Budget and Accounting / District Name & No:
Public Service Building / Vendor No.
255 Capitol Street NE / Encumbrance No. EE
Salem, Oregon 97310-0203 / Index No.
REQUEST FOR FUNDS
Name and Address of Recipient:
Title NameSubgrant Number.
Effective Date:
Beginning
Ending
Original Amount Approved / $
Add: Approved Supplements
Deduct: Approved Reduction
Total Approved to Date / $
Instructions: This form must be used to request payment for all subgrants issued prior to July 1, 2004. You must complete a separate Request for Funds form for each subgrant. Submit the signed original. To expedite payment, ensure all required reports are submitted. Refer to instructions on page 2.
Request for Funds Expenditures Only
A. Total funds previously requested / $ ______
B. Less program expenditures through ______(date) / $ ______
C. Balance: Line A minus line B. / $ ______
Note: The balance on line C:
A positive amount reflects the total amount due to the State.
A negative amount reflects the total amount due the Recipient. / ODE USE ONLY
D. Total Amount Due to the Recipient.
(Only complete if line C is a negative figure.) / $ ______
Is this a final request? / Yes / No / If project is completed, please refund any unused cash to the State.
Name & Title of Official Name of Individual Preparing Report
Signature of Authorized Official Date and Phone
ODE Program Use Only: Payment Approval
APPROVED BY: ______DATE: ______Signature of Program Director
Form 581-3140b-X (Rev 10/04) Page 1
Instructions for grant-In-Aid Request for Funds
(FORM 581-3140b-X)
The subgrant is for the period defined on the Notification of Project Approval. No expenditures may be charged to this subgrant prior to or subsequent to the period described. All reports, invoices, and other documentation required must be submitted to the Department of Education within 30 days of the grant ending date. Grant recipients not adhering to this policy may be subject to the loss of some or all of the grant funds.
On-line forms are available by accessing www.ode.state.or.us/opportunities/grants.
General Information
Federal funds are processed under a letter of credit grant award system. Under this system it is NOT necessary to have cash on hand to obligate funds. Districts may not accumulate funds beyond their immediate needs. The grant is authorization to obligate funds by purchase order, contract, etc. for the period stated, and within the dollar limits and under the other conditions stipulated in the grant. Cash may be requested only for the purpose of making actual disbursements to meet payroll and pay invoices, etc., for goods and services already received. The intent is to minimize federal dollars lying idle and from which tax money is paying interest. If you have questions concerning these reports or the receipt of funds, please call 503/378-3600 ext. 4460.
Filling Out the Form: The signed original of the claim must be submitted via US Mail. Submit only one subgrant per claim. Please do not write in areas designated for ODE use only.
Request for Funds: Use the information provided on the project’s original Notification of Project Approval to complete this information.
Request for Funds Expenditures Only:
Line A Fund total from prior requests.
Line B Expenditures as of reporting date
Line C Subtract line B from line A. A positive amount reflects the total amount due to the State. A negative amount reflects the total amount due the Recipient.
Line D If the number in line C is negative, this is the amount the Recipient will be paid.
When you have completed your project, paid all expenditures and drawn all the money you intend to request, check “yes” to indicate this as a final request. Any unused cash must be immediately returned to the Oregon Department of Education, Business Services.
An original signature by authorized personnel is required to process your claim. Claims submitted without original signatures will be returned and payments delayed.
Audit Requirements
If the program includes federal funds, the recipient agrees to comply with the audit requirements of the Single Audit Act of 1984 PL 104-156 and OMB Circular A-133.
Form 581-3140b-X (Rev10/04) Page 2