United States EPA 540-K-93-006
Environmental Protection Publication 9230.1-09D
Agency PB93-963355
April 1994
Office of Solid Waste and Emergency Response
&ERA Superfund Technical
Assistance Grant (TAG)
Handbook:
Managing Your Grant
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EPA CONTACTS
For more information about the Technical Assistance Grant
(TAG) Program, contact:
Regional TAG Coordinator:
Community Involvement Coordinator:
National TAG Coordinator
U.S. Environmental Protection Agency (5204G)
401 M Street, SW
Washington, DC 20460
(703) 603-8889
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CONTENTS
BASIC REQUIREMENTS 1
What to Do When You Receive Your Grant 1
Keeping Track of Your Administrative Costs 2
Keeping Track of Your TAG Funds 2
Obtaining Payment From EPA 5
Preparing Required Reports 7
Changing, Renewing, or Ending Your Grant 9
DOs AND DON'Ts 13
COMMONLY ASKED QUESTIONS 14
GRANT MANAGEMENT CHECKLIST 16
SAMPLE GRANT MANAGEMENT DOCUMENTS 17
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BASIC REQUIREMENTS FOR MANAGING
YOUR TAG
Managing a Superfund Technical Assistance Grant (TAG) is very similar
to managing household expenses. Just as a checkbook is balanced on a
regular basis, you will have to routinely record your expenditures as you
spend grant money. In general, you need to establish an accounting sys-
tem and keep appropriate records, submit payment forms to EPA to get
the money to pay your contractor(s), as well as other approved expenses,
and prepare reports about your progress. You should take the time to
review all of the requirements covered in
this booklet, even though the due date for
your first report may seem far away. By
knowing what is expected of your group,
you can keep necessary records up to date
and save time in the long run.
Because TAGs are subject to the same regu-
lations as federal grants awarded to non-
profit organizations and universities, there are some standard federal re-
porting requirements. It is important to remember that the requirements
described in this booklet are designed to ensure that your organization is
managing federal funds responsibly and to protect your organization
from the liabilities associated with possible management errors.
In the unlikely event that your group fails to comply with the terms of
the grant agreement—for example, by not completing agreed-upon tasks
or reporting requirements—EPA may take a range of actions, from with-
holding payments to terminating the grant. If an applicant or recipient
becomes involved in a dispute with an EPA official, EPA has standard
procedures for reviewing and resolving the conflict. Contact your Re-
gional TAG Coordinator for more information about these procedures.
(His/her title may vary—see your grant agreement for your contact's
name and title.)
WHAT TO DO WHEN YOU RECEIVE YOUR GRANT
When you receive your grant award, read through the package carefully.
The terms of the grant, including the following items (as well as the
work plan and budget in your approved application), are legally binding
once you accept the award:
• The dollar amount awarded.
• The project period shown on the first page.
• The approved budget.
1
You should
routinely record
your expenditures
as you spend grant
money.
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• The non-federal matching share.
• Any special conditions included.
The grant becomes effective once you
sign it (indicating acceptance of the grant
agreement) and return it to your Regional
EPA Office. Once you sign the agree-
ment, any significant changes to the
above items will require an amendment to the grant (see page 9).
KEEPING TRACK OF YOUR ADMINISTRATIVE COSTS
It is important to keep track of any grant funds or time devoted to grant-
related administrative tasks. Groups may spend no more than 20 per-
cent of the total grant budget on administrative costs. This is to ensure
that TAG funds are used primarily for the interpretation and communi-
cation of site-related technical data. Most groups use the donated time
spent performing administrative tasks as a significant part of their re-
quired matching contribution (see the booklet, Superfund Technical Assis-
tance Grant (TAG) Handbook: Applying for Your Grant, for examples of in-
kind contributions and tasks that a grant administrator might perform).
KEEPING TRACK OF YOUR TAG FUNDS
As a grant recipient, your group is responsible for monitoring the project
budget and documenting all financial transactions throughout your tech-
nical assistance project. This will involve setting up a financial manage-
ment system and opening a bank account for your TAG. In addition,
you will need to keep accurate, up-to-date records of both your expendi-
tures (in order to get reimbursed with grant funds to pay for purchases
and services) and in-kind contributions (in order to document the match-
ing share).
Setting Up a Management System
Your financial management system must, at a minimum, meet the fol-
lowing specific requirements:
• You must have a general ledger that includes an accurate, current,
and complete accounting of all financial transactions for the project.
You also must track all matching contributions, including in-kind
contributions. Your organization will need to keep all cancelled
checks, invoices, time sheets, work orders, receipts, and letters as
supporting documentation.
• You must keep control over all project funds, property, and other
assets, and be able to assure that you used these solely for autho-
rized purposes.
2
Significant changes to
the grant agreement
will require an
amendment to the
grant.
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• Your actual costs must conform to the amounts approved in the
grant budget in your approved application.
• You must conduct internal audits at least every other year and keep
the audit reports on file.
• If you receive TAG funding for multiple sites, you must set up a
separate budget for each site.
The TAG Project Manager, with the help of your group's Board of Direc-
tors, is responsible for setting up a management system and seeing that
it works properly. In the "Sample Grant
Management Documents" section of this
booklet, you will find a suggested layout
for your general ledger and one for track-
ing your matching contribution on a
monthly basis. For your convenience,
blank copies of these forms are included in
the pull-out "Blank Documents" section.
You might decide to arrange the ledger dif-
ferently to suit your group's needs;
however, you should keep the basic com-
ponents the same to ensure that you are
tracking the right information.
Your contractor is responsible for keeping
detailed records related to his/her activities as well. These records must
be broken down to reflect work progress, reports, expenditures, and
commitments and indicate their relationship to the Superfund site and ap-
proved costs and schedules.
Opening a Bank Account
You will need a bank account in the name of your group to manage
project funds. The payment checks from EPA will be made out to your
group and not to an individual. If you do not already have a bank
account, your group may want to inquire at several banks to see if any of
them waive or reduce the service charge for accounts established by non-
profit organizations.
While it is highly unlikely that groups will earn interest on grant funds,
any such interest earned must be reported and returned to EPA.
Keeping Good Records
EPA may perform interim and final audits of your grant. You will need
to establish and maintain a filing system that contains full written finan-
cial records accurately disclosing the amount and settlement of all expen-
ditures. Your filing system also should include all correspondence re-
lated to the grant, grant products and reports, and records of how you
3
Keep and file all:
• cancelled checks
• invoices
• time sheets
• work orders
• receipts
• letters
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selected your advisor (or other vendor). A comprehensive filing system
also will help you prepare required reports, such as quarterly progress
reports (see "Sample Documents" section, page 17).
Grant recipients should have the following documents available for audits:
• A copy of the grant application, agreements, and any amendments.
• Accounting books and records covering receipt and disbursement of
project funds, time and attendance records, travel, and other project-
related costs, such as equipment.
• Records of in-kind contributions.
• Grant bank account records and cancelled checks.
• Copies of progress reports and all reports specified by the grant
agreement.
• Copies of bills paid by project funds.
• Copies of procurement documents relating to the selection of the
contractor.
• Copies of contracts awarded for work under the grant.
You and your contractor(s) must keep your
records for at least ten years following the
submission of the final Financial Status Re-
port (see page 28). If litigation or an audit
begins before the end of the ten-year period,
all records must be kept for at least ten years
following project completion or until the
litigation or audit is completed and re-
solved. In the unlikely event that your
grant is terminated, all records must be kept
for at least ten years from the date of termi-
nation. Before disposing of your records at the end of the recordkeeping
period, you and your contractor(s) must notify EPA in writing. Keep
your records until EPA notifies you in writing that the records may be
destroyed. If you wish, you may use TAG funds to send your TAG
records to the EPA records retention center in your area for storage.
Contact your Regional TAG Coordinator for details.
You and your contractor(s) must allow any authorized representative of
EPA, the Office of Inspector General, or the Comptroller General of the
United States to inspect, copy, or audit records related to the project at
any reasonable time for as long as the records are kept. If EPA, as a re-
sult of an audit, determines that you owe funds to the federal govern-
ment, you will be required to reimburse EPA for that amount in a timely
manner.
4
Keep your
records for at
least ten years
following the
submission of
the final Financial
Status Report.
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Audits
Your group must conduct an internal audit of the accounts and records
pertaining to the TAG at least every other year. A qualified group mem-
ber (other than the bookkeeper or grant administrator) can do this. In
addition, your group must arrange for an independent audit in any year
in which it is reimbursed $25,000 or more from EPA. The specific poli-
cies and guidelines of such an audit are provided in OMB Circular A-
133, "Audits of Institutions of Higher Education and Other Nonprofit
Organizations" (your Regional TAG Coordinator can provide a copy).
The results of this audit must be provided to your Regional EPA Office.
The cost of such an audit is reimbursable with TAG funds, provided that
it appears in the approved budget and funds are available.
OBTAINING PAYMENT FROM EPA
Under the TAG Program, EPA will reimburse you for allowable costs up
to the amount of the federal share of the grant. The principal cost in-
curred under the grant will be paying for a contractor's services. Your
group will submit reimbursement requests to your EPA Regional Office.
Making Sure You Have Acceptable Costs
Since EPA can reimburse you only for eli-
gible and legally incurred, grant-related
costs, you need to make sure that your costs
meet applicable statutory provisions and
regulatory requirements. EPA uses the cost
principles in OMB Circular A-122 for non-
profit organizations to determine whether
costs are eligible. In general, the Circular
states that costs must be allowable, allocable,
and reasonable. These terms are defined in
the booklet, Superfund Technical Assistance
Grant (TAG) Handbook: Procurement—Using TAG Funds, under "Deter-
mining Acceptable Costs." Only those costs that were included in your
approved application and grant budget are eligible for payment.
Getting Paid
To be paid, you must submit quarterly a Request for Reimbursement
(EPA Form SF 270) to EPA (see page 18). If your costs are greater than
$500 in any month, you may submit a Request for Reimbursement form
to cover that month. Your EPA Regional Office may ask you to provide
a summary of costs or copies of bills with your reimbursement request.
Normally, EPA will pay you within 20 to 30 days of receipt and approval
of the costs incurred. EPA will pay only the group identified as the
payee on the grant agreement. The grant funds may not be reassigned to
any other group or individual without EPA's written approval.
5
Only those costs
that were included
in your approved
application and
grant budget are
eligible for
payment.
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You are responsible for ensuring that 20 percent of the total costs of
each reimbursement request meets the matching funds requirement of
the TAG Program. For example, if your matching share is 20 percent
and your contractor bills you for $1,000, your payment request to EPA
must show a total of $1,250 in expenses. The $1,250 includes your $250
match, which may be composed entirely of in-kind contributions. You
will receive $1,000 cash from EPA. You are thus contributing 20 percent
of the "total program outlay" shown on your reimbursement request.
In order to calculate the required matching contribution for a reimburse-
ment request, divide the amount of the invoices by a factor of 0.80 (repre-
senting the federal share of 80 percent) to compute the total project cost.
Then subtract the federal share from the total project cost to get the re-
cipient share, as in the following example:
(Invoices) $1,750.00 _ project costs) $2,188.00
(Federal share) 0.80 F '
Total project cost $2,188.00
less Federal share -1.750.00
Recipient share $438.00
If group members contribute more than the required matching percent-
age during any reimbursement period, submit vouchers for the required
percentage and save the remainder "for a rainy day." Remember, reim-
bursable expenses and group contributions to the matching requirement
begin only after the grant is awarded.
Your EPA Regional Office may allow you some flexibility in meeting
your "match" on your first reimbursement
request if you can show that you will be
able to make this up within a reasonable
period of time. You must keep documen-
tation for all costs and donations, includ-
ing in-kind contributions, in your files.
Paying Your Contractor
Because TAGs are reimbursement grants,
your contractor(s) must first bill you for
completed work before EPA can reim-
burse your group with the money neces-
sary to pay them. EPA recommends that, when possible, you wait to
pay your contractors until the reimbursement check has arrived, rather
than use other group funds to pay the contractor(s). This procedure will
save your group from spending its own money on unallowable contrac-
tor costs. The format of your contractor's billing package will vary, since
6
Reimbursable
expenses and group
contributions to the
matching requirement
begin only after the
grant is awarded.
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a contractor may be independent or an employee of a large engineering
firm. However, at a minimum, your contractor(s) should provide you
with a monthly billing package that includes:
• Invoices indicating the period that the invoice covers, number of
hours spent, a breakdown of the hourly rate, and a breakdown of
expenditures (such as travel costs) for that month.
• Copies of all receipts for expenditures.
• Monthly progress reports indicating the tasks accomplished, the
number of hours associated with each task, and problems encountered.
These billing packages will provide you with the information necessary
to complete your "Request for Reimbursement" forms at the end of each
fiscal quarter. All invoices and accompanying materials should be kept
in your files.
Billing packages are an important tool in managing your grant because
they let you know whether the project is adhering to planned budgets
and schedules. Maintain close communication with your contractor(s) to
ensure that your group is receiving the type of assistance it needs. Your
contractor's billing package should not contain any surprises about how
much was spent or what activities were conducted.
PREPARING REQUIRED REPORTS
TAG recipients are subject to several reporting requirements under EPA's
grant and procurement regulations. These reporting requirements are
discussed below. Step-by-step instructions for completing the required
reports are located in the "Sample Documents" section of this booklet.
Progress Reports
To keep EPA informed of grant activities,
you must submit a quarterly progress re-
port no later than 45 days after the end of
each calendar quarter. The progress reports
describe your progress achieved on the ap-
proved schedule and budget. Any special
problems encountered should be explained,
and you should list activities anticipated dur-
ing the next quarter. You may attach copies
of any final written documents produced by the technical advisor(s) or
your group, such as reports or newsletters.
Progress reports need not be any longer than one or two pages (see
sample on page 26). A narrative format has been used in the sample;
however, you could instead choose to develop a chart to present the
same information.
7
You need to
prepare progress
reports each
calendar quarter.
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Minority Business Enterprise Reports
EPA requires that you make positive efforts to find contractors working
for small (SBEs), minority-owned (MBEs), and women-owned businesses
(WBEs). (See the booklet Superfund Technical Assistance Grant (TAG)
Handbook: Procurement —Using TAG Funds for the definitions of SBEs,
MBEs, and WBEs, as well as specific steps EPA expects you to take.)
As a TAG recipient, you are required to submit to EPA a form entitled
"MBE/WBE Utilization Under Federal Grants, Cooperative Agreements,
and Other Federal Financial Assistance" (EPA Form SF 334), whether or
not you hire disadvantaged contractors. (See page 23 for a completed ex-
ample of this form.) The purpose of this form is to report the dollar
amount of any contracts awarded to MBE firms (you are not required to
report contracts with WBEs or SBEs).
This form must be submitted by October 30 of each year, and is required
for all written contracts, regardless of the contract amount.
Annual and Final Financial Status Reports
A Financial Status Report (EPA Form SF 269) must be submitted to
EPA every year, within 90 days of the anniversary of your grant award.
This report details your expenditures for the past year. You also must
submit a final Financial Status Report within 90 days of the end of the
project period or termination of your technical assistance project. By the
time you file your final Financial Status Report, you should have made
all payments to the contractor(s). See pages 28-31 for a sample com-
pleted Financial Status Report.
Final Project Report
In order to provide EPA with a complete summary of your group's ac-
tivities, you must submit a draft of the Final Project Report to your
EPA Regional Office for review, no later than 90 days prior to the end
of the approved project period (unless you have requested an extension
to the project period). The final version of your report must be submit-
ted within 90 days after the end of the project. This report should con-
tain a narrative description of project activities over the entire period of
the grant and describe your group's
achievements with respect to the project's
purposes and objectives. The various re-
ports that you submit to EPA will be a
good source of information when prepar-
ing your Final Project Report. (You will
find a sample table of contents for your Fi-
nal Project Report on page 33. You may
use another format if you prefer.)
The reports that you
submit to EPA will
be a good source of
information when
preparing your Final
Project Report.
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CHANGING, RENEWING, OR ENDING YOUR GRANT
The TAG Program is intended to provide grant funds to groups of
affected individuals for up to an initial three-year budget period. Be-
cause the cleanup of a hazardous waste site may take more than three
years, the total project period for the technical assistance may be com-
posed of several budget periods. This section discusses the steps neces-
sary to change your grant as well as to renew it, if necessary. It also cov-
ers how to terminate your grant if you should want to end it before its
scheduled completion date.
Changing Your Grant
You can change or "amend" such items as your project's objective or
funding only through a formal amendment to your grant. Formal
amendments must be negotiated with and signed by the EPA Award Of-
ficial and your group. Some examples of changes that require grant
amendments include:
• Extending the project period with no changes in tasks or dollar value.
• Hiring a contractor to perform tasks not originally included in the
grant agreement.
• Shifting the funding among tasks that have already been described
in the application.
Minor changes to your project can be made without a formal amendment.
Examples of changes that do not require grant amendments include:
• Choosing to produce a newsletter rather than fact sheets about the site.
• Changing the format of the group's interaction with the
contractor(s).
Because EPA is not obligated to provide additional funds for any costs in
excess of the approved budget, you should discuss minor and major
changes with your EPA Regional Office prior to implementation. If any
such changes affect existing contracts, the contracts must be amended to
reflect this.
Renewing Your Grant
TAG funds are set aside in "budget periods" of up to three years each.
(Those groups interested in budget periods of less than three years need
to discuss this with their Regional TAG Coordinator before filling out an
initial or continuation grant application.) There are two reasons why
you might want to apply for a grant continuation:
• If your technical assistance project extends beyond the first budget
period, you have funds remaining, and you wish to continue, you
must submit a continuation application for each additional budget
period.
9
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• If you want to request additional funding after you have spent a full
$50,000 in federal funds, you must submit a continuation application
and also apply for a waiver to obtain additional funds (see page 11).
EPA uses the standard grant application (Form SF 424) as the continua-
tion application. The intergovernmental review requirement explained
in the booklet, Superfund Technical Assistance Grant (TAG) Handbook: Ap-
plying For Your Grant, may not apply to a continuation application. EPA
requires two to four weeks to review a continuation application (in addi-
tion to the time required for intergovernmental review, if required).
The directions for filling out and submitting the grant continuation
application are the same as for the initial TAG application (see
Superfund Technical Assistance Grant (TAG) Handbook: The Application
Forms with Instructions) with the following exceptions:
• EPA Form SF 424, # 8: Enter "X" to indicate the application is a
continuation.
• EPA Form SF 424, # 20: Enter the EPA identification number and
title of the current grant.
• EPA Form SF 424, Section A (Budget Summary): Enter in columns
(c) and (d) the estimated amounts of funds that will remain unspent
at the end of the grant funding period only if the EPA Regional
Office instructs you to do so. Otherwise,
leave these columns blank. Enter in columns
(e) and (f) the amounts needed for the
upcoming budget period. The amount in
column (g) should be the sum of the amounts
in columns (e) and (f).
The continuation application must include:
• A detailed progress report for the
current budget period.
• An estimated Financial Status Report (EPA Form SF 269) for the
current budget period that includes the amount your group expects
to spend by the end of the current budget period and the amount of
any unspent funds that your group proposes to carry over into the
new budget period.
• A proposed end date for the new budget period.
• A budget for the new budget period.
• An updated Statement of Work revised to account for your group's
accomplishments during the previous budget period and to provide
more detail about projected activities during the upcoming budget
period.
10
The directions for
the continuation
application are
similar to (but sim-
pler than) the initial
grant application.
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This information, along with any other reports required by the grant
agreement, provides the basis for evaluating your group's progress and
approving funding for the next budget period. You should begin filling
out your continuation application well in advance of the date that the
initial budget period expires (approximately three months before).
Renewing Contracts for Services
If, after renewing your grant, your group's
needs for a TAG have remained the same (for
example, the technical advisor will be doing
work described in his/her original contract or
doing follow-up work on the same site as
before), and you wish to retain the same con-
tractor, then your group does not need to re-
peat the procurement requirements described
in the booklet, Superfund Technical Assistance Grant (TAG) Handbook: Pro-
curement—Using TAG Funds. Instead, you will need a contract amend-
ment, specifying the new time period and dollar amount involved.
If the updated Statement of Work included in your renewal application
describes areas of expertise that were not included in the original State-
ment of Work, your group must amend existing contracts, if they are af-
fected. If the current service providers do not have the skills you need,
then your group should follow the procurement guidelines described in
the booklet, Superfund Technical Assistance Grant (TAG) Handbook: Procure-
ment—Using TAG Funds, to select a technical advisor who can provide
these services.
Waiver of the $50,000 Limit
If, after you have received an initial grant, your group believes that it
will need funds over and above the $50,000 ceiling, you may apply for a
waiver from this limit. To be eligible to apply for a waiver, the site must
be listed as final on the National Priorities List
and not simply as proposed. Your Regional
EPA Office will consider your request for a
waiver and base its decision on factors such as
the complexity of the site or site-related issues
and how successfully your group has man-
aged the initial award.
Specifically, three or more of the following circumstances must be
present for EPA to approve a waiver:
• The Remedial Investigation (RI)/Feasibility Study (FS) costs over $2
million.
• The Record of Decision (ROD) calls for innovative technologies or
treatability studies.
11
Begin filling out
your continuation
application well in
advance of the
expiration of the
budget period.
You may apply
for a waiver
from the grant
limit.
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• EPA reopens the ROD.
• The site's health assessment results in an epidemiological study.
• After a TAG is awarded, EPA identifies additional operable units.
• After a TAG has been awarded, there is a change in a law or regula-
tion. that results in new site-related information.
• The cleanup lasts more than eight years from the start of the RI/FS.
• There is significant public concern (for example, many affected
people requiring many meetings and many copies of documents),
• Any other factor which, in the view of your EPA Regional Office,
indicates that the site is unusually complex.
If you think you need additional technical assistance, your Regional TAG
Coordinator can tell you how to submit a request for a waiver.
Deviation From the $100,000 Award Limit
If after receiving $50,000 in additional TAG funds, your group feels that
more funding is necessary to continue its effective participation in site-
related decisions, it may request a deviation from the $100,000 total per
site award limit. The criteria used for requests to waive the $50,000 limit
are used for $100,000 limit deviation requests as well. However, since
you are asking to deviate from the regulations governing the TAG Pro-
gram, the request must be approved first by EPA's Regional Office and
then by EPA's Headquarters Grants Division. Your Regional TAG Coor-
dinator can help you with this.
Terminating Your Grant Agreement
Usually, TAG projects end when the final budget period is completed or
the group's expenditures have reached the limits of available funding.
Your group and EPA also may terminate the grant agreement at any
time if both parties conclude that continuation of the project would not
produce any beneficial results. The administrative requirements in-
volved in the technical assistance project closeout process include the
completion of the following reports:
• Final Financial Status Report.
• Draft Final Project Report (due 90 days prior to the end of the
approved project period).
• Final Project Report (due 90 days after the end of the project period).
In addition, EPA can terminate the grant for cause, such as the group's
failure to comply with the terms of the grant agreement. There are ap-
peal and dispute resolution processes associated with this type of termi-
nation (see your Regional TAG Coordinator for more information).
Once all required reports are approved and all outstanding financial and
technical issues resolved, your group must store the files pertaining to
the TAG (see "Keeping Good Records" on page 3).
12
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DOs AND DON'Ts
FOR MANAGING YOUR TAG
DOs
DON'Ts
• Do call your Regional TAG
• Don't use grant money to
Coordinator if you have
support any type of
questions regarding
political activity (such as
allowable costs.
supporting a political
candidate or assisting in
voter registration).
• Do keep all receipts, cancelled
checks, invoices, timesheets,
work orders, and
• Don't wait until the last
correspondence.
moment to prepare
quarterly and annual
reports — mark due dates
• Do make copies of all letters,
on a calendar and set
reports, and reimbursement
realistic deadlines for
forms for your files before
preparing, reviewing, and
sending them to EPA.
finalizing each document.
• Do keep documents
explaining and supporting
your in-kind activities
(contributions of labor and
supplies) — your time and
contributions are valuable,
and count toward the non-
federal match percentage.
13
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COMMONLY ASKED QUESTIONS ABOUT
MANAGING A TAG
What Is A Grant Budget Period?
A grant budget period is the length of time (usually three years) specified
in your grant agreement during which you may spend federal funds. A
TAG project period may extend longer than three years and be com-
posed of several budget periods.
May We Hire Someone To Manage Our TAG For Us?
Yes. Remember, however, that there is a limit of 20 percent of the total
grant budget that can be devoted to administrative tasks. You also
should keep in mind that most groups use donated time performing ad-
ministrative tasks as in-kind contributions that make up a significant part
of their required matching contribution. If you use project funds to pay
someone to administer the grant, your group will need to figure out how
that requirement will be met in other ways.
Can Groups Purchase Property With Grant Funds?
Yes. However, groups are strongly discouraged from using limited TAG
monies for the purchase of property (such as office equipment). Because
the primary purpose of this grant program is to acquire the services of a
technical advisor, any request to use TAG funds for the purchase of
property will be scrutinized closely by your EPA Regional Office. In ad-
dition, you either must return such property to EPA when the TAG
project ends or you must reimburse EPA for the federal share of the
present value of the equipment. Written approval for these purchases
and for leasing of equipment must be obtained from EPA's Regional Of-
fice.
Lengthy reports and complicated accounting systems requiring a com-
puter are not necessary for the TAG Program. Almost all work, except a
newsletter, can be done by hand or on a typewriter. A small adding ma-
chine or calculator would be valuable. Rather than purchasing expensive
equipment, you should consider alternatives such as:
• Asking a group member to donate the use of necessary equipment or
supplies as an in-kind contribution.
• Selecting a contractor who has the appropriate equipment to conduct
the work (in general, technical assistance projects should not require
any special equipment other than standard office machines).
14
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• Leasing equipment on a short-term basis, as needed (if leased
equipment is used for work unrelated to the technical assistance
project, that percentage of the leasing costs would not be reimburs-
able under the grant agreement).
What Would Be Involved In An EPA Audit Of A TAG Project?
Should an audit occur, it would be undertaken to ensure that your fed-
eral funds are being used appropriately. By identifying errors early, an
audit could help limit potential liabilities for your group if there has been
a misunderstanding about how your TAG must be managed.
In general, an audit would include the following steps:
• The grant recipient is informed by letter and requested to prepare for
the audit.
• The auditors conduct an entrance conference with the grant recipient.
• The audit is conducted.
• The auditors prepare a draft audit report.
• The grant recipients prepare formal written comments on the draft
report.
• The auditors conduct an exit conference.
• The auditors prepare a final audit report.
• EPA resolves any questions or problems through its audit resolution
process.
15
-------
GRANT MANAGEMENT CHECKLIST
Ongoing Basis:
~ Establish and maintain a financial management system.
~ Set up and maintain a filing system for good recordkeeping.
~ Discuss project changes with your EPA Regional Office.
Quarterly:
~ Submit Request for Reimbursement, EPA Form SF 270.
~ Submit Progress Report.
Annually:
~ Submit Financial Status Report, EPA Form SF 269.
Q Submit MBE/WBE Utilization Under Federal Grants, EPA
Form SF 334, by October 30.
Three Months Prior to Project's End:
~ Submit draft of Final Project Report for review.
Q Request renewal of the grant agreement, if applicable.
At Project's End:
~ Submit final Financial Status Report, EPA Form SF 269,
within 90 days after the end of the project period or termina-
tion of your technical assistance project.
~ Submit Final Project Report within 90 days after the end of
the approved project period.
16
-------
SAMPLE GRANT MANAGEMENT DOCUMENTS
WITH STEP-BY-STEP INSTRUCTIONS FOR
COMPLETING THEM
This section contains the required forms and reports for managing your
grant, along with step-by-step instructions necessary to complete them.
These forms and reports include:
• Request for Reimbursement (Standard Form 270).
• MBE/WBE Utilization Form (Standard Form 334).
• Quarterly Progress Report.
• Financial Status Reports (Standard Form 269, Short version).
• Final Project Report.
In addition, six worksheets are included for your use that are not
required as submissions by EPA, but that will help you keep track of
finances, fill out required forms, and document your administrative
work. They should be kept in your general files. These include:
• Ledger Sheet for Recording Cash Transactions.
• Monthly Recording of a Group's Matching Share (two forms).
• Summary Monthly Recording of Matching Share.
• Time Sheet.
• Summary Request for Reimbursement for Federal Share.
To simplify your work, EPA has filled in those items on the required
grant forms that are the same for all TAG applicants. The instructions
offered are for those items that you need to complete. If you have ques-
tions as you complete these forms, contact your Regional TAG Coordina-
tor for assistance. Blank copies of these documents are provided in the
pull-out "Blank Documents" section.
17
-------
REQUEST FOR REIMBURSEMENT (FORM SF 270)
This form should be filed with the Regional Office on a quarterly basis,
or for any month in which your group incurs more than $500 in ex-
penses. You will find a blank form in the pull-out "Blank Documents"
section.
lb. Type of Payment Requested
Check "partial" for initial and interim payments. Check "final" only for the last
request made for the project.
3. Federal Sponsoring Agency
Enter the Name of the EPA Regional Office designated in the assistance agreement.
4. Federal Grant Number
Enter your federal grant number, assigned by EPA.
5. Payment Request Number
Enter the number (in sequence) of this request.
6. Employer Identification Number
Enter your Employer Identification Number (also found on the application form
SF 424, #6).
8. Period Covered by this Request
Enter the month, day, and year for the period that this reimbursement copers.
9. Recipient Organization
Enter the name and address of your group as authorized in your grant agreement.
(continued on page 20)
18
-------
REQUEST FOR ADVANCE
OR REIMBURSEMENT
{See instructions on back)
OMB APPROVAL NO.
0348-0004
PAGE OF
PAGES
TYPE OF
PAYMENT
REQUESTED
I—1 r-i REIMBURSE-
I 1 ADVANCE QC-! MENT
Q FINAL ED PARTIAL
2. BASIS OF REQUEST
50 CASH
C ACCRUAL
3. FEDERAL SPONSORING AGENCY AND ORGANIZATION ELEMENT TO
WHICH THIS REPORT IS SUBMITTED
EPA Region I
4. FEDERAL GRANT OH OTHER
IDENTIFYING NUMBER ASSIGNED
8Y FEDERAL AGENCY
1-######
5. PARTIAL PAYMENT REQUEST
NUMBER FOR THIS REQUEST
2
6. EMPLOYER IDENTIFICATION
NUMBER
##-#######
7. RECIPIENT'S ACCOUNT NUMBER
OR IDENTIFYING NUMBER
8. PERIOD COVERED BY THIS REQUEST
FROM (month, day, year!
1/1/95
3/31/95
9. RECIPIENT ORGANIZATION
Name ; woodtown Landfill Coalition
Number Main Street
and Street
Woodtown, CT 06890
City. State
and ZIP Code:
10. PAYEE IWhtn check is to to sent ,s different than item 91
Name
NA
Number
and Street
City, State
and ZIP Code:
COMPUTATION QF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED
PROGRAMS/FUNCTIONS/ACTIVITIES ~
(a)
Technical
Assistance
(b)
NA
(c)
NA
TOTAL
„ lAs of date)
a. Total program
outlays to date
$ 13,375
S
$
$ "13,375
b. Less: Cumulative program income
0
0
c. Net program outlays {Line a minus
line b)
13,375
13,375
d. Estimated net cash outlays for advance
period
0
0
e. Total {Sum of lines c Si di
13,375
13,375
f. Non-Federal share of amount on line e
2,675
2,675
g. Federal share of amount on line e
10.700
10,700
h- Federal payments previously requested
4,000
4, 000
i. Federal share now requested [Line g
minus line h)
6, 700
6,700
j. Advances required by
month, when request-
ed by Federal grantor
agency for use in mak-
ing prescheduled ad-
vances
1st month
NA
2nd month
NA
3rd month
NA
12. ALTERNATE COMPUTATION FOR ADVANCES ONLY
a. Estimated Federal cash outlays that will be made during period covered by the advance
$ NA
b. Less: Estimated balance of Federal cash on hand as of beginning of advance period
c. Amount requested (Line a minus line bl
$ NA
AUTHORIZED FOR LOCAL REPRODUCTION {Continued on Reverse) standard form 270 (R«v. 2-921
Prescribed bv Office of Management and Budget
Cir. No. A-102 and A-110
19
-------
REQUEST FOR REIMBURSEMENT (FORM SF 270), cont.
11. Computation of Amount of Reimbursements
a. Total program outlays to date
Enter the total amount spent (outlays) in this time period and all previous
reimbursement periods, including in-kind contributions.
c. Net program outlays
Enter the sum from line 11a, here and in the "total" column.
e. Total
Enter the sum from line 11a, here and in the "total" column.
f. Non-federal share
Enter the total value of your cash and in-kind contributions represented in the
sum in line lie. This value must equal at least 20 percent of the total program
outlay sum (or whatever alternative percentage is shown in your award as the
non-federal percentage).
g. Federal share of amount on line e
Subtract the value in line llffrom the sum in line lie.
h. Federal payments previously requested
Enter the total amount of payment already received from EPA.
i. Federal share now requested
Subtract line llh from line llg. This total represents the amount you are re-
questing for reimbursement from EPA.
13. Certification
— The individual authorized by your group and identified in your grant
agreement must read the certification statement and verify that the infor-
mation is accurate before signing and dating the form.
— The authorized individual's name, title, and telephone number also must be
included.
20
-------
OMR APPROVAL NO.
PAGE Of
REQUEST FOR ADVANCE
OR REIMBURSEMENT
(See instructions on back}
0348-0004
PAGES
|—1 r-l REIMBURSE-
i 1 AOVANCE DC-! WENT
2. BASIS OF REQUEST
PAYMENT
REQUESTED
b. "X* the applicable box
C] FINAL 0 PARTIAL
~ ACCRUAL
I. FEDERAL GRANT 0« OTHER
IDENTIFYING NUMBER ASSIGNED
BY FEDERAL AGENCY
EPA Region I
PERIOD COVERED BY THIS REQUEST
FROM Imonth, day, y
1/1/95
3/31/95
9. RECIPIENT ORGANIZATION
Name : woodtown Landfill Coalition
andSrreer Main Street
Woodtown, CT 06890
10. PAYEE {Where ct
COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED
PROGRAMS/FUNCTIONS/ACTIVITIES ~
Prescribed by Office of Management and Budget
Cif. No. A-102 and A-110
21
-------
MBE/WBE UTILIZATION FORM (FORM SF 334)
NOTE: You will find a blank version in the pull-out "Blank Documents" section.
This form must be completed by October 30 of each year. You only are
required to report contracts to MBEs.
Part 1
1. A. Federal Fiscal Year
Enter the federal fiscal year date. (The federal fiscal year runs from October 1
through September 30, so December 1,1993, is in fiscal year 1994).
2. Federal Agency
Write the name and address of the EPA Regional Office designated in the assis-
tance agreement.
A. Reporting Contact
Write the name and phone number of the EPA Regional TAG Coordinator.
3. Reporting Recipient
Enter the name and address of your group.
A. Reporting Contact
Enter the name and phone number of your group's Project Manager.
4. A. Financial Assistance ID Number
Enter your federal grant number assigned by EPA.
5. A. Procurement Period
Enter the dates during which contracts under the grant were or will be awarded.
B. Total Project Procurement
Enter the total project dollars that will be awarded to the contractor during the
current fiscal year.
C. MBE/WBE Goals
Calculate the percentage of procurement dollars you estimate you will spend
with MBEs during this fiscal year.
D. MBE/WBE Procurement Accomplished
Enter the dollar amount of any contracts awarded to MBEs during this year.
E. Negative Report
Check only if one or more procurements were executed this reporting quarter,
but no MBE procurements occurred.
6. Comments
Leave blank or fill in with additional comments or explanations.
7. Authorized Representative
Type or print name and title of your Project Manager.
8. Signature
Your Project Manager should sign and date the form.
22
-------
MBE/WBE* UTILIZATION UNDER FEDERAL GRANTS, COOPERATIVE
AGREEMENTS, AND OTHER FEDERAL FINANCIAL ASSISTANCE
PART 1. (NEGATIVE REPORTS MAY BE REQUIRED)
1 A. FEDERAL FISCAL YEAR
1994
1B. REPORTING QUARTER (Check appropriate box)
I |l st (Oct-Dec.) Q 2nd (Jan.-Mar.) Q 3rd (Apr.-Jun.) Q 4th (Jul.-Sep.)
2 FEDERAL FINANCIAL ASSISTANCE AGENCY
{Department/Agency, Bureau/Administering Office, Address)
U.S. EPA Region I
JFK Federal Building
Boston, MA 02203
3. REPORTING RECIPIENT (Name and Address)
Woodtown Landfill coalition
Main Street
Woodtown, CT 06898
2A. REPORTING CONTACT
Mr. John Doe
PHONE:
(617 )m~m#
3A. REPORTING CONTACT
Pat Jones
PHONE:
(203 )m-m#
4A. FINANCIAL ASSISTANCE AGREEMENT ID NUMBER
1- mm
4B. FEDERAL FINANCIAL ASSISTANCE PROGRAM
Technical Assistance
4C. TYPE OF FEDERAL ASSISTANCE AGREEMENT
0 GRANT Q COOPERATIVE AGREEMENT Q OTHER FEDERAL FINANCIAL ASSISTANCE
5A. PERIOD WHEN PROCUREMENT UNDER THIS AWARD WILL
OCCUR
start date: December 15. 1994
END DATE: .Tnlv 1^ -\
58. AMOUNT OF TOTAL PROJECT
DOLLARS PLANNED FOR
PROCUREMENT THIS FISCAL YEAR
$ 23,125
5C. RECIPIENTS MBE/WBE GOALS (Perce
MBE 35 %
nt of total procurement dollars (5b) for each)
WBE 0 %
5D. MBE/WBE PROCUREMENT ACCOMPLISHED THIS QUARTER
MBE $ | WBES
5E. NEGATIVE REPORT (Check)
~ SEE INSTRUCTIONS
6. COMMENTS:
7. NAME OF AUTHORIZED REPRESENTATIVE
TITLE
Pat Jones
Executive
Director
8. SIGNATURE OF AUTHORIZED REPRESENTATIVE
DATE
1/05/96
23
-------
MBE/WBE UTILIZATION FORM (FORM SF 334), cont.
Part 2
Fill in Part 2 of this form only if a contract was awarded to a MBE during
this fiscal year.
Business Enterprise
Check "Minority" if procurement was awarded to the MBE.
Dollar Value of Procurement
Enter the dollar amount of the procurement with the MBE.
Date of Award
Enter the date the contract was awarded to the MBE.
Type of Product or Service
Fill in, using the codes at the bottom of the form identifying the product or ser-
vice procured.
— If an MBE is serving as the technical advisor, fill in 9b (Professional Services).
— If an MBE is serving as the grant administrator, fill in 9a (Business Services).
Name/Address of MBE/WBE Contractor or Vendor
Enter the name and the address of the MBE firm to which the contract was
awarded.
24
-------
Name/Address of MBE/WBE Contractor or Vendor
Jan Carter, Walnut Street
Woodtown, CT
Type of Product
or Service 1
(Enter Code)
9b
Date of
Award
(MM/DD/YY)
12/15/94
$ Value of
Procurement .
$10,824
Business
Enterprise
Minority I Women
i
X
Procurement
Made By
Recipient I Other
X
m c Ct/»
25
-------
QUARTERLY PROGRESS REPORT
NOTE: You will find a blank outline for this report in the pull-out "Blank
Documents" section.
This sample report is based on the activities at a fictitious site. Any simi-
larity to actual people, places, or events is not intended.
Progress Achieved
Describe the types of grant activities conducted during the reporting quarter
and the hours required to accomplish these tasks.
— Indicate whether you are initiating, continuing, or concluding the activity.
Difficulties Encountered
Indicate if your group is having any unforeseen problems. For example, you
should document if activities are going slower than expected or if your budget is
not working out as anticipated.
Percent of Project Complete to Date
Enter the percentage of technical assistance project completed to date.
Materials Produced This Quarter
If you wish, you may attach a copy of material produced with the quarterly
progress report. These materials have not been attached here due to the fictitious
nature of this example.
— Indicate any documents prepared by your technical adznsor(s) or your group.
— Attach copies of these materials to your progress report and submit to EPA.
Activities Anticipated Next Quarter
Describe the types of activities that your group and your technical advisor(s)
will be working on during the next quarter (note new activities along with those
that are continuing). If you have nothing to report, indicate "none" in that
category.
26
-------
TAG QUARTERLY PROGRESS REPORT
Date: 1/6/94
Report Number: 1
Report Period: 10/1/93 - 12/31/93
Site: Woodtown Landfill, Litchfield, Connecticut
Grant Recipient: Woodtown Landfill Coalition
Recipient Group Representative: Pat Jones, Executive Director
Technical Advisor: Professor Jan Carter
PROGRESS ACHIEVED:
• Technical advisor completed review of the remedial investigation work plan (9
hours).
• Technical advisor prepared an evaluation memo on the remedial investigation
work plan (8 hours).
• Technical advisor and other Woodtown Landfill coalition members attended the
remedial investigation kick-off meeting (4 hours for technical advisor meeting
preparation; 4 hours for technical advisors meeting attendance).
• Coalition held four general membership meetings to discuss future group activities
and review the remedial investigation work plan memo.
• Coalition mailed the technical advisor's evaluation memo to interested individuals
and to EPA to be included in the site information repositories.
DIFFICULTIES ENCOUNTERED:
• None
PERCENT OF PROJECT COMPLETED TO DATE:
• Estimate percentage of technical assistance project completed to date: 10 percent
MATERIALS PRODUCED THIS QUARTER:
1. Document: Evaluation memo on remedial investigation work plan (attached)
Date produced: 11/6/93
Author: Professor Jan Carter, Technical Advisor
ACTIVITY ANTICIPATED IN NEXT QUARTER:
• Technical advisor will review risk assessment report completed by EPA as part of
the remedial investigation.
• Coalition will attend a public meeting to inform community members about the
progress at the site.
• Coalition will prepare a newsletter for distribution to interested community mem-
bers and the information repositories.
27
-------
FINANCIAL STATUS REPORT (SF 269, Short Form)
NOTE: You will find a blank form in the pull-out "Blank Documents"
section.
This form should be filled out and submitted to the EPA Award Official
within 90 days of the anniversary of the start of the project.
1. Federal Agency
Enter the appropriate Financial Management or Grants Office (varies by Re-
gion) as specified in the grant agreement.
2. Federal Grant Number
Enter the grant number assigned by EPA in the grant agreement.
3. Recipient Organization
Enter the name and address of your group.
4. Employer Identification Number
Enter your employer identification number (EIN).
6. Report Status
Check "Yes" if this is the final report, otherwise, check "No."
8. Funding Period
Enter the dates of the beginning and end of the total project period.
9. Report Period
Enter the dates covered by this report.
10. Transactions
Instructions for a through i: If this is the initial report, leave columns I and II
blank and fill in column III. Otherwise, enter previously reported amounts in
column I, current amounts in II, and total in III.
a. Total outlays
Enter total outlays for the year (the group's plus federal outlays).
b. Recipient outlays
Enter the total group outlays (cash expenditures plus in-kind contributions).
c. Federal outlays
Enter the federal share of the outlays.
d. Unliquidated obligations
Enter the amount owed to contractors and any other outstanding bills. All
debts must be paid prior to submission of final Financial Status Report; this
amount must be zero if this is a final Financial Status Report.
(continued on page 30)
28
-------
FINANCIAL STATUS REPORT
(Short Form)
(Follow instructions on the back)
EPA Region I
2. Federal Grant or Other Identifying Number Assigned
By Federal Agency
1-######
OMB Approval
No.
0348-0038
3. Recipient Organization (Name and complete address, including ZIP code)
Woodtown Landfill Coalition
Main Street
Woodtown, CT 06890
4. Employer Identification Number
5. Recipient Account Number or Identifying Number
NA
6. Final Report
~ Yes £
7. Basis
Cash n Accrual
. Funding/Grant Period (See Instructions)
From: (Month, Day. Year) To: (Month, Day, Year)
09/01/94
08/30/97
i. Period Covered by this Report
From: (Month, Day. Year)
09/01/94
To: {Month, Day. Year)
08/30/95
10. Transactions:
Technical Assistance Activities
b. Recipient share of outlays
c. Federal share of outlays
18,544
d. Total unliquidated obligations
e. Recipient share of unliquidated obligations
f,- Federal share of unliquidated obligations
g. Total Federal share (Sum of lines c and f)
18,544
h. Total Federal funds authorized for this funding period
:: sa
¦H
Unobligated balance of Federal funds (Line h n
31,456
Expense b. Rate
a Type of Rate (Place "X" in appropriate fao*;NA
~ Provisional ~ Predetermined
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 beat 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.
Typed or Printed Name and Titte
Pat Jones, Executive Director
Telephone (Area code, number and extension)
(203) ###-#§§§
Signature of Authorized Certifying Official
NSN 7540-01-218-4387
Date Report Submitted
09/15/95
Standard Form 269A (REV 2-92)
Prescribed by OMB Circulars A-102 and A-110
29
-------
FINANCIAL STATUS REPORT (SF 269, Short Form), cont.
10. e. Unliquidated recipient obligations
Enter the portion of the amount owed to contractors that will he paid with the
matching contribution.
f. Unliquidated federal obligations
Enter the portion of the amount owed to contractors that will he paid with
federal funds (EPA reimbursement).
g. Total federal share
Enter the sum of 10c and lOf.
h. Total federal authorized funds
Enter the total federal contribution as specified in the grant agreement.
i. Unobligated federal funds
Subtract the amount in lOg from the amount in lOh.
12. Remarks
Optional. You may attach a separate sheet providing explanatory information if
you believe it necessary to explain data entered on this report.
13. Certification
The Project Manager should read, sign, and date this certification.
30
-------
FINANCIAL STATUS REPORT
(Short Form)
(Follow instructions on the back)
1. Federal Agency and Organization at Element
to Which Report is Submitted
EPA Region I
2. Federal Grant or Other Identifying Number Assigned
By Federal Agency
1-######
OMB Approval
No.
0348-0038
Page
1
of
1 pages
3. Recipient Organization (Name arid complete address, including ZIP code)
Woodtown Landfill Coalition
Main Street
Woodtown, CT 06890
4. Employer Identification Number
5. Recipient Account Number or Identifying Number
NA
6. Final Report
Q Yes 59 No
7. Basis
S Cash Q Accrual
8. Funding/Grant Period (See instructions)
From: (Month, Day, Year)
09/01/9 4
To : (Month, Day. Year)
08/30/97
9. Period Covered by this Report .
From: (Month, Day, Year) To: (Month, Day, Year)
09/01 /94 1 08/30/95
10. Transactions:
Technical Assistance Activities
i
Previously
Reported
II
This
Period
III
Cumulative
a. Total outlays
23,180
b. Recipient share of outlays
4,636
c. Federal share of outlays
18,544
d. Total unliquidated obligations
iiiiiit
SHpi»
m
•
e. Recipient share of unliquidated obligations
sitiiL *
sii
0
f. Federal share of unliquidated obligations
y. - , *'/
ipipilipMi
0
g. Total Federal share (Sum of fines c and f)
18,544
h. Total Federal funds authorized for this funding period
ill
ii|ll|ii|S
50,000
L Unobligated balance of Federal funds (Line h minus tine g)
I 31,456
11. Indirect
Expense
a. Type of Rate (Place "X" in appropriate box)NA
~ Provisional ~ Predetermined Q Final Q Fixed
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 beatof 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.
Typed or Printed Name and Title
Pat Jones, Executive Director
Telephone (Area code, number and extension)
(203) ###-####
Signature of Authorized Certifying Official
Date Report Submitted
09/15/95
NSN 7540-01-21S-4387 269-202 Standard Form 269A (REV 2-92)
Prescribed by OMB Circulars A-102 and A-110
31
-------
FINAL PROJECT REPORT
Grant recipients must submit to EPA a draft of their Final Project Report
for review no later than 90 days prior to the end of the approved project
period and final report within 90 days of the end of the project (see pages
8 and 12 for more information).
The report need not be any longer than three to four pages. The follow-
ing example is of a sample table of contents for a Final Project Report.
32
-------
FINAL PROJECT REPORT
Pase
I. INTRODUCTION 1
II. PROJECT GOALS AND OBJECTIVES 1
III. ACTIVITIES UNDERTAKEN TO ACHIEVE 2
GOALS AND OBJECTIVES
IV. DIFFICULTIES ENCOUNTERED 2
V. TECHNICAL ADVISORS WORK 3
PRODUCTS
VI. FUNDS SPENT 4
A. Federal Share
B. Matching Share
1. Cash
2. In-Kind Contributions
VI. CONCLUSION 4
33
-------
LEDGER SHEET FOR RECORDING CASH TRANSACTIONS
NOTE: You will probably want to balance your accounts on a ledger
sheet such as this on a monthly basis. You will find a blank outline for
this form in the pull-out "Blank Documents" section.
Date
Enter the date of each transaction.
Description
Describe the cash transaction, such as the number of the payment check received
from EPA, the source of a cash contribution, or the type of expenditure (goods or
services purchased).
Federal Grant Funds
Enter the amount of any payment received from EPA in response to a Request
for Reimbursement.
Cash Contributions
Enter the amount of any cash contribution.
Expenditure
Enter the amount of any payments made for services or materials.
Previous Balance
Enter the amount of funds that carried over from the previous month's ledger.
Amount /Balance
Enter the amount of the cash transaction.
— If the transaction is income, note this with a (+).
— If the transaction is an expenditure, note this with a (-).
For your first entry, calculate the balance by adding or subtracting the entry on
the "amount" line from the amount shown in the "previous balance" line. Each
of the following balances is calculated by adding or subtracting the entry in the
"amount" line from the entry in the "balance" line directly above it.
Totals
You can balance the cash transaction ledger by using the entries on this line. To
balance your monthly ledger, add the totals of "federal grant funds" to "cash
contributions." Subtract from this amount the total for "expenditures." Add
the "previous balance" to this total. This amount should equal the last balance
entry.
34
-------
Monthly L
Month VAK"*)
v_ iW ^
.edger for Recording Cash
Transactions
Income
Expenditures
Date
Description
Federal
Grant Funds
Cash
Contributions
Amount
Balance
'/io
1(2-1 lltviCW
1,1 MO.oo
_
M40
V17-
IMz. i WAv'-S."Smf+ti
'bo.oo
-\ m
•bo
3.1 41
1/|3
IWs. Bvoww
-------
MONTHLY RECORDING OF A GROUP'S MATCHING
CONTRIBUTION
NOTE: You will find a blank form in the pull-out "Blank Documents"
section.
In-Kind Contributions of Donated Time, Products, or Services
Date
Enter the information on the date that the contributions were made.
Type of Contribution
Enter the type of contributions. You must save any receipts and keep individual
time sheets (see page 43 for a sample form) to document the contribution.
Hours / Quantity
Enter the number of labor hours or quantity for each type of contribution.
Rate
Enter the rate (if any) associated with each contribution. Labor rates are typi-
cally an hourly rate, and copying a newsletter would be a per copy rate. The
rates used must correspond to those included in your approved grant application
budget.
Value Balance
To calculate a dollar value for each type of contribution, multiply the hours or
quantity by the rate. As you continue filling out the form, enter a running total
of the value on the "balance" line.
Total In-Kind
Enter the total sum of your in-kind contributions based on your entries (this fig-
ure should be the same as your last "balance" entry). You may need several cop-
ies of this sheet each month, depending on the level of your group's activities.
36
-------
Monthly Matching Contribution
Worksheet
In-Kind Contributions
Month: rTfliumwy
Member: u
Date
Activity or Contribution
Hours X Rate = Value
1
2
lAJr i+in^\ NlewsVt<+eV
looo
i yo-
3
j
4
*
NW>Ictfcv
2-
~1X> ¦00
M.O-.
ft
J
7
8
9
10
11
12
13
14
15
Ifi
17
18
19
20
21
22
23
24
25
26
27
Accounting Sewic-cs.
<4
>Hoo
28
J
29
30
31
Total In-Kind for the Month
"$ J-'ilo
-------
MONTHLY RECORDING OF A GROUP'S MATCHING
CONTRIBUTION, cont.
NOTE: You will find a blank form in the pull-out "Blank Documents"
section.
Cash Expenditures (for items purchased with group funds)
Receipt #
Enter the information as the expenditures are made.
Vendor
Enter the name of the product or service provider.
Purpose
Enter the reason or justification for the purchase.
Total
Enter the total value of the purchase.
Total Cash Expenditures for the Month
Total the last column to get the total cash expenditures for the month.
38
-------
Monthly Matching Contribution
Worksheet
Cash Expenditures
Month: TTOUMUW
Member: J
Receipt #
Vendor
Purpose
Total
1
Tkixv Ajv MuOsletW"
ZU-.oo
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Total Cash Expenditures for the Month
$21*-
Receipts Attached:
39
-------
SUMMARY MONTHLY SHARE
NOTE: You will find a blank form in the pull-out "Blank Documents"
section.
Using the totals from the In-Kind and Cash Expenditure Worksheets, list
each person's contributions and total them to get the total share for the
current month.
— If this is the first month, repeat this figure in the last line, "Total Re-
cipient Matching Share to Date."
— Otherwise, use the summary worksheet from the previous month to
calculate the total to date.
40
-------
Woodtown Landfill Coalition
Summary
Monthly Recording of Group's Matching Contribution
Month
Year \f\^\
Member
In-kind
Cash
Expenditure
Total
Awn
2-1 (»"
—
2-31*"
hob Sw-iMa
—
40"
40-
WMWhA. i)t>S
is-
12--
2,T
CmoUHU'llw
ns-
—
15'
TOTAL
3 &(p-
5Z_
TOTAL MATCHING SHARE FOR THE MONTH
RECIPIENT MATCHING SHARE THROUGH THE PRIOR MONTH
TOTAL RECIPIENT MATCHING SHARE TO DATE
$ 4i€T
$
$ k^ll-
41
-------
GROUP MEMBER'S TIME SHEET
NOTE: You will find a blank form in the pull-out "Blank Documents"
section.
Group members may use this worksheet to keep track of the time that
they spend doing TAG-related activities that count as in-kind contribu-
tions toward the 20 percent matching requirement.
42
-------
Woodtown Landfill Coalition
Time Sheet
Name Aiaia Kyl-c.
Period ~5cm ¦ 1 \ to ]Jam_ 1^4
Date
Task
Hours
Rate
Value
'/x
UJ/i4inA Naosk+fev
l.o
U . O
i to.
ILcO -
l/T
6ril(4iU^ Wooslfttc/
l.o
i to-
M.O'
i /a-T
Accootch'i^
O <5
{¦s
to
^ 24 .
<\
-------
SUMMARY REQUEST FOR REIMBURSEMENT (FEDERAL SHARE)
WORKSHEET
NOTE: You will find a blank form in the pull-out "Blank Documents"
section.
This worksheet, or any other similar format or system, will help organize
the information that you will be presenting on the Request for Reim-
bursement Form (Standard Form 270).
Period
Enter the time period that this worksheet accounts for—typically either one
quarter or one month.
Year
Enter the year.
Partial Payment Request Number
Enter the number of this reimbursement period request (this should correspond-
to the number entered on the Request for Reimbursement Form, line 5).
Date
Enter the date of the invoice.
Item
These subcategories may be altered to fit the types of payments that your group
makes—the categories shown are examples of some of the expenses for which
your group may request reimbursement. For each item, list the hours or quan-
tity, the rate that the service or product provider has charged, and multiply these
to arrive at the total value. [NOTE: Round figures to the nearest dollar. Round
amounts less than $0.50 down. Round amounts of $0.50 and more up. For ex-
ample, you have newsletter costs of $74.75. You would round this figure up to
$75.00. Be sure that your ledger shoivs this adjustment.]
Total Reimbursement Requested
Add the figures in the "Value" column to arrive at a total for the reimbursement
requested. Check your figures by adding the figures in each of the "Hours/
Quantity" and "Rate" columns and multiplying those two figures together. The
result should equal the total of the "Value" column.
44
-------
Woodtown Landfill Coalition
Summary
Request for Reimbursement—Federal Share
Period from: 1 / 1 / to:
Year
Partial Payment Request Number
Date
Item
Hoars or
Quantity
Rate
Value
TA Contractor:
HO
ilu>.
3,0^0.
Administrator Contractor:
T>h\
Llo
3s.
eo
0
Copying & Printing:
Mi\
NetOstetje/-
l"^0
4 0.0*?
T5"
Postage:
xl\t>
KJewslttfev
TOO
4 o
203
T~IV2-
MAteJi'nA fi.iuw)uncemei*-'t"
i o .M
1-5
J
Telephone:
>/vi
Decew< (j€V Uw ^ fei-5 tjl/UCfc.
i<4
TOTAL REIMBURSEMENT REQUESTED
$ 5,42.7-
45
-------
46
-------
BLANK DOCUMENTS YOU WILL NEED
TO MANAGE YOUR TAG
In this section, you will find blank copies of each document you will need for
managing your TAG. Please note that there is no blank form to correspond with
the Final Project Report. Whenever questions on these forms call for standard an-
swers by all TAG recipients, EPA has supplied the appropriate response to sim-
plify the application process for you.
Documents and worksheets that you will find in this section include:
• Request for Reimbursement (Standard Form 270 [7-76]).
• Quarterly Progress Report.
• Financial Status Report (Standard Form 269 [4-88], Short Form).
• Ledger Sheet for Recording Cash Transactions.
• Monthly Recording of a Group's Matching Share (two forms).
• Summary Monthly Recording of Matching Share.
• Time Sheet.
• Summary Request for Reimbursement for Federal Share.
• MBE/WBE Utilization Form (Standard Form 334).
-------
REQUEST FOR ADVANCE
OR REIMBURSEMENT
ijtiJr ULfji'ijU lift bJOJifJ
owBArrnu^ALND.
034«-ono4.
Jidt or
1 I
i.
TYncar
piiVMfcMT
HHIUhri I HI
q, "Si" 41117 /ft Hii.-J/i winvi
~ L- | .nciuauflsc-
pjivaMlL ELI MCNT
"X" f'n1 n^ftin./r/ttrt !*¦*
~ h-h.sl LI ivnriAt
2
.¦ nARii?o= BFQIJE5T
£] Mir
O jm:i.hlj.-:
¦< hh i in Krti xk mnriKih h drjtNr;v a ^«i i ihhani/ai ii ir-: -i -ms-n i i a
jVHIEX IH X KI-HI iiH I IX Kl. KMl I ' hll
EPA Regiart
J hHlhKffl HHjIPJI ilHrilHhK
111 h rri MhYINH NL IMHfcH AgtylUNHT
KV F-l-lll-H.M
h HAHiirti KL-wr-jr h.bqueET
MJMHhK H.IH IHI? »1tCUC!i"
II \-tSH UVhH IIJhN IIHL.AIKI'V
¦'•JLJP/IHhH
¦ 5S.'"LHitiv.r t ^ciou-nt NUMncn
C5fl rfjlS Ps Tlh Y.Mi NIIMHhK
NA
PERIOD COVERED BY THIE REQUEST
HHIIM [i -ii riHJi, tt/ty, ytviij
f D r.-Mi^nrr.. i?.kKi yiiwij
H, AFtllhlFhT llMlViiMl7n"llVl>.
iV.l flirt
iVvmfiflr
jiai? jTt-jmf
t.'jrft .SNi»
jwd Zf.u l L'c/v ;
" II |Hn.r" n ii'iMiV ••• in fn i.iii iT .a jiVI.Vii nrl n..iid* 'lir*i i
iVi.rTi ^
.Vumbw
friii Sl.-LL-f
Ciiy. Siut-.-
11
COMPUTATfON OF AMOUNT OF REEM BURSEMEMT6/ADVANCE5 REQUESTED
PH;j(iHAIVlH/l-L.Nt::KJKy/AL IIVII IfcS ~
j. lot?l pngr^r-,
: j i j 11 xyx :-:i dnln
tAr nt rf.w'
b. L^tv. CumileIidLivil ^n:^i u'li ii luiT'l
r. Nptf prrajrjirn tiurh -jx \ \ tnti * trtfrcM
tiuw b)
L3. "«limstn^1 r\*i- nutlhyH: fnr .Hi:«.-niii:^
; :i :
iJj
Technical
'cl
HA
NA
TOTAL
C. T-ljIu I fS ijjr; in' J7i'.'i»w rr A ij'.J
T. Mi>i i-Fhi £h i h I .hHh r+i u-" h i i\ki j i i I u ¦ i ' i i ¦ h w
q. F-hcJh-thI H'lHrn nf nmciLinh cm liiiH h
h FurJpfrjil [ w* y ir mil x pimi'inujilY rh<|iihmIhiof
Annj^mt rBClUWtSd iiinv ? .injj i?}
AU11 lOHiiLU l;UHLUt7VL P.LPHUUUr;i ION
(l^ntiruturl fin ftHvnraifly
s NA
xiiMURn FT1FM 270 in™. 3-SJ)
''V Mtii-ain-r*n: md C-udpic
L.U. Nu. jL- a :n
-------
11 CEBTI FICatiom"
5ICNATUPE Cf 4UTIICr.lZ13 CCimrYlhr. LJhflfJAL
DATE nCQJCST
aunftjtmtD
i c-flrtily i-n-ac 10 [fit- b«i of m/ kna^lodgo
tiwii LihUhI 1 hih+ tJmIh <1 ri "hht r«v«r«H htm
r.nrrt>c\ jnd ch ji jj| ouilays were mode "n
c!h11lh wilh IHm EjriMil <:rnicJilii3riK hi
r-rh?r florc-ornc-ni and Thai paymcni Is duo
iJlH'J flMH 1IE31 ! HHME1 flTH-V ifllCH h/ THC111 h+Kl 4id.
rvru an. phintcd namf Tjn -
TFI hPhOKIF iaA^a
LL.'fV, K-L^Wkth.
F'/TF NfilO Vj)
l'hls space for agency uic
Public ri'jj'jiiirifl burden -?r this- goIIco-lon of Inform at on ii tiiiiViaTed iu averse 00 rriinuper
rKKfinium, inriliiHirm ITnim for rL'viewirig rrixLjiJc'i^riH, xnwrrhinrj iviKlimj '1jta kmiiivihh, ||HllmiiriH mill
maintaining the cist? hum tinf] and reviewing The cclle:rtcn Gt IntoTatJon. yflnr.1
Luiriiiiiiriiu ilhj, dirifi iho burden esTlmaTO o' Jrv ¦jiIkli ui' rhiu LmNut'.iuii of inrorm^ii-cri.
inn).idling T.ijgrjHX'ifHiH for 'HiJuiJuy liiih L111rdnji. In 'hn I'lfficn nf MngitnnnI ahH MiiiHijhI, F1 itp mn.vn'k
I Inaction I Yoject \rtfjtxlnrnjlnri, 114: I'dljtf/IJ,
PLEASE t]Q NOT RETURN VOUR COMPLETED FGllM TO THE OFFICE Of MANAGEMENT
AND BUDGET, SfiiUQ it fO rtft AUDRrsr. PROVIDED BY the SPoriKOHirjf; ai;i:iu[:y.
INSTRUCTIONS
PlH«:;e ly]j« »r firfn: leg illy. lleiiiS 1, 3, 5. 0, 1Qr 111:, I 11:, 11f, lly, 11i, 12 arid 13 are Hell-SKpJaiialury; niiiuz.tic.
iHHlruLlkins for (iLhi:r item:; uri; ;r; follows:
/Jmjm
iEj rr.' i--'
Errhy
y 1^.^X5 whf^n^r request ES prn^flrHrt <:n i:hhIi nr hh-i--.inr.d
oxpendlTu'c bjiii. All itqucsis tor advances shaK be
lirH[i*rmi n:i ,i <:snh IixnIh.
4 Eiiior ih'.1: Fi^l~uruI hm'.iii 11 uinLli1, or oTher Icfntltylng number
HHHKjn^^l l?y tl"fl I 5^5 TP I Vf.KnLKnjin^ m^hiilv- I' lim udvuri:* m
rcifrbursemcrii ia for more Than or» rjr»rt ot^sr
MF4 r+4Hn i h 111, inxHrl Nj'A; I hi-H11,. xliOw TllL aQQregatC aniCujH:J.
IJn a Separate JhTCt. ¦ t^st MCh yHrl e space 'a reierv*d H|L iiuiiiboi oi u'I^he
idoiiTlfyrrg .-iiiivibcr Thai may be jis*iur«iH liy um r«npi*n(
5 Lnter the montti. daiy. and ye*r for ili» Ijkh inning nrni •ruIiriH
jf ihu phml'ilJ Li'jvi^iiiL'J !ri This [¦eqtiesT. It th? review is tor an
ME^vjinnH i?r for pri niJvhtlihiiiJ le'fi'.bjl'SOiTPeilT, illuw
the period th-aT The advance win -n^n-r. ir ikn m.:i'.jnxi in for
¦ hiiriljurhhnim111, xIhiv; Mini period tc which the reifTi
ijivs^rnsnt is raquaftflO.
Notc: Tba-H F-H-i'l-HmI H[iriFinf»rin^ H^bfnL:w» lt^v£ The epTlen at requEr'rig
recipients :o te^nplc^p Items tt y<-nui Ij^cIi- li«i"
filiuij^i bu uhhlE whflii orly1 i mlrimLim amount of
infr?r-r>Ht nn nfiHHli^r^ la riiH^H un Jdva^C Ofld Outlay
EntormaTlon tenTalncd In Item n ran :m i:-b11hi11h-iJ in h iin«ly
jiiHiiriHr frun: lill'mi
n The puv(iL>ae a' The veril&al co'umns |h), uric I (<:}, in ho
rtrcivlHLM hif xH^iriru[« Luii 'jitikdcwni v^hen a protect
has been planns^ t?i,jfi^niHrJ L^v furkCTicifir or
m
acTMTy. If addlTlonal ooJymns an? n-jny
j4lJ¦ ji11 i11^ |)Hiii)d Ilj wli'nh 'liix uinouii:
app.les. Ln:cr program outlays to d»t« -ftyncis.
rHljulL'j.. JJ11lJ iliuLouI'lia)^ ill Lll£ jpiiroprl~!'? COlllU'l^. Fiji
rnq^MnlK pn^pnmil nil i| {'.hjcI i hHxiHr liuIiiivh ^rH 11 ih Hum of
actual cash disbursements tcr groifr ?nr.i ^^rvises. nt
HriHKJiil -:jl" ii11JFihi:I «;¦:[jhiinnn lI'iLh^^J, !ht value Of in ki11¦::
COr^'rib^tlOnS flpplipd. anM thrt ^rTiiiLinl 11r chxIi HiJvwnr.ij*.
and aaymenTS made to sjbconTractcr^ urut Ffuhnflr,ipifn;s.
Fem r*nuH:iin [jmi^rwiJ uii Ail aeii'ued expendliure bai.i>i,
OLlt'l^yS ¦!!¦« H^liml -:hhIi LJiML^uiHHiriHiilH. 1liH
aflnount ot IndlrccT e^pcnces Incurrsd. ^rd th« mceflsc
(eh iJM^:iHH»Hf in Lliu miiuuiiTa Owed by The recipient fi?i
JOOdS and Othflr propitrty rm:ttiv«iJ MibiJ ft:r nwrvn^n
pertormod bv offiploye«, eonracis. Eubgrant??s and other
[lMyHHN.
Eiut' ihc iuri^ulnTi^L- eash 'rieofre receivsd to daw. it
rijiq^p%Kt]t jinj nil ii LiiiaiS. F^i le^uu^lx
prepared on an accrued fjfpijrviitiirn Iihkihj ptniwr iti^
[iiinnir^iJuH jni:[ji[iv ilm advance.
¦13 CompiHifl tf'H rHriiilc:jiiii!ii jufoic submitting This requeiT.
us
QTANDiLKn FElKM7Tfl HAEIH |H.iv T HV|
-------
TAG QUARTERLY PROGRESS REPORT
Date:
Report Number:
Report Period:
Site:
Grant Recipient:
Recipient Group Representative:
Technical Advisor:
PROGRESS ACHIEVED:
DIFFICULTIES ENCOUNTERED:
PERCENT OF PROJECT COMPLETED TO DATE:
MATERIALS PRODUCED THIS QUARTER:
ACTIVITY ANTICIPATED IN NEXT QUARTER:
-------
FINANCIAL STATUS REPORT
ftlfrorf Pr-ny,)
vHqw fr(Yirjtiijnc zr (hy wwl1)
1. FhiIht.hI A:jHr <.y Hr:rd OfjjapirllCnBl l~.lrj|nt^rit
id W1-ih!'- Refill la giihmintfl
EPA Hiqion
/. ri+:lHrHl !";r.-tnl i :¦• I'JIIihi IdH.'il lyir>;i "J.Ji i iI.:h-' A:-::-:-:jrwr!
5y FeJeral
Omu Appfoval
r-Ji.i.
034a-twae
Faao
1
¦1
11. RH4:l|:ihwil Onj^1 (,toyrnt' 3P^ ii"ii^KJiriy 7 IP i a.>:Ih ^
¦i i icon(ifcat»n Nunbcr
5 Koypajni Ar^/junL Nuf^?r jr dorrity rg Nufntoer
NA
f. \'wim\ Nypxjrt
I".] Yes ~ No
7 L^si?
E] Cash n A.f^in/'il
E. FLinfln-'^'Gi JT'I PlYkld I'Si'iI ulj r,'0.-i :T>
0. Paiio.1 Tic.vur-.A tiv nil
i 'cm: iMon;^. Day. Y^!
To: iMontn. Uay. Y?arJ
Fror: (Moniti. Ooy- vcar)
ir: [Month, Day, Yflarj i
10. Tr'i'u' Si^jlii YiS.
P'fiviO.jily
' WPDnrlnii
IC
This
P-«rni1
UurT.j kuIivw":
fL Ti : IhI iiullxyu
n hi :ir;i^i( ?•?"!> gf autlaya
l' i stje-ai JhaT of c^dayi
c. Tclal Ln-illqi.tjjTL.-i] flblifi.nu.inr.
C. Rfl^'AhiH xIhtA i:I iinli[^iiii!Hlml -:iLiKjH.l.ijri:H
fijr^rnl JlliqLTClalWi
j. lota fodwal ihare f'-Su.Ti ~ < f.'yicr e f.i
roti' Frfcfal lUrds authwiicrl If/ thin H-ndlnj pcnd
.J"i:it;lirj#M telsn» Of I BtJcaJ Opr.1# ^i-TTW b mi'1/iv ijj
i1 .Irdlrec:
L^onsa
? l/pe cf Rata "K" !x:xi
Pnjvuoiirjjl
iiwl
~ =ifJHl
t. FUSES
Uaio
¦1. ratal .Amount
1 t weral Sngro
m, 2. flfr.-K.l-Ki. rtfty wrrrixuvtii>rta ifiWirrjflrf ilflOUSSJfy a.'1 Jul rr?:Vu.'- fif,1 frv Fa!lh"r,V .i;i'jf.-.Mn:)|? AdC.iWy 'rt COfflpiVilCC #!lt\ QOvdiAiih'j
13. G1.'." litii'iHlii :r1: I h:« rti^v to the fjdjHi at my fen ~ wImcI h!« und lm]l n f thxt th i it m inprl i.H L :V"i W
SUftM Form SflflA [F:P> 3 «)
bvO^ r.rTT.ilsrn A-102 inri A-1 !~
-------
Monthly Ledger for Recording Cash
Transactions
Month
Year
Income
Expenditures
Previc
Balar
JUS
Cf
Date
Description
Federal
Grant Funds
Cash
Contributions
TOTALS:
-------
Monthly Matching Contribution
Worksheet
Cash Expenditures
Month:
Member:
Receipt #
Vendor
Purpose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Total Cash Expenditures for the Month
Receipts Attached:
-------
Monthly Matching Contribution
Worksheet
In-Kind Contributions
Month:
Member:
Date
Activity or Contribution
Hours X Rate = Value
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total In-Kind for the Month
-------
Woodtown Landfill Coalition
Summary
Monthly Recording of Group's Hatching Contribution
Member
In-kind
Cash
Expenditure
TOTAL
TOTAL MATCHING SHARE FOR THE MONTH
RECIPIENT MATCHING SHARE THROUGH THE PRIOR MONTH
TOTAL RECIPIENT MATCHING SHARE TO DATE
Month
Year
-------
Woodtown Landfill Coalition
Time Sheet
Name
Period to
Date
Task
Hours
TOTALS
-------
Woodtown Landfill Coalition
Summary
Request for Reimbursement—Federal Share
Period from: / / to: / /
Year
Partial Payment Request Number
Date
Item
Hours or
Quantity
TA Contractor:
Administrator Contractor:
Copying & Printing:
Postage:
Telephone:
TOTAL REIMBURSEMENT REQUESTED
-------
MBE/WBE* UTILIZATION UNDER FEDERAL GRANTS, COOPERATIVE
AGREEMENTS, AND OTHER FEDERAL FINANCIAL ASSISTANCE
PART 1. (NEGATIVE REPORTS MAY BE REQUIRED)
1A. FEDERAL FISCAL YEAR
19
1B, REPORTING QUARTER (Check appropriate box)
Qlst (Oct.-Dec.) Q 2nd (Jan,-Mar.) Q 3rd (Apr.-Jun.) I 14th (Jul.-Sep.)
2 FEDERAL FINANCIAL ASSISTANCE AGENCY
(Department/Agency, Bureau/Administering Office, Address)
3. REPORTING RECIPIENT (Name and Address)
2A. REPORTING CONTACT
PHONE:
3A. REPORTING CONTACT
PHONE:
4A. FINANCIAL ASSISTANCE AGREEMENT ID NUMBER
4B. FEDERAL FINANCIAL ASSISTANCE PROGRAM
4C. TYPE OF FEDERAL ASSISTANCE AGREEMENT
~ GRANT ~ COOPERATIVE AGREEMENT Q] OTHER FEDERAL FINANCIAL ASSISTANCE
5A. PERIOD WHEN PROCUREMENT UNDER THIS AWARD WILL
OCCUR
START DATE:
END DATE:
5B. AMOUNT OF TOTAL PROJECT
DOLLARS PLANNED FOR
PROCUREMENT THIS FISCAL YEAR
$
5C. RECIPIENTS MBE/WBE GOALS (Perce
nt of total procurement dollars (5b) for each)
5D. MBE/WBE PROC
MBE $
JUREMENT ACCOMPLISHED THIS QUARTER
WBE S
5E. NEGATIVE REPORT (Check)
~ SEE INSTRUCTIONS
6. COMMENTS:
7. NAME OF AUTHORIZED REPRESENTATIVE
TITLE
8. SIGNATURE OF AUTHORIZED REPRESENTATIVE
DATE
* WBE reporting is optional at the direction of Federal Financial assistance agency.
AUTHORIZED FOR LOCAL REPRODUCTION
STANDARD FORM 334
Prescribed by DEPARTMENT OF COMMERCE
-------
MBE/WBE PROCUREMENTS OVER $10,000 MADE DURING REPORTING QUARTER
PART II.
Procurement
Made By
Business
Enterprise
$ Value of
Procurement
Date of
Award
(MM/DD/YY)
Type of Product
or Service 1
(Enter Code)
Name/Address of MBE/WBE Contractor or Vendor
Recipient ' Other
Minority I Women
I
I
I
I
I
I
I
I
I
I
I
i
I
I
I
|
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
1 Type of product or service codes:
1 = Agriculture
2 = Mining
3 = Construction
4 = Manufacturing
5 = Transportation 9 =
6 = Wholesale Trade
7 = Retail Trade
8 = Finance, Insurance, Real Estate
Services 10 = Other
a = Business Services
b = Professional Services
c = Repair Services
d = Personal Services
------- |