STATE OF NEW MEXICO

SPECIAL PROJECTS APPROPRIATIONS – TCPP Project #______

Quarterly/Final Report Form – ending:______

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Narrative Report: For the quarter dated (July 1 – September 30 / October 1 – December 31 / January 1 – March 31 / April 1 – June 30), our project achieved the following accomplishments:

Describe your major accomplishments in this section. This can be in bullet or paragraph form, but should provide quantitative and qualitative information about your activities. How many people attended your event? How many people quit smoking? What information can you provide that demonstrates a meaningful impact to the community?

Quantitative Data for Reported Quarter
Q1 / Q2 / Q3 / Q4
Total Estimated Number of People Served:
Total Estimated Number of People Who Quit Tobacco Use:
Total Estimated Number of People Participating in Prevention Activities:
Number of activities for the quarter?
What percentage of spending benefited children?

Budget Activity / Description:

Project Amount Spent During This Quarter: $

Please attach receipts, purchase orders, and other documents to provide proof on how funding was spent.

INELIGIBLE EXPENSES: Because this project is funded with public funds, there are restrictions in what is considered “eligible” for reimbursement. Some expenses may not be approved for reimbursement if they are considered ineligible. Examples include: prizes, gift cards, items that may become an asset (over $5,000), items unrelated to tobacco control and approved contract activity. A good rule of thumb is to ask yourself is, “Does this expense relate to tobacco control? AND Does this expense align with my approved scope of work?” If the answer is “no,” please seek approval before incurring the expense.

MILEAGE REIMBURSEMENT: Mileage reimbursement is equal to 80% of federal reimbursement rates. For project travel in personal vehicles, you may receive mileage reimbursement at $0.44 per mile (as of 8/16/2013).

BUDGET MODIFICATIONS: As you move through the project year, you may need to adjust approved budgeted line items to reflect actual spending. Please complete the Budget Modification form and obtain approval before incurring expenses outside of what was previously approved.