Form 3156, Quarterly Program Income Report

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Documents

Effective Date: 5/2017

Instructions

Updated 5/2017

Use

This form must reflect projections of program income and expenditures of program income or matching funds. The numbers reflected as program income must reconcile with the Form 3157, Quarterly Financial Report and Analysis.

Copies and Distribution

The provider submits the report, signed by the Financial Administration Authority identified in the grant application, to the Texas Health and Human Services Commission (HHSC) grant manager. This report is due 30 days after the close of the quarter, except for the final quarterly report for the year, which is due 45 days after the end of the grant year.

Retention

Grantee records and accounts must be retained for at least three years after:

  • HHSC has made final payments, and
  • all other pending matters are closed.

Detailed Instructions

  1. Complete the grant identifying information (grantee organization, grant number, and budget period).
  2. Indicate the reporting period (for example, 1st quarter, 2nd quarter, etc.).
  3. Enter Program Income (PI). This is gross income earned by the recipient that is directly generated by a supported activity or earned as a result of the award. If none, enter "0".
  4. Enter expenses associated with PI using the approved budget categories from the Statement of Grant Award.
  5. Submit all the following reports at the same time:
  • Form 3156, Quarterly Program Income Report,
  • Form 3157, Quarterly Financial Report and Analysis, and
  • Form 3159, Final Report of Expenditures (fourth quarter only).