Financial eBounties Report

FINANCIAL EBOUNTIES REPORT

Report Identification

Report Number:     Report Date:

Submitting Entity / Program

Program / Funding

Program Name:     Funding Source / Budget Code:

Itemized eBounties Disbursed

Provide a line for each distinct bounty payment. Attach transaction logs, receipts, and authorizing communications.

Attachments & Supporting Documentation

Transaction logs    Recipient tax forms (W-9 or equivalent)    Receipts / Payment confirmations    Authorizing communications

Compliance Certification

By submitting this Financial eBounties Report and signing below, the submitter certifies all of the following under penalty of law:

1. All information and amounts reported are true, complete, and accurate to the best of the submitter's knowledge.
2. Payments identified herein were made only for eligible activities pursuant to program rules and authorized budgets; no duplicate payments have been requested or received.
3. Appropriate tax documentation has been obtained or exemption documented for each recipient and records supporting each payment are retained for a minimum of seven years and made available upon lawful request.
4. The submitter will promptly notify finance of any required corrections, recoveries, or compliance issues and will cooperate in any audit or inquiry.

Certification Checkbox: I certify the statements above are true and accurate.

Administrative Use / Approval

WARNING: Knowingly submitting false information may subject the submitter and responsible parties to administrative action, civil liability, and criminal penalties under applicable law. This report and supporting records may be used for internal audit, tax reporting, and compliance review.

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