Attachment III
SISTEMA UNIVERSITARIO ANA G. MENDEZ
VICE-PRESIDENCY OF FINANCIAL AFFAIRS
ASSISTANT VICE-PRESIDENCY OF
SPONSORED PROGRAMS FINANCIAL MANAGEMENT
EFFORT REPORT
Name of SUAGM Employee / Identification NumberType Employee Name / S00######
Institutional Position Title / Position Number
Type Position Title / #########
Institution / Department
Type Institution / Type Department
Do you receive COMPENSATION from multiple sources for work performed on multiple SPONSORED PROGRAMS?
Yes ☐ No ☐
Has the value for your professional services been used to calculate IN-KIND CONTRIBUTIONS for any proposed SPONSORED PROGRAM? Yes ☐ No ☐
Period Certified: From 1/1/12 (mm/dd/yy) To 3/31/12 (mm/dd/yy)
PLEASE DISCLOSE THE DISTRIBUTION OF EFFORT DEDICATED TO ALL SPONSORED PROGRAMS AND INSTITUTIONAL ACTIVITIES
Activity or Sponsored Program / Sources of Funds
(Agency) / Fund Code / Percent of
Effort
______/ ______/ ______/ ### %
______/ ______/ ______/ ### %
______/ ______/ ______/ ### %
______/ ______/ ______/ ### %
______/ ______/ ______/ ### %
The sum of Effort for work performed on Sponsored Programs and Institutional activities must equal 100%.
The sum of compensation corresponding to the percent of Effort must not exceed employee base salary for the reporting period. / 100%
Effort reporting excludes services for which an extra compensation or other bonus is received.
I CERTIFY on the best of my knowledge that the information provided on this report is COMPLETE, ACCURATE and IN COMPLIANCE with SUAGM effort reporting policy (VPFA_AVPSRPFM-13-003-005) and 2CFR Part 200, section 200.430 Compensation-Personal Services.
Employee Name / Signature / Date (mm/dd/yr)Type Name
Responsible Official / Signature / Date (mm/dd/yr)
Type Name
Responsible Official
(if applicable) / Signature / Date (mm/dd/yr)
Type Name
Revised – May 2015