Standard Form 272a - Federal Cash Transactions Report printable pdf download

FEDERAL CASH TRANSACTIONS REPORT

OMB APPROVAL No. 0348-0003

CONTINUATION

1. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL

(This form is completed and attached to Standard Form 272 only when reporting

ELEMENT TO WHICH THIS REPORT IS SUBMITTED

more than one grant or assistance agreement.)

2. RECIPIENT ORGANIZATION

(Give name only as shown in item 2, SF-272)

3. PERIOD COVERED BY THIS REPORT (As shown on SF-272)

FROM (month, day, year)

TO (month, day, year)

4. List information below for each grant or other agreement covered by this report. Use additional forms if more space is required.

FEDERAL GRANT OR OTHER

RECIPIENT ACCOUNT NUMBER

FEDERAL SHARE OF NET DISBURSEMENTS

IDENTIFICATION NUMBER

OR OTHER

(Show a subdivision by other

NET DISBURSEMENTS (Gross

IDENTIFYING NUMBER

CUMULATIVE

identifying numbers if required by the

disbursements less program income

NET DISBURSEMENTS

Federal Sponsoring Agency)

received) FOR REPORTING PERIOD

(a)

(b)

(c)

(d)

TOTALS (Should correspond with amounts shown on SF 272 as follows:

column (c) the same as line 11h; column (d) the sum of lines 11h and 11i

of the SF-272 and cumulative disbursements shown on last report. Attach

explanation of any differences.)

Public reporting burden for this collection of information is estimated to average 120 minutes per response, including time for reviewing instructions, searching

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden

estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork

Reduction Project (0348-0003), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET.

SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 272A (Rev. 7-97)

Previous Edition Usable

Prescribed by OMB Circulars A-102 and A-110

272-203