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Forms for Non-Governmental Agencies
(includes both non-profit and for profit organizations receiving State grant funds)

Grantee Forms for Reporting on State or Federal Pass-through Grants

    Level 1 Reporting: Receiving less than $25,000
    - Certification Form (.PDF file) (Word file)
    - State Grants Compliance Reporting: < $25,000 (.PDF file) (Word file)
    - Both forms above due within 6 months of organization's year end; submit these to the funding agency only.

    Level 2 Reporting: Receiving at least $25,000 but less than $500,000
    - Certification Form (.PDF file) (Word file)
    - State Grants Compliance Reporting: >= $25,000 (.PDF file) (Word file)
    - Program Activities and Accomplishments Report (.PDF file) (Word file)
    - Schedule of Receipts and Expenditures (.PDF file) (Word file)
    - All forms above due within 6 months of organization's year end; submit these to the funding agency only.

    Level 3 Reporting: Receiving $500,000 or more
    - Certification Form (.PDF file) (Word file)
    - State Grants Compliance Reporting: >= $25,000 (.PDF file) (Word file)
    - Program Activities and Accomplishments Report (.PDF file) (Word file)
    - "Yellow Book" Audit done by CPA to include Schedule of Federal and State Awards (.PDF file) (Excel file)
    - All forms and report due within 9 months of organization's year end; submit these to the funding agency. Note: An A-133 audit may be substituted for the yellow book audit.

Forms for State Agencies

    Forms
    - State Agency Grant Certification - No Overdue Tax Debts Form (.PDF file) (Word file)