| Project Cost Category | FedNor Rate of Assistance (percentage) | Actual Claimed To (YYYY-MM-DD) | Month | Month | Month | Month | Month | Month | Month | Month | Month | Month | Month | Month | TOTALYEAR 1 | Year (Enter project fiscal, i.e., Jan/12 to Dec/12) | Year (Enter project fiscal, i.e., Jan/12 to Dec/12) | Total Forecasted and Claimed | Variance (Annex 1 less Total Forecasted) | Eligible Costs (per Annex 1) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| i.e., Salary & Benefits | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| i.e., Regional Travel | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Total | - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - | $ - |
Prepared by
Date (YYYY-MM-DD)