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STATE OF WASHINGTON JUSTICE ASSISTANCE GRANT <br /> DEPARTMENT OF COMMERCE FORM 12 <br /> FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT <br /> (FFATA) <br /> Section 1 <br /> Agency/Jurisdiction Legal Name: <br /> Section 2 <br /> Responses should be for the entire Jurisdiction/Organization,not just the department/division to utilize <br /> grant funds. <br /> a) Total Federal Revenues for the prior fiscal year <br /> (ARRA, Non-ARRA,Directly & Indirectly received) <br /> b) Is 'a' above equal to or greater than $25,000,000? Yes No <br /> (Circle One) <br /> c) If'b' above is 'No',skip to Section 3 a), enter check 'Not Required' <br /> and execute the certificate, otherwise continue, compensation reporting may <br /> be required. <br /> d) Total Revenue(including Federal Revenue) for the prior fiscal year <br /> e) Calculation: a-d (Total Federal Revenue divided by Total Revenue) <br /> I) Is `e' above equal to or greater than .8? Yes No <br /> (Circle One) <br /> g) If 1' above is 'No', skip to Section 3, enter check 'Not Required' <br /> and execute the certificate, otherwise continue, compensation reporting may <br /> be required. <br /> h) Have you filed senior executive's compensation with either of the following? <br /> 1. Securities & Exchange Commission <br /> (under sec 13(a) or 15(d) of the Securities Exchange Act of 1954) <br /> 2. Internal Revenue Service <br /> (Sec 6104 of the Internal Revenue Code of 1986) Yes No <br /> (Circle One) <br /> i) If`h' above is `Yes',skip to Section 3a), enter check 'Not Required' <br /> and execute the certificate, otherwise continue, compensation reporting <br /> is required. <br /> 31 <br />