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19 <br /> FEDERAL FINANCIAL REPORT <br /> _ (Follow form in b <br /> stru ons _ <br /> 1_ Federal Agency and Organizational Element nt Federal Grant or Other Identifying Number Assigned by Federal Agency Page of 1 <br /> to Which Report is Submitted <br /> (To report multiple grarrts r use FFR Attachment) � q <br /> i <br /> . 1 <br /> 3. Recipient Organization(Name and complete address including Zip code) <br /> 4a_ DUNS Number 41a_ EIN 15. Recipient Account Number or Identifying Number 6, Report Tj+po 7. Basis of Accounting <br /> (To report multiple grants,use FFR Attachment) r Qaa rier iy <br /> C en -Annual <br /> r Annual <br /> i-Anal rl Cash El Accrual <br /> 8. Project" rant Period 9. Reporting Period End Date <br /> From: (Month,Day,Year) To: (Month,Day.Year) (Month,Day.Year) <br /> 10. Transactions <br /> Cumulative <br /> (Use fines a-C for single or multiple grant reporting) <br /> \. t__., -•W�.,-ice + i• _ <br /> Federal Cash (To report multi pl a gra rats,also use F F F.t fillaol m errt: <br /> a. Cash R$ceipts <br /> b. Cash Disbursements <br /> c. Cash.on Hand(line a minus b) <br /> (Use lines d-o for <br /> single grant reporting) <br /> npo <br /> � - -Federal Expenditures and U n ob lfgatad Balance: <br /> d. Total Federal funds authorized 1 <br /> e. Federal share of expenditures <br /> f_ Federat share of u nlinul fated cbI G atio ns r <br /> Total Federal 9- share(sum of lines e and f) <br /> --------- <br /> Ii. Unobligate■ balance of Federal funds line d minus gam. _ <br /> _Recipient ipiant t ores <br /> i. Total root lent share.required <br /> j. Rooipient share of expor4t ru es <br /> _ i(. Ede rnainirrg recrpien t sh arc to be provided Me I minus.j <br /> l� ,ra rri Income: - <br /> 1. Total Federal p-ro*ram Income earned <br /> rn_ Pro ;..... <br /> m income ex.-tided in accordance with the deduction alternative <br /> n_ Pro.ram income expended ir}accordance with the addition alternative <br /> 0. Unex i ended program income(line I rrnErru s tine m or line n) I ~- <br /> .a, Type b..Pale C.Period From Period To d.Base 'e. Amount Cl rg f_Federal <br /> 11_Indirect IIII= MI Expense �``� .' <br /> ., ._Totals: _ <br /> 12. Remarks; Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing IegisIat on_ <br /> ertifi tion: By signing this report,1 certify that it is true,complete,and accurate to the best of my knowledge. I'am aware that <br /> arty false,fictitious,or fraudulent information may subject me to criminal,civil,or administrative pe nal ities. (U.S.Code,Title 18,Section 1 001) <br /> a. Typed or Printed Name and Title of Authorized CertLfyi ng Official :c_ Telephone(Area code,number and extension) J <br /> d. Email address <br /> I <br /> T\•1 \ � w + „1. - .1 <br /> b. Signature of Authorized Certifying Official o. Date Report Submitted (Month,Day,Year) <br /> Sta nd lard Form 425 <br /> Clikni Approval Number:X 4e-Oo51 <br /> ,r,,,, Expiration Dale'l an tin 11 <br /> Fapnrworlc Burden Staterng nt <br /> According to the Paperwork Reduction Act,as amended,no persons are required to respond to a collection of infcir nation unless it displays a vatid OMS Control Number_The varid OMB control <br /> number for this information collection is 0348-0061. Public reporting burdan for Ihrs collection of information is estimated to average 1.5 hours}per response,including time for reviewing instructions, <br /> searching existing data source s1 gallon ng and maintaining the data needed,and completing and reviewing the collection of information_Send comments regarding the burden estimate or any other <br /> cspect Cl.f this collection of inforrnatian,inclu J oetior for r�ducinglhia burden its rice of Mena emenI and Oud t.PaperworkRuction Pro ecl 034-8-1:1060.Weshin ton,DC 2051:1 1. <br />