(*) Data with this notation will be published in our annual Federal Funds to State Agencies.
CGFA – Commission on Government Forecasting & Accountability - 802 Stratton Building, Springfield, IL 62706 217/782-5320 2/2019
FORM CGFA-191
FEDERAL AID INFORMATION (SURVEY) FY 20
1. Agency: (Division(s) Receiving/Administering Funds)
2. Program Title:
3. CATALOG OF FEDERAL DOMESTIC
ASSISTANCE NUMBER (CFDA #)
(CGFA INTERNAL USE ONLY)
4. Federal Granting Agency:
5. Agency Division and Number
6. Type of Program:
Formula Grant Project Grant Contract
Other (Specify):_________________________________________________
7. Type of Payment Mechanism:
“Draw Down” as required Regular Installment
Reimbursement-portion of expenditures Lump sum in advance
Other (Specify):________________________________________________________
8. Federal funds are deposited in the following State Treasury Fund(s) (*)
Treasury Fund No. _________________________________ Treasury
Fund Name ____________________________________________________________________________
Treasury Fund No. _________________________________ Treasury Fund Name ____________________________________________________________________________
9. Were funds Appropriated by the General Assembly?
FY 2019 Yes No
FY 2020 Yes No
10. Under what authority does your Agency receive and expend these funds?
ILCS: Chapter______________________Section________________________________________
11. Matching Requirements:
State Match Required to be: Cash In Kind
If Yes, specify:
Federal %
State %
Local %
State Match Required? Yes No
Source of State Match:
Treasury Fund No. _________ Treasury Fund Name ___________________________________________
If no Local Match is indicated, does the program allow use of Local funds in lieu of State Match? Yes No
12. Indirect Costs: Is your agency operating under a federally approved indirect costs reimbursement plan? Yes No
If Yes, will the reimbursement amount be set by: an indirect cost rate? a cost allocation plan? a negotiated lump sum for overhead costs?
Estimated indirect costs to be recovered from the federal government: FY 2019 $_________________________________ FY 2020 $_________________________________
13. Source of Funds:
Direct from the federal government (Appendix B*)
Indirect; through an intermediary (Appendix C*) (Specify Agency): ______________________________________________________________________________________
14. What would be the total cost to the State if federal funds available under this program were discontinued and the State assumed full financial responsibility?
FY 2019 $________________________________________________________________ FY 2020 $____________________________________________________________
15. Are some of these funds subgranted to other state agencies?
Yes No
If YES, list probable state agency and amounts:
17. Planning and Reporting Requirements:
Does the granting agency require
planning document? Yes No
Does the granting agency require other reports? Yes No If YES, complete items below:
A. Evaluation Report Annual Quarterly Monthly Other
B. Financial Report Annual Quarterly Monthly Other
C. Performance Report Annual Quarterly Monthly Other
16. Are some of these funds subgranted to local governments?
Yes
No
D. Other (please specify)
____________________________________________________________________________
(IN THOUSANDS OF DOLLARS)
PROGRAM FISCAL INFORMATION
Amount of funds legally available from allocation. (Enter NA if not a formula grant.)
19. Available Awards: (*)
A. Amount of federal funds awarded (*)
B. Amount of federal funds carried over from previous years.
C. TOTAL federal funds available for expenditure (A+B).
D. Amount of STATE funds awarded.
E. Amount of LOCAL funds awarded.
F. Amount of OTHER funds awarded.
G. TOTAL funds available for expenditure (C+D+E+F).
PROGRAM INFORMATION (*)
Please provide information on the State programs and services provided with these funds. For example, the Preventive Health Services Block Grant supports programs for hypertension, rape crisis centers,
and grants to local health agencies. The area served might be “statewide” or a particular target area such as “city” or “county.” Also provide an estimate of the number of persons/clients served by each program.
20. State Program Name (*) additional data can be submitted on a separate page if needed
21. Survey completed by: Single Point of Contact for your agency Y
es No
.
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