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FY 2022 - 2023 EMPG AGREEMENT ATTACHMENT H REPORTING FORMS FLORIDA DIVISION OF EMERGENCY MANAGEMENT 2022-2023 EMERGENCY MANAGEMENT PERFORMANCE GRANT - EMPG BASE GRANT AGREEMENT #: AWARD AMOUNT: SUB -RECIPIENT: COUNTY: ADDRESS: POINT OF CONTACT: PHONE/EMAIL: DIVISION FORM 1A - QUARTERLY FINANCIAL REPORT CLAIM #: 1 QUARTER #: 1 REPORTING FORMS DUE DATES (30 DAYS AFTER QUARTER) 1 - October 1 - Dec. 31, 2022 (Forms are due no later than January 30) 2 - January 1 - March 31, 2023 (Forms are due no later than April 30) 3 - April 1 -June 30, 2023 (Forms are due no later than July 30) 4 - July 1 - Sep. 30, 2023 (Form are due no later than October 30) EMPG ALLOCATION CATEGORIES BUDGETED ALLOCATIONS Q1 CLAIM Q2 CLAIM Q3 CLAIM Q4 CLAIM CUMULATIVE EXPENDED FUNDS REMAINING BALANCE 1. PLANNING $0.00 $0.00 $0.00 2. ORGANIZATION $0.00 $0.00 $0.00 3. EQUIPMENT $0.00 $0.00 $0.00 4. TRAINING $0.00 $0.00 $0.00 5. EXERCISE $0.00 $0.00 $0.00 6. MGMTANDADMIN(upto 5114 $0.00 $0.00 $0.00 TOTAL $0.00 $0.00 r $0.00 r $0.00 r $0.00 $0.00 $0.00 AMOUNT OF REIMBURSEMENT FOR THIS CLAIM: "By signing this report, I certify to the best of my know ledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terns and conditions of the Federal aw ard. I am aw are that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject rte to criminal, civi or administrative penalties for fraud, false statements, false claims or otherw ise. (U.S. Code Title 18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)" SIGNATURE: AUTHOR= RFPRFSENTATIVE DATE QUARTERLY STATUS REPORT Please report EM activities. meetingstrainina. exercises. or other necessary information to su000rt ouarterly orooression. THE SECTION BE AWARD AMOUNT PRIOR CLAIMS THIS CLAIM AMOUNT BALANCE OF AWARD 61 DIVISION DATE RECEIVED STAM P 193