HomeMy Public PortalAbout2023.01.11 SF270-V1.0 MYL AIP 028 FINAL signedOMB Number: 4040-0012
Expiration Date: 01/31/2025
ADVANCE
a. "X" one or both boxes
REIMBURSEMENT
b. "X" the applicable box
FINAL
PARTIAL
2. BASIS OF REQUEST
CASH
ACCRUALREQUEST FOR ADVANCE
OR REIMBURSEMENT
1.
TYPE OF
PAYMENT
REQUESTED
3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL
ELEMENT TO WHICH THIS REPORT IS SUBMITTED
3-16-0023-028-2020Federal Aviation Administration
4. FEDERAL GRANT OR OTHER IDENTIFYING NUMBER
ASSIGNED BY FEDERAL AGENCY
5. PARTIAL PAYMENT REQUEST
NUMBER FOR THIS REQUEST
17 1889226110000
6. EMPLOYER IDENTIFICATION
NUMBER
82-6000022
7. FINANCIAL ASSISTANCE
IDENTIFICATION NUMBER
08/31/202204/30/2020
8. PERIOD COVERED BY THIS REQUEST
From: To:
Name:City of McCall
9. RECIPIENT ORGANIZATION
Street1:
Street2:
City:
State:
ZIP / Postal Code:
Country:
County:
Province:
216 E. Park Street
McCall
Valley
ID: Idaho
USA: UNITED STATES
83638-0000
Name:
10. PAYEE (Where check is to be sent if different than item 9)
Street1:
Street2:
City:
State:
ZIP / Postal Code:
Country:
County:
Province:
11 . COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED
PROGRAMS/FU NCTI ONS/ (a) 20 .106 (b1 (c)
ACT IVITIES
TOTAL
(As of date) a . Total program
outlays to date 1 0811012022 I $1 366 ,332 . oo l $ $ I $ I 366 ,332 .00 1
b . Less: Cumula tive p rogram I I I income
c . Net program outlays (Lin e a I 366 ,332 .00 1 I I 366 ,332 .00 1 minus line b)
d . Estimated net cas h outlay s for I I I advan ce period
e . Total (Sum oflines c & d) I 366 ,332 . oo l I I 366 ,332 . oo l
f . Non-Fede ral sh are o f amount I I I on line e
Federal sha re of amoun t o n
366 ,332 . oo l g . I 366 ,332 .oo l I I line e
h . Federal payments prev iously I 315 ,151 .83 1 I I 315 ,151 .83 1 requested
Federal share now requested 51,180 .17 1 I 51 ,180 ,17 1 i. I I I (Line g minus lin e h) ~
j. Ad van ces required 1st month I I by month , when
requested by Fede ral
2nd month I I granter agen cy for
use in ma ki ng
prescheduled 3rd month I r ad van ces
12 . ALTERNATE COMPUTATION FOR ADVANCES ONLY
a . Estimated Fede ra l cash outlays tha t w ill be made during period cove red by the ad vance $
b . Less: Estima ted balance of Federa l cas h on hand as of beg inning of advance period
c . Amount req u ested (Line a minus line b) $
13 . CERTIFICATION
I certify that to th e best of my know ledge and bel ief the data o n the reverse are co rrect an d th at al l outla y s we re made in accordance wi th th e g rant
conditions or othe r ag reement and that payment is due and has not bee n previously reques ted .
S IGNAT URE O R AUTH OR IZED C ERTIFY IN G OFFIC IA L DATE R EQ UE ST S U BMITTED
I I
TY P ED OR P RI NTED NAME AN D TITLE
Prefi x : I Fi rst Name : !Robe r t
Last Name : Gi les
Midd le Name: s . ~---====:::;--------'
Suffix:
Title : Mayo r
TELEPHONE (AREA CODE , NUM BER , EXTENSION )
1208 -673 4 -71 4 2 I
T h is spa ce for agency use
Publi c report ing burd en for this co ll ecti o n of in forma tion is estimated to average 60 mi n utes per response , includ in g time for rev iewin g instructi o ns ,
searching existin g data sources , gath e rin g and maintai nin g th e data needed , an d com pl eting a nd review ing th e co ll ection of info rmatio n . Send
comments rega rdin g the burden es tim ate or a ny other aspect of th is co ll ection of in fo rmati on , in cluding suggesti on s fo r redu cing th is bu rden , to the
Office of Managemen t and Budget , Paperwo rk Reduction Project (0348-0004), Washi ngto n , 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 .
I
I
I
01/11/2023
INSTRUCTIONS
Please type or print legibly. Items 1, 3, 5, 9, 10, 11e, 11f, 11g, 11i, 12 and 13 are self-explanatory; specific instructions
for other items are as follows:
2 Indicate whether request is prepared on cash or accrued
expenditure basis. All requests for advances shall be
prepared on a cash basis.
4 Enter the Federal grant number, or other identifying number
assigned by the Federal sponsoring agency. If the advance
or reimbursement is for more than one grant or other
agreement, insert N/A; then, show the aggregate amounts.
On a separate sheet, list each grant or agreement number
and the Federal share of outlays made against the grant or
agreement.
6 Enter the employer identification number assigned by the
U.S. Internal Revenue Service, or the FICE (institution)
code if requested by the Federal agency.
7 This space is reserved for an account number or other
identifying number that may be assigned by the recipient.
8 Enter the month, day, and year for the beginning and
ending of the period covered in this request. If the request
is for an advance or for both an advance and
reimbursement, show the period that the advance will
cover. If the request is for reimbursement, show the period
for which the reimbursement is requested.
Note: The Federal sponsoring agencies have the option of
requiring recipients to complete items 11 or 12, but not
both. Item 12 should be used when only a minimum
amount of information is needed to make an advance
and outlay information contained in item 11 can be
obtained in a timely manner from other reports.
11 The purpose of the vertical columns (a), (b), and (c) is to
provide space for separate cost breakdowns when a
project has been planned and budgeted by program,
function, or activity. If additional columns are needed, use
Item Entry
as many additional forms as needed and indicate page
number in space provided in upper right; however, the
summary totals of all programs, functions, or activities
should be shown in the "total" column on the first page.
11a Enter in "as of date," the month, day, and year of the
ending of the accounting period to which this amount
applies. Enter program outlays to date (net of refunds,
rebates, and discounts), in the appropriate columns. For
requests prepared on a cash basis, outlays are the sum
of actual cash disbursements for goods and services,
the amount of indirect expenses charged, the value of
in- kind contributions applied, and the amount of cash
advances and payments made to subcontractors and
subrecipients. For requests prepared on an accrued
expenditure basis, outlays are the sum of the actual
cash disbursements, the amount of indirect expenses
incurred, and the net increase (or decrease) in the
amounts owed by the recipient for goods and other
property received and for services performed by
employees, contracts, subgrantees and other payees.
11b Enter the cumulative cash income received to date, if
requests are prepared on a cash basis. For requests
prepared on an accrued expenditure basis, enter the
cumulative income earned to date. Under either basis,
enter only the amount applicable to program income
that was required to be used for the project or program
by the terms of the grant or other agreement.
11d Only when making requests for advance payments,
enter the total estimated amount of cash outlays that
will be made during the period covered by the advance.
13 Complete the certification before submitting this request.
Item Entry