Use this form to report cost share to a sponsored project prior to the regular effort reporting period. University of Nevada, Reno Early Cost Share Effort Report Form Dates Work Performed: ____________________________________________ Name: ___________________ Employee ID: ________________ Job Title: __________________ Sub Dept: ________________ Division: ____________________ Position #:_________________ Accounts
Account Name Cost Share %
Cost Share $
Certified Effort % __________
___________% __________
___________% __________
___________% __________
___________% Sponsored Accounts: (accounts you are cost sharing to) ____________________ ____________________ __________% ____________________ ____________________ __________% ____________________ ____________________ __________% ____________________ ____________________ __________%
Non‐Sponsored Accounts: (accounts you are cost sharing from) ____________________ ____________________ __________% __________
___________% ____________________ ____________________ __________% __________
___________% ____________________ ____________________ __________% __________
___________% ____________________ ____________________ __________% __________
___________
I certify that the proportion of my salary cost shared to each of the accounts on this effort report represents a reasonable % estimate of my actual effort on each sponsored project during this reporting period. Or, in the event that I am certifying effort for someone other than myself, I have first‐hand knowledge of the employee’s cost shared effort during this reporting period. I understand that falsification of effort statements may result in potential disallowed costs, penalties and/or actions under the Federal False Claims Act. Print Name: _______________________________ Date: __________________________ Signature: _________________________________ Title: ___________________________ Why is this early cost share effort report necessary? Please submit completed form to the Office of Sponsored Projects at [email protected] or Mail Stop 325.