Instructions For Completing The Sf-425 Form Gpd Capital And Van Grants (Page 4 of 4) in pdf

Instructions For Completing The Sf-425 Form Gpd Capital And Van Grants Page 4

Instructions For Completing the SF -425 Form

GPD Capital and Van Grants

INDIRECT EXPENSE:

Blocks 11a-11g:

The recipient should capture whether indirect expenses are charged to the GPD project by completing all

required fields under block 11. Forward a copy of your agency’s indirect rate agreement to the GPD Office If

indirect costs were attributed to the project.

NOTE: Indirect costs are not an allowable under the Capital Grant component.

11(a)

Type of Rate(s)

N/A

11(b)

Rate

N/A

11(c)

Period From; Period To

N/A

11(d)

Base

N/A

11(e)

Amount Charged

N/A

11(f)

Federal Share

N/A

11(g)

Totals

N/A

REMARKS, CERTIFICATION, AND AGENCY USE ONLY

Remarks

Record the number of bed days of care

provided during the reporting period in the

field identified as Bed Days (i.e., 2,670 bed

days of care provided).

13(a)

Typed or Printed Name and Title of

Enter the name and title of the authorized

Authorized Certifying Official

certifying official.

13(b)

Signature of Authorized Certifying Official

The authorized certifying official must sign

here.

13(c)

Telephone (area code, number and

Enter the telephone number (including area

extension)

code and extension) of the individual listed in

Line 13a.

13(d)

E-mail Address

Enter the e-mail address of the individual

listed in Line 13a.

Enter the date the FFR is submitted to the

13(e)

Date Report Submitted (Month, Day, Year)

Federal agency using the month, day, year

format.

Agency Use Only

This section is reserved for Federal agency

use.

Instructions For Completing The Sf-425 Form Gpd Capital And Van Grants Page 4

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