Laserfiche WebLink
INSTRUCTIONS FOR COMPLETING <br /> ATTACHMENT B <br /> PAYMENT REQUEST SUMMARY FORM <br /> GRANTEE : Enter the name of the grantee ' s agency. <br /> DEP AGREEMENT NO. : This is the number on your grant agreement. <br /> DATE OF REQUEST : This is the date you are submitting the request. <br /> AMOUNT REQUESTED : This should match the amount on the " TOTAL AMOUNT " line for the "AMOUNT OF THIS <br /> REQUEST' column. <br /> GRANTEE ' S GRANT MANAGER: This should be the person identified as grant manager in the grant agreement. <br /> PAYMENT REQUEST NO. : This is the number of your payment request, not the quarter number. <br /> PERFORMANCE PERIOD : This is the beginning and ending date of the invoice period. <br /> PERCENT MATCHING REQUIRED : Enter your match requirement here . <br /> GRANT EXPENDITURES SUMMAR Y SECTION: <br /> "AMOUNT OF THIS REQUEST" COLUMN : Enter the amount that was paid out during the invoice period. This must <br /> be by budget category as in the currently approved budget in the current Grant Work Plan of your grant Agreement. Do not <br /> claim expenses in a budget category that does not have an approved budget. Do not claim items that are not specifically <br /> identified in the current Budget Narrative section of the current Grant Work Plan. Enter the column total on the " TOTALS" <br /> line. Enter the budget amount on the "AGREEMENT AMOUNT' line . Enter the total cumulative amount of this request <br /> and all previous payments on the "LESS TOTAL CUMULATIVE PAYMENTS OF' line . Deduct the "LESS TOTAL <br /> CUMULATIVE PAYMENTS OF' from the "AGREEMENT AMOUNT' for the amount to enter on the " TOTAL <br /> REMAINING IN GRANT' line . <br /> "TOTAL CUMULATIVE PAYMENTS" COLUMN : Enter the cumulative amounts that have been paid to date for <br /> expenses by budget category. The final report should show the total of all payments, fust through the final payment, etc . <br /> Enter the column total on the " TOTALS" line . Do not enter anything in the shaded areas. <br /> "MATCHING FUNDS" COLUMN : Enter the amount to be claimed as match for the invoice period. This needs to be <br /> shown under specific budget categories according to the currently approved Grant Work Plan. Enter the total on the <br /> " TOTALS" line for this column. Enter the match budget amount on the "AGREEMENT AMOUNT' line for this column. <br /> Enter the total cumulative amount of this and any previous match claimed on the "LESS TOTAL <br /> CUMULATIVE <br /> PAYMENTS OF' line for this column. Deduct the "LESS TOTAL CUMULATIVE PAYMENTS OF' from the <br /> "AGREEMENT AMOUNT' for the amount to enter on the " TOTAL REMAINING IN GRANT' line . <br /> "TOTAL CUMULATIVE MATCHING FUNDS" COLUMN : Enter the cumulative amount you have claimed to date <br /> for match by budget category. Put the total of all on the line titled " TOTALS. " The final report should show the total of <br />all <br /> claims , first claim through the final claim, etc . Do not enter anything in the shaded areas. <br /> GRANTEE CERTIFICATION : Must be signed by both the Grantee ' s Grant Manager as identified in the grant <br /> agreement and the Grantee' s Fiscal Agent. <br /> NOTE : If claiming reimbursement for travel, you must include copies of receipts and a copy of the <br /> travel <br /> reimbursement form approved by the Department of Financial Services, Chief Financial Officer. <br /> DEP Agreement No . GO 143 , Attachment B , Page 2 of 2 <br />