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 grantadministration@diabetes.org should you have any questions.
 American Diabetes Association
3-Year Award Financial Report
To be prepared by the institution's Fiscal Office. Signature page to be signed by both Principal Investigator and Fiscal Officer.
PRINCIPAL INVESTIGATOR/MENTOR: FELLOW: (Mentor Awards ONLY)
Type PI/Mentor Name Here Type Fellow Name here
INSTITUTION: ADA AWARD NO.:
Type Institution Here Type # Here
TITLE OF PROJECT: INSTITUTE AWARD NO.:
Type Title Here Type # Here
AWARD PERIOD: CURRENT REPORT PERIOD:
Type Award Years Here Type Report Period Here
Institutional Actual Expense ADA Approved Budget
YEAR 1 Expenses YEAR 2 Expenses YEAR 3 Expenses TOTAL Expenses YEAR 1 Budget YEAR 2 Budget YEAR 3 Budget TOTAL Budget
Type Period Here Type Period Here Type Period Here Type Period Here Type Period Here Type Period Here
SALARY for Principal Investigator or Postdoc Fellow (Fellowship Awards ONLY)
$ - $ -
###
FRINGE BENEFIT @ ____% of salary $ - $ ###
-
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ -
###
TECHNICAL PERSONNEL (Itemize below by name and degree/title)
Include Fringe Benefits for each person. NOT applicable to Training Awards.
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ -
###
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ -
###
SUPPLIES (Categorize below)
Please observe maximum (Fellowship Awards not to exceed $3000/Year)
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ -
###
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ -
###
EQUIPMENT (Itemize below)
NOT applicable to Training Awards $ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ -
###
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ -
###
OTHER EXPENSES (Itemize below) ###
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ - $ ###
-
$ -
$ - $ ###
-
$ - $ ###
-
TRAVEL (Please observe minimum) $ - $ -
###
SUBTOTAL $ - $ - $ - $ - $ - $ - $ - $ -
###

22:18:41 07/24/2022 3
PRINCIPAL INVESTIGATOR/MENTOR: FELLOW: (Mentor Awards ONLY)
Type PI/Mentor Name Here Type Fellow Name here
INSTITUTION: ADA AWARD NO.:
Type Institution Here Type # Here
TITLE OF PROJECT: INSTITUTE AWARD NO.:
Type Title Here Type # Here
AWARD PERIOD: CURRENT REPORT PERIOD:
Type Award Years Here Type Report Period Here
Institutional Actual Expense ADA Approved Budget
YEAR 1 Expenses YEAR 2 Expenses YEAR 3 Expenses TOTAL Expenses YEAR 1 Budget YEAR 2 Budget YEAR 3 Budget TOTAL Budget
Type Period Here Type Period Here Type Period Here Type Period Here Type Period Here Type Period Here
DIRECT COSTS TOTAL $ - $ - $ - $ - $ - $ - $ - $ -
###
INDIRECT COSTS—Not to exceed 15% of
direct costs (10% for IN awards) NOT
applicable to Training Awards $ - $ -
###
GRAND TOTAL OF EXPENSES $ - $ - $ - $ - $ - $ - $ - $ -
###
Unexpended YR1 Unexpended YR2 Due to ADA Received YR1 Received YR2 Received YR3 TOTAL SENT
Enter Amount
$ - $ - $ - Received from ADA : $ - $ - $ - $ -
PAYMENT DUE: $ - $ - $ - ###
Prepared by: Phone: Email:
Type Name and Title Here Type # Here Type Email Address Here

22:18:41 07/24/2022 4
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 our
Financial Manager at grantadministration@diabetes.org.