单位负责人： 财务负责人： 填表人： 联系电话： 填表日期：
附件3：“小金库”自查自纠情况统计表
报送地区（部门）（盖章）： 单位：万元/个
| 行次 | 项目 | 合计 | 省级（中央一级）单位 | 地市级（中央二级）单位 | 县级（中央三级）单位 | 县级（中央三级）以下单位 | 备注 |
| 合计 | 党政机关 | 事业单位 | 小计 | 党政机关 | 事业单位 | 小计 | 党政机关 | 事业单位 | 小计 | 党政机关 | 事业单位 | 小计 | 党政机关 | 事业单位 |
| 一 | 自查基本情况 | | | | | | | | | | | | | | | | |
| 1 | 党政机关和事业单位户数 | | | | | | | | | | | | | | | | |
| 2 | 自查单位户数 | | | | | | | | | | | | | | | | |
| 3 | 自查违纪单位户数 | | | | | | | | | | | | | | | | |
| 二 | 2006年底小金库资金滚存余额和资产原值 | | | | | | | | | | | | | | | | |
| | 其中：滚存资金余额 | | | | | | | | | | | | | | | | |
| 三 | 2007年至今小金库资金来源合计 | | | | | | | | | | | | | | | | |
| 1 | 财政拨款 | | | | | | | | | | | | | | | | |
| 2 | 政府性基金收入 | | | | | | | | | | | | | | | | |
| 3 | 专项收入 | | | | | | | | | | | | | | | | |
| 4 | 行政事业性收费收入 | | | | | | | | | | | | | | | | |
| 5 | 罚没收入 | | | | | | | | | | | | | | | | |
| 6 | 国有资本经营收入 | | | | | | | | | | | | | | | | |
| 7 | 国有资源（资产）有偿使用收入 | | | | | | | | | | | | | | | | |
| 8 | 资产处置收入 | | | | | | | | | | | | | | | | |
| 9 | 资产出租收入 | | | | | | | | | | | | | | | | |
| 10 | 经营收入 | | | | | | | | | | | | | | | | |
| 11 | 利息收入 | | | | | | | | | | | | | | | | |
| 12 | 捐赠收入 | | | | | | | | | | | | | | | | |
| 13 | 附属单位上缴收入 | | | | | | | | | | | | | | | | |
| 14 | 其他 | | | | | | | | | | | | | | | | |
| 四 | 2007年至今小金库资金支出合计 | | | | | | | | | | | | | | | | |
| 1 | 弥补经费 | | | | | | | | | | | | | | | | |
| 2 | 购建资产支出 | | | | | | | | | | | | | | | | |
| 3 | 发放奖金、津补贴、福利等支出 | | | | | | | | | | | | | | | | |
| 4 | 接待宴请、公款旅游支出 | | | | | | | | | | | | | | | | |
| 5 | 礼品礼金支出 | | | | | | | | | | | | | | | | |
| 6 | 私分 | | | | | | | | | | | | | | | | |
| 7 | 其他 | | | | | | | | | | | | | | | | |
| 五 | 期末小金库资金滚存余额和资产原值 | | | | | | | | | | | | | | | | |
| 1 | 现金 | | | | | | | | | | | | | | | | |
| 2 | 银行存款 | | | | | | | | | | | | | | | | |
| 3 | 有价证券 | | | | | | | | | | | | | | | | |
| 4 | 固定资产原值 | | | | | | | | | | | | | | | | |
| 5 | 股权和债权 | | | | | | | | | | | | | | | | |
| 6 | 其他 | | | | | | | | | | | | | | | | |
| 六 | 小金库主要表现形式 | | | | | | | | | | | | | | | | |
| 1 | 违规收费、罚款及摊派设立小金库金额 | | | | | | | | | | | | | | | | |
| 2 | 用资产处置、出租收入设立小金库金额 | | | | | | | | | | | | | | | | |
| 3 | 以会议费、劳务费、培训费和咨询费等名义套取资金设立小金库金额 | | | | | | | | | | | | | | | | |
| 4 | 经营收入未纳入规定账户核算设立小金库金额 | | | | | | | | | | | | | | | | |
| 5 | 虚列支出转出资金设立小金库金额 | | | | | | | | | | | | | | | | |
| 6 | 以假发票等非法票据骗取资金设立小金库金额 | | | | | | | | | | | | | | | | |
| 7 | 上下级单位之间相互转移资金设立小金库金额 | | | | | | | | | | | | | | | | |
| 8 | 其他 | | | | | | | | | | | | | | | | |
| 七 | 自查发现小金库及纠正情况 | | | | | | | | | | | | | | | | |
| 1 | 自查发现小金库个数 | | | | | | | | | | | | | | | | |
| 2 | 自查纠正处理小金库个数 | | | | | | | | | | | | | | | | |
| 3 | 自查发现小金库账户个数 | | | | | | | | | | | | | | | | |
| | 其中：违规开设单位账户个数 | | | | | | | | | | | | | | | | |
| | 公款私存账户个数 | | | | | | | | | | | | | | | | |
| 4 | 自查已撤销小金库账户个数 | | | | | | | | | | | | | | | | |
| | 其中：已撤销单位账户个数 | | | | | | | | | | | | | | | | |
| | 已撤销公款私存账户个数 | | | | | | | | | | | | | | | | |
| 八 | 自查发现小金库处理情况 | | | | | | | | | | | | | | | | |
| 1 | 应上缴财政金额 | | | | | | | | | | | | | | | | |
| | 已上缴财政金额 | | | | | | | | | | | | | | | | |
| 2 | 应补缴税款金额 | | | | | | | | | | | | | | | | |
| | 已补缴税款金额 | | | | | | | | | | | | | | | | |
| 3 | 应退还违规收费及摊派等金额 | | | | | | | | | | | | | | | | |
| | 已退还违规收费及摊派等金额 | | | | | | | | | | | | | | | | |
| 4 | 个人应退还违规所得金额 | | | | | | | | | | | | | | | | |
| | 个人已退还违规所得金额 | | | | | | | | | | | | | | | | |
| 5 | 其他应追回违规支出金额 | | | | | | | | | | | | | | | | |
| | 其他已追回违规支出金额 | | | | | | | | | | | | | | | | |
| 6 | 应调账处理金额 | | | | | | | | | | | | | | | | |
| | 已调账处理金额 | | | | | | | | | | | | | | | | |
| 九 | 自查处罚通报情况 | | | | | | | | | | | | | | | | |
| 1 | 自查受行政处罚人数 | | | | | | | | | | | | | | | | |
| | 其中：单位主要负责人受行政处罚人数 | | | | | | | | | | | | | | | | |
| | 单位会计人员受行政处罚人数 | | | | | | | | | | | | | | | | |
| 2 | 自查受组织处理人数 | | | | | | | | | | | | | | | | |
| | 其中：处理省部级人数 | | | | | | | | | | | | | | | | |
| | 处理地厅级人数 | | | | | | | | | | | | | | | | |
| | 处理县处级人数 | | | | | | | | | | | | | | | | |
| | 处理乡科级以下人数 | | | | | | | | | | | | | | | | |
| 3 | 自查受党纪政纪处理人数 | | | | | | | | | | | | | | | | |
| | 其中：处理省部级人数 | | | | | | | | | | | | | | | | |
| | 处理地厅级人数 | | | | | | | | | | | | | | | | |
| | 处理县处级人数 | | | | | | | | | | | | | | | | |
| | 处理乡科级以下人数 | | | | | | | | | | | | | | | | |
| 4 | 自查移交司法机关处理人数 | | | | | | | | | | | | | | | | |
| | 其中：处理省部级人数 | | | | | | | | | | | | | | | | |
| | 处理地厅级人数 | | | | | | | | | | | | | | | | |
| | 处理县处级人数 | | | | | | | | | | | | | | | | |
| | 处理乡科级以下人数 | | | | | | | | | | | | | | | | |
| 5 | 自查通报的案件数 | | | | | | | | | | | | | | | | |
| 6 | 新闻媒体曝光案件数 | | | | | | | | | | | | | | | | |
