HomeMy Public PortalAboutsf425_AIP030_12.15.2023Federal Financial Report
(Follow form Instructions)
OMB Number: 4040-0014
Expiration Date: 02/28/2025
1. Federal Agency and Organizational Element to Which Report is Submitted 2. Federal Grant or Other Identifying Number Assigned by Federal
Agency (To report multiple grants, use FFR Attachment)
3. Recipient Organization (Name and complete address including Zip code)
Recipient Organization Name:
Street1:
Street2:
City: County:
State:Province:
Country:ZIP / Postal Code:
4a. UEI 4b. EIN 5. Recipient Account Number or Identifying Number
(To report multiple grants, use FFR Attachment)
6. Report Type
Quarterly
Semi-Annual
Annual
Final
7. Basis of Accounting
Cash
Accrual
8. Project/Grant Period
From: To:
9. Reporting Period End Date
10.Transactions Cumulative
(Use lines a-c for single or multiple grant reporting)
Federal Cash (To report multiple grants, also use FFR attachment):
a. Cash Receipts
b. Cash Disbursements
c. Cash on Hand (line a minus b)
(Use lines d-o for single grant reporting)
Federal Expenditures and Unobligated Balance:
d. Total Federal funds authorized
e. Federal share of expenditures
f. Federal share of unliquidated obligations
g. Total Federal share (sum of lines e and f)
h. Unobligated balance of Federal Funds (line d minus g)
Recipient Share:
i. Total recipient share required
j. Recipient share of expenditures
k. Remaining recipient share to be provided (line i minus j)
Program Income:
l. Total Federal program income earned
m. Program Income expended in accordance with the deduction alternative
n. Program Income expended in accordance with the addition alternative
o. Unexpended program income (line l minus line m or line n)
City of McCall 3-16-023-030-2023
City of McCall
216 E. Park St.
ID
83638
JN7SN9LGRV66 JN7SN9LGRV66
10/1/23 9/30/23
09/30/2023
13,000.00
13,000.00
0.00
13,000.00
13,000.00
13,000.00
0.00
0.00
McCall
View Burden Statement
n
DocuSign Envelope ID: 27F4E244-9093-47C4-81BB-0FAE47851722
11. Indirect Expense
a. Type b. Rate c.Period From Period To d. Base
e. Amount f. Federal ShareCharged
g. Totals:
12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation:
Add Attachment Delete Attachment View Attachment
13. Certification: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the
expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I
am aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730
and 3801-3812).
a. Name and Title of Authorized Certifying Official
Prefix: First Name: Middle Name:
Last Name: Suffix:
Title:
b. Signature of Authorized Certifying Official c. Telephone (Area code, number and extension)
d. Email Address e. Date Report Submitted 14. Agency use only:
Standard Form 425
0.00
Robert
Giles
Mayor
208-634-7142
bgiles@mccall.id.us 12/29/2023
0.00 0.00
DocuSign Envelope ID: 27F4E244-9093-47C4-81BB-0FAE47851722