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["Entity:",null,null,null,null,null,"Fiscal Year End (FYE):"]
["Based on the type of grant expenditures claimed during the reporting FYE, please answer both \nPart I. State Funds and Part II. Federal Funds Sections below:"]
[]
["Part I. State Funds",null,false]
["For Expenditures of State Funding Check appropriate box below:"]
[null,"We have exceeded the $750,000 state expenditure threshold for the fiscal year referenced above. We will have our Single Audit or Program Specific Audit completed and will submit the audit report to SAandACF@tdhca.texas.gov within nine (9) months after the end of the audited fiscal year."]
[null,"We did not exceed the $750,000 state expenditure threshold for the fiscal year referenced above. A Single Audit or a Program Specific Audit is not required for this fiscal year. (Complete the State Funds Schedules below)"]
[]
["State Funds Schedule "]
["State Grantor",null,"Pass-through Grantor ",null,"Program Name ",null,"Contract Number",null,"Expenditures"]
[{"$f":"IF(C4,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C4,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C4,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C4,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C4,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C4,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
["Total State Expenditures for the Fiscal Year",null,null,null,null,null,null,null,{"$f":"SUM(I11:I16)","v":0}]
[]
["Part II. Federal Funds",null,false]
["For Expenditures of Federal Funding Check appropriate box below:"]
[null,"We have exceeded the $750,000 federal expenditure threshold or have an outstanding loan balance associated with a federal resource of $750,000 or more with continuing compliance requirements, or a combination thereof for the fiscal year referenced above.. We will have our Single Audit or Program Specific Audit completed and will submit the audit report to the Federal Audit Clearinghouse AND notice of submission to SAandACF@tdhca.texas.gov within nine (9) months after the end of the audited fiscal year."]
[null,"We did not exceed the $750,000 federal expenditure threshold or have an outstanding loan balance associated with a federal resource of $750,000 or more with continuing compliance requirements, or a combination thereof for the fiscal year referenced above. A Single Audit or a Program Specific Audit is not required for this fiscal year. (Complete the Federal Funds Schedules below)"]
[]
["Federal Funds Schedule "]
["Federal Grantor",null,"Pass-through Grantor ",null,null,"Program Name / CFDA #","Contract Number",null,"Expenditures"]
[{"$f":"IF(C19,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C19,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C19,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C19,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C19,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
[{"$f":"IF(C19,\"NA\",\"\")","v":""},null,null,null,null,null,null,null,0]
["Total Federal Expenditures for the Fiscal Year",null,null,null,null,null,null,null,{"$f":"SUM(I26:I31)","v":0}]
[]
["I certify that I understand that fines and imprisonment up to five years are penalties for knowingly and willfully making a materially falso, fictious, or fraudulent statement or entry in any matter within the jurisdiction of the deferal government (18 U.S.C. Sec. 1001)"]
[]
[]
["Authorized Signature ",null,null,null,null,"Printed Name ",null,null,"Title"]
[]
["Email Address",null,null,null,null,null,null,null,"Phone Number"]
["Unless directed otherwise during the application process, submit this form wiithin 60 days after the end of the fiscal year to: \nCompliance Division \nSAandACF@tdhca.texas.gov"]