Instructions – CDBG Request For Reimbursement

Exhibit II-A.1 Reimbersement Instructions

Exhibit II-A: Request for Reimbursement (Public Facility and Economic Development Projects) (Word download)

Block 1:    Send one (1) reimbursement request form with original signature.  

Block 2:    Specify the type of payment.  One or more of the items may apply.  If this is a Final Request for funds, check appropriately.

Block 3:    The recipient organization is the grantee with whom the State contract is made.  In some cases, the grantee may sub-contract with another organization, but checks from the State can only be made payable to the grantee named in the contract.

Block 4:    The period covered by the request is the period in which the first expense was incurred and the date the last expense was incurred.

Block 5:    Specify payment request numbers in numerical order for the entire grant.  If a request is returned to the grantee to be corrected, changed, or re-submitted, please number the payment request the same as the one that is being replaced and mark “Revised.”

Block 6:    The CMS Number is located in the top right box of the cover page (CMS Number) of the contract between the State and the grantee.  This number is a six-digit number.

Block 7:    Budget category is to identify what line item and how much is being requested. Back up documentation must be attached to each request to support the reimbursement request. For assistance on Budget Categories, please refer to Exhibit B in the contract between the State and the grantee.

Block 8:    Computation of the total CDBG contract amount, previous reimbursement requests, current reimbursement requests, and remaining balance.

Block 9:    The form must be signed by the appropriate Elected Official or Responsible Administrator named in the Contract, if given written signatory authority. Exhibit II-E: Signatory Delegation (Word Download)