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20 <br /> OMB APPROVAL NO PAGE OF <br /> 0348-0004 , PAGES <br /> REQUEST FOR ADVANCE a. 'X"obe or both boxes 2.BASIS OF REQUEST <br /> OR REIMBURSEMENT (ADVANCE n REIMBURSE- <br /> TYPE of CASH <br /> PAYMENT I 1 MENT 0 <br /> REQUESTED b X"ihe applicable box ACCRUAL <br /> (See instructions on back) FINAL 0 PARTIAL <br /> 3 FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO d.FEDERAL GRANT OR OTHER 5.PARTIAL PAYMENT REQUEST <br /> WHICH THIS REPORT IS SUBMITTED IDENTIFYING.NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> BY FEDERAL AGENCY <br /> 6 EMPLOYER IDENTIFICATION 7.RECIPIENTS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br /> NUMBER OR IDENTIFYING NUMBER <br /> FROM (menlh,day,year] TO (month,day,year) <br /> 9.RECIPIENT ORGANIZATION 10.PAYEE (Where check is to be sent if different than item 9) <br /> Name: Name: <br /> Number Number <br /> and Street: and Street: <br /> City, State City,State <br /> and,ZIP Code: and ZIP Code: <br /> 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> (b) <br /> PROGRAMS/FUNCTIONS/ACTIVITIES 1 - <br /> TOTAL <br /> a.Total program (As of dale) <br /> outlays to date <br /> b.Less: Cumulative pro.ram income , <br /> c.Net program outlays (Line a minus . <br /> line b) <br /> d.Estimated net cash outlays for advance ■ <br /> period <br /> e.Total (Sum of lines c&d) ■ <br /> f.Non-Federal share of amount on line e <br /> q.Federal share of amount on line e �� ■ <br /> h.Federal payments previously requested <br /> i. Federal share now requested (Line g <br /> minus line h) <br /> j. Advances required by . <br /> month,when requested •1st month <br /> by Federal grantor <br /> agency for use in 2nd month <br /> making preseheduled ■ <br /> advances 3rd month <br /> 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> a.Estimated Federal cash outlays that will be made during period covered by the advance $ <br /> b.Less: Estimated balance of Federal cash on hand as of beginning of advance period <br /> c'.Amount requested(Line a minus line b) $ <br /> AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 (Rev.7-57} <br /> Prescribed by OMB Circulars A-102 and A-110 <br />