DIRECT SERVICES PROVIDER

FINANCIAL STATUS REPORT -- PART 1

(1) Local Partnership Name:

(5) Contract #:

(2) Direct Service Provider Name:

(6) Contract Period:

(3) Activity Name:

(7) Period Covered by Column D:

(4) Final Report  [   ]    Amended Report  [   ]

(8) Period Covered by Column C:

(9)

(10)

(11)

(12)

(13)

A.              Approved           Budget

B.                Previously Reported Expenditures

C.                        Current Period Expenditures

D.                                 Year to Date Expenditures    (Column B+C)

E.         Unexpended Budget          (Column A-D)

Expenditure Categories

11) Personnel

12) Contracted Professional Services

13)          Total Personnel/ Contracted Services Costs

14) Office Supplies and Materials

15) Service-Related Supplies and Materials

16)                            Total Supplies & Materials Costs

17) Travel

18) Communications and Postage

19) Utilities

20) Printing and Binding

21) Repair and Maintenance

22) Meeting/Conference Expense

23) Employee Training (no travel)

24) Advertising and Outreach

25) Not Available for Use

26)                     Total Non-Fixed Operating Expenses

27) Office Rent (Land, Buildings, etc.)

28) Furniture Rental

29) Equipment Rental (Phones, Computer, etc.)

30) Vehicle Rental

31) Dues, Subscriptions and Fees

32) Insurance and Bonding

33) Books/Library Reference Materials

34) Not Available for Use

35) Other Expenses

36)                  Total Fixed Charges & Other Expenses

39) Furniture/Non-Computer Eqpt., $500+ per item

40) Computer Equipment/Printers, $500+ per item

41) Furniture/Eqpt., under $500 per item

42)                       Total Property & Equipment Outlay

43) Purchase of Services

44) Contracts With Service Providers

45) Stipends/Scholarships

46) Cash Grants and Awards

47) Non-Cash Grants and Awards

48)                            Total Services/Contracts/Grants

50)                                Total Budgeted Expenditures