INSTRUCTIONS FOR COMPLETING NSP MONTHLY FINANCIAL STATUS REPORT rev. 01/2010

We suggest that a master document be made with all standard information filled. Standard information includes numbers: 1, 2, 3, 5, 7, and 7E. Monthly reports are to be submitted to your Asset Manager no later than 10 days after the end of the month. Line 3.

Fill in the contract encumbrance number found in the first Whereas paragraph on the first page of the contract.

Line 4.

Regular monthly reports need one original copy. Final reports need two original copies.

Line 5.

The From date is the date of execution, as found on the signature page of the contract. The To date is the date of expiration, as found in the Scope of Services, under Time of Performance.

Line 6.

This can be one of twelve options, January 10, February 10, March 10, etc. Please include the year that applies to the reporting month. The information reported applies only to the month for which the report is prepared.

Line 7.

In the columns listed type the budget item(s) that the DOH funds are designated for, as shown in the Scope of Services -- Project Budget. Other Funds, includes CDOH money going into the project from sources other than the NSP contract funds. Row 7. A)

For each budget category enter the amount spent in that category during this contract. List the sum of all budget categories in the TOTAL column.

Row 7. b)

Report the actual amount spent (check written) during this month for each budget category. Total these columns in 7. F), and include other funds spent, in column G).

Row 7. c)

Add rows a) and b) together for each column.

Row 7. d)

Include bills received, but the check has not been written, for each column including G) Other Funds.

Row 7. e)

Add rows c) and d) together for each column.

Row 7. f)

Type the budget amount(s) for the DOH designated funds, as shown in the Scope of Services -- Project Budget.

Row 7. g)

Subtract row e) from row f)

Line 8.

Add all payment requests sent to the DOH by the end of this month.

Line 9.

Type the name of the certifying official where indicated, and have them sign the report. If the report preparer is different from the certifying official, type their name and telephone number where indicated. Finally, fill in the date that the report was prepared.

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