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["FLORIDA DEPARTMENT OF EDUCATION"]
["PROGRAM INCOME SUMMARY WORKSHEET"]
["Adult Education and Family Literacy Act of 1998 (AEFLA)"]
[]
["The completion and submission of this form is required for all Adult Education and Family Literacy projects regardless of the calculated amount of program income."]
[]
["Enter Agency Info:"]
[]
["(1) District/College Name"]
[]
["(2) Contact Person ",null,"Name"]
[null,null,"Phone"]
[null,null,"E-mail"]
[]
["(3) Program Income Reporting Methods",null,null,null,"Addition"]
[{"$nulls":4},"Deduction"]
[]
["Step 1:","Calculate percentage of the total cost of the program supported by AEFLA funds ONLY:"]
[]
["(4)\n Row\n No.","(5)\nAgency\nProject No.","(6)\nProject/\nProgram Title","(7)\nAEFLA Grant\nAward Amount","(8)\n% of AEFLA\nGrant Amount","(9)\nReportable Federal\nProgram Income\n(Special Revenue)",null,"(10)\nDisbursement Reported on DOE 499"]
[{"$nulls":5},"Reportable Federal"]
[{"$nulls":5},"Program Income",null,"Program Instruction\n(0-8)",null,"Program Instruction"]
[{"$nulls":5},"(Special Revenue)",null,"(0-8)",null,"(9-12)"]
[1,null,null,null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
[2,null,null,null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
[3,null,null,null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
[4,null,null,null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
[5,null,null,null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
["(11) Totals",null,null,0,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"},null,0,null,0]
[{"$nulls":7},"Grand Total Disbursement (0-12)",null,0]
["(12) Total Program Costs of AEFLA-Supported Activities (from eligible programs)"]
[]
["(13) % Supported by AEFLA Grant Award",null,null,{"$error":"#DIV/0!"}]
[]
[]
["Step 2:","Costs incurred to generate program income may be deducted from gross income to determine program income.",{"$nulls":5},"(21) CERTIFICATION: "]
[{"$nulls":7},"I hereby certify that I have reviewed this Program Income Summary Worksheet and that all items shown above are in accordance with applicable law and regulation, and have been classified properly according to this agency's financial accounting.  All records necessary to substantiate these items are available for monitoring.  I further certify that all Federal program income was obligated after the project approval date and prior to the termination date and have not been reported previously."]
[]
["(14) Gross Program Income Generated by AEFLA Grant Award (from eligibile programs)"]
[]
["(15) Costs Incurred to Generate Program Income"]
[]
["(16) Net Adult Education Program Income",{"$nulls":4},0]
[]
["Step 3:","Determination of Program Income:"]
[]
["(17) Net Adult Education Program Income",{"$nulls":4},0,null,"Certified Correct ______________________________________"]
[{"$nulls":8},"Finance Officer or Authorized Representative"]
["(18) % Supported by AEFLA Grant Award",{"$nulls":4},{"$error":"#DIV/0!"}]
[]
["(19) Reportable Federal Program Income (Special Revenue)",{"$nulls":4},{"$error":"#DIV/0!"},null,"Date ___/___/___"]
[]
["(20) Percentage (%) of Reportable Federal Program Income:",{"$nulls":8},"DOE","Audited by: ___________________"]
[{"$nulls":9},"USE","Date ___/___/___"]
[null,null,"Program Instruction (0-8)",null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
[null,null,"Program Instruction (9-12)",null,{"$error":"#DIV/0!"},{"$error":"#DIV/0!"}]
[]
["DOE 499A"]
["Rev 03/12"]
[]
[]
["PROGRAM INCOME SUMMARY WORKSHEET"]
["INSTRUCTIONS"]
[]
["COMPLETE ITEMS (1) THROUGH (21)."]
[]
["Federal Programs:",null,"Submit two copies, with original signature, and the DOE 499, Project Disbursement form by August 20, following the project end date: Comptroller's Office, Florida Department of Education, 944 Ralph Turlington Building, Tallahassee, Florida 32399-0400, (850) 487-2460."]
["State Programs:",null,"Do not submit monthly disbursement reports unless instructed to do so by the Comptroller's Office or the state grant program."]
[]
["(1)","Enter in District/College Name. Use the Project Recipient exactly as it appears in Box 1 on Form DOE 200 (Project Award Notification)."]
["(2)","Enter in Contact Person Name/Phone/E-mail. "]
["(3)","All agencies are required to identify their selected Program Income Reporting Method. EDGAR [§80.25(b)] and the Green Book describe the two alternatives for applying program income to the AEFLA grants: (1) deducting program income from the total allowable costs to determine the net allowable costs, thus reducing the Federal agency’s or grantee’s contributions; or (2) adding program income to the funds committed by the grant, thereby increasing the total amount committed to the grant program. "]
["(4)","Five rows have been provided for all AEFLA projects to be listed and accounted for."]
["(5)","Use the Project Number exactly as it appears in Box 2 on Form DOE 200 (Project Award Notification)."]
["(6)","Use the Project/Program Title exactly as it appears in Box 3 on Form DOE 200 (Project Award Notification)."]
["(7)","Use the Authorized Funding Approved Budget Amount exactly as it appears in Box 7 on Form DOE 200 (Project Award Notification). The total sum must agree with the total award amount reported on Form DOE 499, and the sum will auto-populate in Row (11)."]
["(8)","The Percentage of AEFLA Grant Amount is automatically calculated by dividing each row in Column (8) by the Total AEFLA Grant Award in Row (11). The sum of the percentages should total exactly 100.00% and will auto-populate in Row (11)."]
["(9)","The Reportable Federal Program Income (Special Revenue) in Column (9) will auto-populate once the entire form is complete. The sum will auto-populate in Row (11)."]
["(10)","Enter the Disbursement Amounts for both Programs of Instruction (0-8) and (9-12), found on Rows (9) and (10) of Form DOE 499."]
["(11)","The Totals for AEFLA Grant Award, Percentage of AEFLA Grant Amount, and Disbursement for Program Instruction [the sums for (0-8) and (9-12)] will auto-populate. The Reportable Federal Program Income (Special Revenue) sum will auto-populate once the entire form is complete. This amount should balance with the amount in Row (19)."]
["(12)","Enter in Total Program Costs of AEFLA-Supported Activities (Include appropriate expenditures from all revenue sources). Below are lists of adult general education programs which are AEFLA and non-AEFLA supported. Only AEFLA supported programs should be included in the total cost calculation."]
[null,"AEFLA Supported Programs",null,"Program Number","CIP Number",null,"Non-AEFLA Supported Programs",null,null,null,"Program Number","CIP Number"]
[null,"Adult Basic Education",null,9900000,1532.0102,null,"Adult High School co-enrollment",null,null,null,9900099,1532.0199]
[null,"Adult High School - note: Does not include co-enrolled high school program (see below)",null,9900010,1532.010202,null,"Adult General Education for Adults with Disabilities Plan",null,null,null,9900100,1532.010204]
[]
[null,"GED® Preparation",null,9900130,1532.010204,null,"Literacy Skills of Adult ESOL Learners",null,null,null,9900300,1532.010303]
[null,"English for Speakers of Other Languages (ESOL)",null,9900040,1532.0103,null,"Adult ESOL College and Career Readiness",null,null,null,9900051,1532.010302]
[null,"English Literacy for Career and Technical Education (ELCATE)",null,9900050,1532.010301,null,"Citizenship",null,null,null,9900090,1533.0102]
[{"$nulls":6},"Applied Academics for Adult Education",null,null,null,"S990001",1532.010503]
["(13)","The Percentage Supported by AEFLA Grant Award will auto-populate. This is determined by dividing the Total AEFLA Grant Award in Row (11) by the Total Cost of Adult Education Program in Row (12). This percentage will also auto-populate in Row (18)."]
["(14)","Enter in the Gross Program Income Generated by AEFLA Grant Award (Total Block Tuition and Out-of-State Fees collected for applicable programs as identified in Step 12.)."]
["(15)","Enter in the Costs Incurred to Generate Program Income."]
["(16)","The Net Adult Education Program Income will auto-populate. This is determined by subtracting Costs Incurred to Generate Program Income in Row (15) from the Gross Program Income in Row (14). This number will also auto-populate in Row (17)."]
["(17)","The Net Adult Education Program Income will auto-populate from Row (16)."]
["(18)","The Percentage Supported by AEFLA Grant Award will auto-populate from Row (13)."]
["(19)","The Reportable Federal Program Income (Special Revenue) will auto-populate. This is determined by multiplying The Total Adult Education Program Income in Row (17) by the Percentage Supported by AEFLA Grant Award in Row (18). The amount populated in Row (19) should balance with the amount auto-populated in Row (11). If Row (19) results in a negative amount, there is no reportable Federal income."]
["(20)","The Percentage (%) of Reportable Federal Program Income will auto-populate by dividing the Total Disbursement for Program Instruction Row (11) by the Reportable Federal Program Income (Special Revenue) Row (19)."]
["(21)","The Finance Officer or authorized representative must certify and date the Program Income Summary Worksheet."]
["DOE 499A"]
["Rev 03/12"]