbers).

  3. The tax identification number (EIN number) of the contractor/subcontractor.

  4. Whether or not the contractor/subcontractor is a minority provider. For the purposes of the CLC, a minority provider is defined as having more than:

    1. 50 percent of positions on the executive board or governing body of the contractor filled by persons of a racial/ethnic minority, and

    2. 50 percent of key management, supervisory and administrative positions (e.g., executive director, program director, fiscal director) and more than 50 percent of key service provision positions (e.g., outreach worker, case manager, counselor, nurse, physician, social worker) filled by persons of a racial/ethnic minority.

  5. Whether or not the contractor/subcontractor received any Minority AIDS Initiative (MAI) funds.

  6. Whether or not the contractor/subcontractor is a faith-based organization.

  7. Whether or not clients are/will be served directly under this contract/subcontract.

  8. The name of the service to be provided under the contract/subcontract. Use the service categories provided in the Appendix. If the provider had four contracts for the provision of four services, the provider would be listed four times, once for each contracted service.

  9. The amount of Part A funds only awarded under the contract/subcontract.

  10. The overall total of ALL contractor/subcontractor budgets included on the CLC list.

Consolidated List of Part A Contracts/Subcontracts
(sample form)

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3. Contractor Budget Packages

Grantees must submit a budget package for each Part A contract/subcontract awarded by the grantee to provide a service to clients or to perform some other program activity-for example, activities related to Grantee Administration and Clinical Quality Management.

Complete budget packages must be received on time, as specified each year in the Condition of Award. However, "on-time" points will be awarded only for budget package submissions that obligate all funds. "Obligated" means all funds are accounted for by the receipt of the Grants Management Office in HAB by the due date of a:

  • Contract Review Certification (CRC) for each entity awarded a contract/subcontract

  • Budget narrative and justification for each service/activity to be provided by each contractor/subcontractor, and

  • Attachment E—Summary of Funding Sources for each entity awarded a contract/subcontract.

The grantee will incur cost at its own risk until this condition is satisfied and removed.

Extensions for late submissions will not be approved.

Contract Review Certification

The Contract Review Certification (CRC) serves as the cover page for each budget package.  Only one CRC is required for each entity receiving Part A funds that year (i.e., not for each individual contracted service/activity to be provided by that entity).

A sample format is included. A paper copy of the format along with a diskette containing a Microsoft Word electronic copy of the CRC is provided to grantees each year. Grantees must submit signed originals of the CRCs when they submit their budget packages. Below are instructions for completing the CRC.

  1. Line 1 in Section B1 of the CRC refers to the administrative requirements for the entity (grantee or administrative agent) who conducted the Request for Proposals (RFP) process to award the contracts/subcontracts, negotiated the budgets, and awarded the contracts. It requires the signature of the Grantee Program Director.

  2. Enter the name of the EMA/TGA on the first line, and the grantee agency's name on line 2. 

  3. Enter the name of the contractor on line 3; do not use acronyms. In the space below, indicate whether or not the contractor is a minority provider as defined by HRSA/HAB.

  4. Enter the total amount of Part A funds awarded for that fiscal year on line 4a and the amount of any Part A funds awarded under the Minority AIDS Initiative on line 4b.

  5. Use the spaces provided under line 5 to describe the purpose and scope of the contract (i.e., all services or activities to be provided).

  6. Indicate in the spaces next to line 6 whether these activities are services to be provided to clients, or activities being undertaken with respect to Grantee Administration or Clinical Quality Management.

  7. The Grantee Program Director must sign and date this portion of the CRC.

  8. Section B2 refers to the cost principles applicable for the type of organization receiving Part A funds to provide services. It requires the signature of the grantee's fiscal representative and date signed.

    1. Procedures used to advertise and award funds. To certify that the grantee met the minimum standards required by the Office of Management and Budget (OMB), the fiscal representative must select and check either Circular A-102 or Circular A-110, whichever applies to this contractor/subcontractor entity.

    2. Cost principles and standards. To certify that funds contracted for services/activities with this contractor/subcontractor were determined allowable according to OMB-established principles and standards, the fiscal representative must check the one Circular that applies in this case (i.e., A-122 Cost Principles for Non-Profit Organizations; A-87 Cost Principles for State, local and Indian Tribe governments; A-21 Cost Principles for Educational Institutions; or 48 CFR Part 31 Cost Principles for For-Profit Organizations).

    3. Accuracy of budget information. In signing the CRC, the fiscal agent attests that there are no math errors in the budget contract(s) awarded to this contractor/subcontractor.
       

  9. The CRC is to be signed by the grantee, NOT a contracted administrative agent; it must include the signatures of two different individuals in sections B1 and B2.

  10. The amounts on the CRC must agree with the budget(s) and the amounts entered in Attachment E-Summary of Funding Sources, column 1.

Contractor Budgets and Narrative Justification

  • Grantees must submit a categorical budget and narrative justification for each service/activity to be provided by a contractor/subcontractor. Budgets must be prepared using the applicable Cost Principles and HAB/DSS program policies.

  • All budget narratives must be consistent in format and level of detail, and must explain and justify the amounts budgeted.

  • Include the name of the contractor/subcontractor on the budget, as it appears on the CRC.

  • Keep budgets for subcontracts with the primary contract and CRC, making certain they are identified as subcontracts.

  • Indirect charges on contracts are allowable only with a Federally-approved indirect cost rate agreement.

  • Object Class Categories: Guidelines for budgeting costs associated with each Object Class within each contract/subcontract budget and the accompanying narrative justification are the same as those provided for the Part A Program Budget as described in this chapter (i.e., personnel, fringe benefits, travel, equipment, supplies, other, and contractual, which is used to report subcontracts and indirect costs).

  • Unit cost reimbursement contracts must report the total amount of the contract, the precise unit cost, and the proportion of the unit cost represented by each of the object classes (as noted above). The narrative justification must explain and define how the unit cost was established, and the rationale for the number of clients to be served.

  • Each contract/subcontract budget and narrative justification must be prepared using the guidance provided regarding the SF 424-A and Narrative Justification.

Attachment E – Summary of Funding Sources

Grantees must submit one Attachment E – Summary of Funding Sources for each contractor/subcontractor receiving Part A funds that year. This includes contractors/subcontractors providing a Grantee Administration or Clinical Quality Management.

Enter the name of the contractor as it appears on the CRC at the top of the Summary, and follow the instructions below to prepare each Summary.

  1. Enter the amount of funds awarded under this Part A award only in column 1 activity(ies) for each object class category. Refer to Object Class Categories, above, for guidance on each object class.

  2. Use column 2 to report other Part A funds from other sources (i.e., prior fiscal year(s) that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category).

  3. Use column 3 to report Ryan White Part B funds awarded to the contractor/provider that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category.

  4. Use column 4 to report Ryan White Part C funds awarded to the contractor/provider that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category.

  5. Use column 5 to report Ryan White Part D funds awarded to the contractor/provider that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category.

  6. Use column 6 to report funds awarded to the contractor/provider under the Housing Opportunities for People With AIDS (HOPWA) grant program that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category.

  7. Use column 7 to report city/county and/or State funds awarded to the contractor/provider that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category.

  8. Use column 8 to report General Operating funds from private sources awarded to the contractor/provider (e.g., a grant from a corporation, foundation, or United Way, that will be used to provide this year's Part A-funded service(s)/activity(ies) for each object class category).

  9. Total the amounts budgeted from various sources that will be used by the contractor/provider to provide this year's Part A-funded service(s)/activity(ies) in column 9, across each object class category.

  10. Total Costs: Add up the amounts budgeted for each object class in each column, and enter the resulting sums for each column on the bottom line.

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4. Financial Status Report

Part A grantees are required, as a Grants Management requirement and as noted as a Condition of Award, to submit an annual final Financial Status Report (FSR) using Standard Form (SF) 269. The form and instructions also may be downloaded as a PDF file from the Federal government's Program Support Center.

The annual final FSR submitted by grantees must report on grant expenditures during that completed one-year budget period. It may not include any unliquidated obligations. In addition, it must agree with grantee reports filed with the Payment Management System using the SF 272 Report of Disbursements.

The deadline for submitting the annual final FSR is usually 90 days after the end of the fiscal year. For the exact deadline each year, check the Conditions of Award attached to your Notice of Grant Award. An extension may be obtained provided the grantee submits a written request to the HAB Grants Management Officer before the deadline that explains briefly why an extension is needed. However, requests for extensions beyond six months after the end of the fiscal year will not be approved.

For instructions on how to prepare the annual final FSR using SF-269, see below.

Financial Status Report Instructions

Public reporting burden for this collection of information is estimated to average 30 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 YOUR COMPLETED FORM TO
THE HRSA GRANTS MANAGEMENT OFFICER.

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 Public Health Service 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). You may also contact HRSA directly.

  • Items 1, 2, and 3 are self-explanatory.
  • Item 4: Enter the Employer Identification Number (EIN) assigned by the Internal Revenue Service.
  • Item 5: Space reserved for an account number or other identifying number assigned by the recipient.
  • Item 6: Check "yes" only if this is the last report for the period shown in item 8.
  • Item 7: Self-explanatory.
  • Item 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."
  • Item 9: Self-explanatory.
  • Item 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.
  • Item 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 expenses charged, the value of in-kind contributions applied, and the amount of cash advances and payments made to sub-recipients. 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 expenses 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.

  • Item 10b: 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.
  • Item 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.
  • Items 10d, 10e, 10f, 10g, 10h, 10i, and 10j are self-explanatory.
  • Item 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.

  • Item 10l: Self-explanatory.
  • Item 10m: On the final report, line 10m must also be zero.
  • Items 10n, 10o, 10p, 10q, 10r, 10s, and 10t are self-explanatory.
  • Item 11a: Self-explanatory.
  • Item 11b: Enter the indirect cost rate in effect during the reporting period.
  • b: Enter the amount of the base against which the rate was applied.
  • Item 11d: Enter the total amount of indirect costs charged during the report period.
  • Item 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.
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