Instructions for Completion

INSTRUCTIONS FOR COMPLETION

FORM I

1. At the top of the page indicate that this is your Initial/Revision close out for WIA PY’09 Funds.

2.Indicate your status as a For Profit or a Not-for-Profit Organization.

3.Complete the agency information such as agency name, address, phone number, contract number, and contact person. This close-out covers the use of PY’ 09 awards covering the period July 1, 2009 through June 30, 2010. Also, the period covered is reflected on Forms IIand Forms III.

4.Read instructions and complete form II andform III.

5.Read the Contract Close-out Certification statement carefully. When the responsible authority is sure that the presentation is accurate, have the authorized person sign and date the document in blue ink.

FORMS II andIII

1.Identify the award(s) that must be part of this close out. These instructions will help you complete the close out forms IIand IIIfor the awards you are closing out. The header information is linked to Form I.

2.Column 3 – Record your final Award Amount by line item.

3.Column 4 - Indicate the total Actualcosts you incurred for each line item (i.e. Personnel, Fringe Benefits, Operating/Technical, etc.). Please include ALL costs to operate your programs whether or not they were included in the approved FSS budget.

4.Column 5 - Indicate the FSS WIA Reimbursed/Reimbursable (including outstanding vouchers) costs (PY’09 funds), both actual and accrued through June 30, 2010.

5.The system will perform all calculations and transfer the appropriate numbers to Form I.

6.Return to Item 5 above.

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FORMIV

If any property with an acquisition cost of $5,000.00 or more and a life expectancy of one year or more has been acquired during this grant period (07/01/09 – 06/30/10) with WIA funds, the contractor must include a property inventory form.

1.Complete Form IV by filling in your agency’s name, contract number and the name of the person preparing this document.

2.Supply a description of the property, any identifying numbers, and the vendor from where property as purchased, the condition of the property, purchase date, amount and location of the property.

3.Indicate whether the property has been tagged by FSS.

FORMV

1.Complete Form V by filling in your agency’s name, contract number and the agency’s address.

2. The same person who signed Form I must sign Form V in blue ink.

FORMVI

1.Complete Form VIby filling in your agency’s name and contract number.

2.The same person who signed Form I must sign Form VIin blue ink.

FORMVII

1.Complete Form VII by filling in the your agency’s name and the total amount of expenses incurred and accrued against this contract and then separate the total expenses into two amounts: (1) amounts already paid by FSS and (2) amounts still to be paid by FSS.

2.The same person who signed Form I must sign Form VII in blue ink.

3.Note: Please submit a separate Form VII for each funded program (i.e., In-School Youth and Out-of-School Youth).

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