17-CA/I-001
Automotive Industry Apprenticeship Trust Fund

Financial Status Report
(Short Form)
1. Federal Sponsoring Agency and Organizational Element to Which Report is Submitted:

Federal Mediation and Conciliation Service, Grants
2. Federal Grant or Other Identifying No. Assigned by Federal Agency:

OMB Approval No.

3076-0006
Exp: 11/30/2020
3. Recipient Organization (Name and complete address, including ZIP code)




,

4. Employer Identification No.

5. Final Report 6. Basis
Yes X No X Cash Accrual
7. Funding/Grant Period
From: (Month, Day, Year)

To: (Month, Day, Year)

8. Period Covered by this Report
From: (Month, Day, Year)

10/01/2010
To: (Month, Day, Year)

12/31/2010
9. Transactions: I
Previously Reported
II
This Period
III
Cumulative
a: Total Outlays $0.00 $43.15
b: Recipient share of outlays $0.00 0.00
c: Federal share of outlays $0.00 43.15
d: Total unliquidated obligations 43.15
e: Recipient share of unliquidated obligations

(Grantee Match)
0.00
f: Federal share of unliquidated obligations $43.15
g: Total Federal share (Sum of lines c and f) $86.30
h: Total Federal funds authorized for this funding period $50,892.00
i: Unobligated balance of Federal funds (Line h minus line g) $50,805.70
10. Remarks: Attach any explanations deemed necessary or information required by Federal sponsoring agency in compliance with governing legislation.

11. Certification I certify that to the best of my knowledge and belief that this report is correct and complete and that all outlays and unliquidated obligations are for the purposes set forth in the award documents.
Typed or Printed Name and Title:

Phone:

Signature of Authorized Certifying Official

Date Report Submitted:

FMCS FORM LM-7 (Revised 11/2001)
STANDARD FORM 269a(Revised 2/1992)
Prescribed by OMB Circulars A-102 and A-110

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