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11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS /ADVANCES REQUESTED <br />OMB APPROVAL NO. <br />PAGE OF <br />(c) <br />0348 -0004 <br />1 2 PAGES <br />REQUEST FOR ADVANCE <br />a.'X " one or both boxes <br />2. BASIS OF REQUEST <br />OR REIMBURSEMENT <br />a. Total program (As of date) <br />® ADVANCE ❑ REIMBURSE - <br />Q $ <br />Q $ <br />TYPE OF <br />MENT <br />® CASH <br />b. 'X" the applicable box <br />PAYMENT <br />b. Less: Cumulative program income <br />(See instructions on back) <br />REQUESTED <br />❑ FINAL ❑ PARTIAL <br />❑ ACCRUAL <br />3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO <br />4. FEDERAL GRANTOR OTHER <br />5. PARTIAL PAYMENT REQUEST <br />WHICH THIS REPORT IS SUBMITTED <br />IDENTIFYING NUMBER ASSIGNED <br />NUMBER FOR THIS REQUEST <br />BYFEDERALAGENCY <br />USDA/NRCS /NC <br />d. Estimated net cash outlays for advance <br />6. EMPLOYER IDENTIFICATION <br />7. RECIPIENT'S ACCOUNT NUMBER <br />8. PERIOD COVERED BY THIS REQUEST <br />FROM (month, day, year) <br />TO (month, day, year) <br />NUMBER <br />OR IDENTIFYING NUMBER <br />9. RECIPIENT ORGANIZATION <br />10. PAYEE (Where check is to be sent if different than item 9) <br />Name: <br />Name: <br />Number <br />Number <br />and Street: <br />and Street: <br />City, State <br />City, State <br />and ZIP Code: <br />and ZIP Code: <br />11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS /ADVANCES REQUESTED <br />12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br />a. Estimated Federal cash outlays that will be made during period covered by the advance <br />b. Less: Estimated balance of Federal cash on hand as of beginning of advance <br />c. Amount requested (Line a minus line b) 1 $ 0.00 <br />AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 (Rev. 7 -97) <br />Prescribed by OMB Circulars A -102 and A -110 <br />Attachment number 1 <br />F -7 Page 180 <br />(a) <br />(b) <br />(c) <br />PROGRAMS /FUNCTIONS /ACTIVITIES low <br />TOTAL <br />a. Total program (As of date) <br />Q <br />$ <br />Q $ <br />Q $ <br />Q $ O o0 <br />outlays to date <br />b. Less: Cumulative program income <br />0.00 <br />0.00 <br />c. Net program outlays (Line a minus <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />line b) <br />d. Estimated net cash outlays for advance <br />0.00 <br />0.00 <br />p eriod <br />e. Total (Sum of lines c & d) <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />f. Non - Federal share of amount on line a <br />0.00 <br />0.00 <br />g. Federal share of amount on line a <br />0.00 <br />0.00 <br />h. Federal payments previously requested <br />0.00 <br />0.00 <br />0.00 <br />i. Federal share now requested (Line g <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />minus line h) <br />1. Advances required by <br />0.00 <br />month, when requested <br />1 st month <br />0.00 <br />by Federal grantor <br />agency for use in making <br />2nd month <br />3rd month <br />0.00 <br />prescheduled advances <br />12. ALTERNATE COMPUTATION FOR ADVANCES ONLY <br />a. Estimated Federal cash outlays that will be made during period covered by the advance <br />b. Less: Estimated balance of Federal cash on hand as of beginning of advance <br />c. Amount requested (Line a minus line b) 1 $ 0.00 <br />AUTHORIZED FOR LOCAL REPRODUCTION (Continued on Reverse) STANDARD FORM 270 (Rev. 7 -97) <br />Prescribed by OMB Circulars A -102 and A -110 <br />Attachment number 1 <br />F -7 Page 180 <br />