QUARTERLY PROGRAM INCOME SUMMARY REPORT


OFFICE OF CRIMINAL JUSTICE PROGRAMS
(State and Local Governments only)

All income generated as a direct result of the grant shall be deemed program income. Fines are not counted as program income.
(see CH. IV of the OCJP Administrative Manual)

Project Title:
Grant No:
Agency Name:
Person Completing Report:
Phone Number:
Email:

Fund Source: (CHECK ONLY ONE)
Byrne/JAG
FVS
METH
STOP
VOCA
REPORT FOR QUARTER ENDING: (CHECK ONLY ONE)
SEPT
DEC
MAR
JUN
Check this choice if you are filing ONE form for the entire Fiscal Year: FOR FISCAL YEAR:

Accumulated Previously This Fiscal Year Accumulated this Quarter Total Accumulation
Forfeited funds. (cash only)
Forfeited property.
Other Program Income.
TOTAL PROGRAM INCOME

Financial Officer's Name:
Email of same:Date:

Project Director's Name:
Email of same:Date:


"The Financial Officer certifies that to the best of his or her knowledge and belief that the information contained in
this certification is correct and in accordance with the requirements of the application guidelines.
The Financial Officer also certifies that they are considered to be certifying this report, and is either the person
legally responsible for committing the applying agency to this certification, or is executing this certification with
the informed consent of the authorizing person (named and described in section 8 of attachment A of the
Application for Funding)."

I certify that the above information in Quarterly Program Income Report is correct and accurate.

(Please check)



quarterlyincomesummaryreport.htm