ANNUAL FINANCIAL REPORT

 
 
 
Please provide the contact information of the person that has prepared the financial report.

Name:
Email: Phone:
 
 
The annual financial report is a yearly expense report that is required in order to monitor the financial progress
of the award. This required form should be prepared by the institution’s Grants and Contracts office. The
finanical report is a required component of the annual Progress Report. Complete details regarding Progress
Report requirements and submission can be found on our website at http://professional.diabetes.org/grants-
admin.
 
Please note that it is the responsibility of the Principal Investigator to ensure that ADA receives all required
documentation for this report. Once the progress report has been approved, renewal notification will be
submitted to the Principal Investigator. The PI should forward this information to the Grant Administrator and
Fiscal Officer. In the event your Progress Report is not received on or before the due date, your current award
year will be reduced by 5%. The reduction, if any, will be deducted from the next scheduled payment(s).
Thank you in advance for complying with ADA guidelines.
Financial Report Instructions

1. Ensure that the top portion of the report is completely filled out.

2. Fill out the Budget section (Green) with the most current institutional budget broken down by year for
this award; please note that this should not have any changes greater than 25% of the originally approved
Association budget.
3. Fill out the Actual section (Blue) with the correct expense broken down by year for this award.

4. This financial report form should be filled out for all prior years of the award and the currently reported
year.

5. The carryover amount should represent the total carryover of the award from the start of the award to
the currently reported year.

 
 
 
Please contact us at pathway@diabetes.org should you have any questions.
 American Diabetes Association
Award Financial Report
To be prepared by the institution's Fiscal Office and signed by both Principal Investigator and Fiscal Officer

PRINCIPAL INVESTIGATOR/MENTOR: ADA AWARD NO.:

Type PI/Mentor Name Here Type # Here

INSTITUTION: INSTITUTE AWARD NO.:

Type Institute Here Type # Here

TITLE OF PROJECT: CURRENT REPORT PERIOD:

Type Title Here Type Report Period Here

AWARD PERIOD:
Type Award Years Here

Institutional Actual Expense ADA Approved Budget

YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 TOTAL YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 TOTAL Total
Expenses Expenses Expenses Expenses Expenses Expenses Budget Budget Budget Budget Budget Budget Carryover
Enter Period Enter Period Enter Period Enter Period Enter Period Enter Period Enter Period Enter Period Enter Period Enter Period
SALARY for PI $ - $ - $ -
FRINGE BENEFIT @ ____% of $ - $ - $ -
salary SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -
TECHNICAL PERSONNEL (itemize below by name and degree/title)
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -
SUPPLIES (categorize below) Observe maximum per award guidelines.
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -
EQUIPMENT (itemize below)
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

OTHER EXPENSES (itemize)

$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
$ - $ - $ -
TRAVEL $ - $ - $ -
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -
DIRECT COSTS TOTAL $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -
INDIRECT COSTS (cannot exceed 30% of
direct costs)
$ - $ - $ -

GRAND TOTAL OF EXPENSES $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ -

TOTAL AWARDED (Current Year Award Only):
TOTAL RECEIVED (Current Year Only):
TOTAL DUE TO ADA (End of Award Only) $ -
Prepared by: Phone: Email:
Type Name and Title Here Type # Here Type Email Address Here
Carryover/NO COST EXTENSION Justification
 
 

Please explain below why the funds are needed and how they will be used to further your research. Please be
sure to adhere to the budget guidelines outlined in the application, grant stipulations, and guidelines.
 
  
 
 
 
 
 
 
 
 
 
 
NO COST EXTENSION DURATION
The NCE duration can be either 6 months or 1 year. Only 1 NCE will be granted per award.
 
 Requested duration:

 
 
 
 
 

Please note: Budget reallocation requests should be submitted separately. For more details, contact
pathway@diabetes.org.