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20 <br /> OMB APPROVAL NO PAGE OF <br /> 0348-0004 <br /> REQUEST FOR ADVANCE <br /> a. 'X"erwe or both boxes 2-BASIS OF REQUEST <br /> OR REIMBURSEMENT flADVANCE flREIMBURSE- . <br /> TYPE OF CASH <br /> PAYMENT <br /> MENT <br /> REQUESTED b "X'to apfirable box ACCRUAL <br /> (See instructions on back) _ FINAL 0 PARTIAL <br /> 3 FEDERAL SPONSORING GA N CY AND ORGANIZATIONAL ELEMENT TO O 4.FEDERAL GRANT OR OTHER 5-PARTIAL PAYMENT REQUEST <br /> WHICH THIS REPORT IS SUBMITTED IDENTIFYING.NUMBER ASSIGNED NU1411BER FOR THIS RECIUEST <br /> BY FE OFFAL AGENCY <br /> 6 EMPLOYER IDENTIFICATION 7,RECIPIENT'S ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br /> NUMBER OR IDENTIFYING NUMBER <br /> FROM (rrornIh,day,yeah I TO WW1,day,year) <br /> r <br /> 9.RECIPIENT ORGANIZATION 10_PAYEE (where check is to be sent if different Than hiem <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 /> PROGRAMS/FUNCTIONS/ACTIVITIES <br /> TOTAL <br /> a,Total program (As of dale) <br /> outlays to date <br /> b.Less: Cumulative program income <br /> D.Net program o utFay;s (Line a minus <br /> line b) <br /> d.Estimated net cash outlays for advance <br /> period <br /> e.Total (Sum of fines c&d) <br /> 1.Non-Federal share of amount on line e <br /> cIeral share of amount on line e <br /> h,Federal payments previously requested <br /> i. Federal share now requested (Line g <br /> minus lime h) <br /> j. Advances required by <br /> month.when requested •l st month <br /> by Federal grantor <br /> agency for use in 2nd month <br /> making prestheduled F <br /> advances <br /> 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 (Rea.7-57} <br /> Prescribed by OMB Circulars A-102 and A-110 <br />