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<br />G.R.E.A.T. Program <br /> <br />---. <br /> <br /> OMB APPROVAl. NO. PAGE . OF <br /> , 0348-0004 I PAGES <br /> REQUEST FOR ADVANCE .. ox. OM 01" boIh boJtN 2. BASIS OF REQUEST <br /> OR REIMBURSEMENT 1. o ADVANCE 0 REIMBURSE- <br /> TYPE OF MENT o CASH <br /> . PAYMENT b. ?(" 1M appllubM bolt <br /> (See Instructions on back) REQUESTED o FINAL o PARTIAL o ACCRUAL <br />3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAl ELEMENT TO .. FEDERAL GRANT OR OTHER 5. PARTIAl. PAYMENT REQUEST <br />WHICH THIS REPORT IS SUBMITTED IDENTIFYING NUMBER ASSIGNED NUMBER FOR THIS REQUEST <br /> .. " ,. ... 'BY FEDERAL AGENCY . .- '" <br />e. EMPLOYER IDENTIACATlON 7. RECIPIENrS ACCOUNT NUMBER 8. PERIOD COVERED BY THIS REQUEST <br />NUMBER OR IDENTIFYING NUMBER FROM (month, tMy, yeeQ TO (month, day. )'HIj <br />9. RECIPIENT ORGANIZATION 10. PAYEE (WIler9 check Is to be sent Ifdltrerent than Item 9) <br />Name: Name: <br />Number Number <br />and Street: and Street: <br />City. State City, State <br />and ZIP Code: and ZIP Code: <br /> <br />11. <br /> <br />COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED <br /> <br /> (a) (b) (c) <br />PROGRAMS/FUNCTIONS/ACTIVITIES ~ <br /> TOTAL <br />a. Total program (A3 01 dele) $ $ $ $ <br />outlays to date <br />b. Less: Cumulallve program Income <br />c. Net program outlays (Une a minus <br />'ne b) <br />d. Estimated net cash outlays for advance <br />Derlod <br />e. Total (Sum o( 'nes c & d) <br />, <br />f. Non-Federal share of amount on line e <br />g. Federal share of amount on line e <br />h. Federal payments prevtouslY reQuested <br />I. Federal share now requested (Une 9 , <br />minus Ine h) , <br />J. Advances required by <br />month, when requested 1 st month <br />by Federal grantor 2nd month <br />agency for use In making <br />prescf1eduled advances 3rd month <br /> <br />, <br />" <br /> <br />12. <br /> <br />ALTERNATE COMPUTATION FOR ADVANCES ONLY <br /> <br />a. Estimated Federal cash outla that will be made durl <br /> <br /> <br />the advance <br /> <br />$ <br /> <br />b. Less: Estimated balance of Federal cash on hand as of <br /> <br /> <br />$ <br /> <br />(Continued on Reverse) <br /> <br />STANDARD fORM 270 (RaY. 7.01) <br />Prescribed by OMS Circulars A-102 and A.110 <br />