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Run: Time and Effort Personnel Activity Certification

This Time and Effort Personnel Activity Certification template records how an employee’s work was split across federal awards for a specific period. It helps...

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Certification Period and Employee Information

Employee Full Name (required)

Employee ID / HR System Number (required)

As assigned in your HR or payroll system.

Department / Organizational Unit (required)

Position Title (required)

Reporting Basis (required)

Select whether this is a semi-annual or after-the-fact certification per 2 CFR 200.430(i).

Certification Period Start Date (required)

Certification Period End Date (required)

Appointment Type (required)

Effort Allocation by Award

Effort Allocation by Funding Source (required)

Add one row per award or activity. Percentages must sum to 100%.

Total Effort Percentage (must equal 100%) (required)

Sum of all rows above. Enter 100 to confirm allocations are complete.

Does any award above include a cost-sharing or matching commitment? (required)

Cost-Sharing Detail

Identify the award(s) and describe the cost-sharing commitment (e.g., 5% effort on Award #ABC-123 per approved budget).

Payroll Reconciliation Confirmation

Are the effort percentages above consistent with actual payroll charges to each award? (required)

Describe Required Payroll Adjustment

Identify the award(s), dollar amount(s), and reason for the cost transfer. Contact your grant accountant to initiate the correction.

Was any portion of this period covered by paid leave (vacation, sick, FMLA)? (required)

Approximate Leave Dates

Provide approximate dates. Leave charged to a federal award must comply with your organization's leave policy applied consistently.

Employee Certification and Signature

I certify that the information provided is accurate and reflects actual effort devoted to each listed award and activity during the certification period. (required)

Yes No N/A

Employee Signature (required)

Draw or apply your electronic signature to certify this report.

Date Signed by Employee (required)

Additional Comments (Optional)

Supervisor or PI Countersignature

Is a supervisor or PI countersignature required for this certification? (required)

Supervisor / Principal Investigator Name

Supervisor / PI Title

The supervisor/PI confirms the effort allocations above reflect actual work performed to the best of their knowledge.

Yes No N/A

Supervisor / PI Signature

Date Signed by Supervisor / PI

Grant Accountant Use Only

Review Status

Cost Transfer / Journal Entry Reference Number

Reviewer Notes

Reviewed By (Grant Accountant Name)

Date of Review

Record Retention Confirmed (retain 3 years post-award closeout per 2 CFR 200.334)

Yes No N/A

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