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EXHIBIT 5 <br />FEDERAL FINANCIAL REPORT <br />(Follow form instructions) <br />1. Federal Agency and Organizational Element to Which <br />Report is Submitted <br />2. Federal Grant or Other Identifying Number Assigned by Federal Agency (To <br />report multiple grants, use FFR Attachment) <br />Page of <br />1 <br />pages <br />3. Recipient Organization (Name and complete address including Zip code) <br />4a. DUNS Number <br />4b. EIN <br />5. Recipient Account Number or Identifying <br />Number (To report multiple grants, use FFR <br />Attachment) <br />6. Report Type <br />❑ Quarterly <br />Q Semi- Annual <br />LJ Annual <br />Final <br />7. Basis of Accounting <br />Cash <br />Q Accrual <br />8. Project /Grant Period (Month, Day, Year) <br />From: To: <br />9. Reporting Period End Date (Month, Day, Year) <br />10. Transactions Cumulative <br />Use lines a -c for single or combined multiple grant reportin <br />Federal Cash To report multiple grants separately, also use FFR Attachment): <br />a. Cash Receipts <br />b. Cash Disbursements <br />c. Cash on Hand line a minus b <br />Use lines d -o for single grant reportin <br />Federal Expenditures and Unobli ated Balance: <br />d. Total Federal funds authorized <br />e. Federal share of expenditures <br />f. Federal share of unli uidated obligations <br />q. Total Federal share sum of lines a and <br />h. Unobli ated balance of Federal funds line d minus <br />Recipient Share: <br />i. Total recipient share required <br />i. Recipient share of expenditures <br />k. Remaining recipient share to be provided line i minus <br />Program Income: <br />I. Total Federal share of program income earned <br />m. Program income expended in accordance with the deduction alternative <br />n. Program income expended in accordance with the addition alternative <br />o. Unex ended program income line I minus line m or line n <br />11. <br />Indirect <br />a. Type <br />b. Rate <br />c. Period Period To <br />From <br />d. Base <br />e. Amount Charged <br />f. Federal Share <br />Expense <br />Totals: <br />12. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation: <br />13. Certification: By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the <br />expenditures, disbursements and cash receipts are for the purposes and intent set forth in the award documents. I am aware that any false, <br />fictitious, or fraudulent information may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) <br />a. Typed or Printed Name and Title of Authorized Certifying Official <br />c. Telephone (Area code, number, and extension) <br />d. Email Address <br />b. Signature of Authorized Certifying Official <br />e. Date Report Submitted (Month, Day, Year) <br />14. Agency use only: <br />Standard Form 425 - Revised 10/11/2011 <br />OMB Approval Number: 0348 -0061 <br />Expiration Date: 2/28/2015 <br />Paperwork Burden Statement <br />According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The <br />valid OMB control number for this information collection is 0348 -0061. Public reporting burden for this collection of information is estimated to average 1.5 hours per <br />response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection <br />of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office <br />of Management and Budget, Paperwork Reduction Project (0348 - 0061), Washington, DC 20503. <br />F -7 Page 196 <br />