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Certification of Cost Sharing By <br />Name of Third Party <br />Address of Third Party <br />Salaries and Benefits <br />This is to certify that during the period <br />employees of <br />indicated: <br />to <br />the following <br />spent time and effort in support of the <br />activities /program on an in -kind basis and in the percentages <br />Name <br />Title <br />Percent <br />effort* <br />Value of Effort <br />Value of <br />Benefits <br />The effort was an integral and necessary part of the activities /program. The time and effort <br />was not charged to the respective program and was otherwise paid from qualifying and <br />non - federal sources pursuant to Office of Management and Budget (OMB) Circular A -110. <br />The value of effort represents the actual amounts paid to the respective individuals at their <br />regular rate of pay. The value for fringe benefits does not include an overhead component and <br />reflect reasonable, allowable and allocable amounts. Documentation of the time spent by the <br />individual is available if necessary. <br />*If the subcontracting institution monitors hours of work instead of percent effort, please <br />include hours devoted to the activities /program in this space. <br />Supplies, Equipment Space Service Fees Other <br />This is to certify that during the period to <br />expenditures were incurred in support of the <br />_, the following <br />activities /program: <br />W TIT R1 <br />The expenditures listed above were not charged to the respective program and were otherwise <br />paid from qualifying and non - federal sources pursuant to Office of Management and Budget <br />