Request for Funds - Planning Grant SampleRequest for Funds
CFDA: 97.047
INVOICE REQUEST PERIOD: From 1/1/2020 to 6/30/2020 GRANT AMOUNT: $7,500.00
ACTIVITY / COST CLASSIFICATION a. Total Budget
Approved
b. Total of ALL
costs PAID to date
c. Federal Share
available (% of
approved budget)
d. Federal share
being requested
(must have been
paid)
e. Total of previous
federal payments
requested and/or
paid
f. Balance of grant
(c less d less e)
1 Hazard Mitigation Plan $10,000.00 $7,000.00 $7,500.00 $5,250.00 $0.00 $2,250.00
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12 Subtotal $10,000.00 $7,000.00 $7,500.00 $5,250.00 $0.00 $2,250.00
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14 Total Project Costs $10,000.00 $7,000.00 $7,500.00 $5,250.00 $0.00 $2,250.00
DATE:
DATE:
DATE:
MEMA USE ONLY- COMMENTS
Column a: Enter approved budget. Column b: Enter amounts paid by City/Town to date.This is
a reimbursement program so column b must always be a running total. Column c: Federal
share available(this is the percentage of the approved budget available for reimbursement,
normally 75%) This column should remain the same, and the total should be grant amount.
Column d: Enter amount for reimbursement. Column e: This is the total of previous federal
payments made( Must be a running total) Column f: Balance of grant ( Must be running
total) (Columc c minus column d minus column e)
SIGNATURE:
REQUEST FOR FUNDS- MITIGATION PROGRAMS DATE: REQUEST #: 1
VENDOR CODE: VC6xxxxxxxxx
NAME OF SUB-RECIPIENT: TOWN OF [Town name]
MEMA DISASTER RECOVERY MANAGER APPROVING PAYMENT
SIGNATURE:
MEMA MITIGATION COORDINATOR REVIEWING PAYMENT
CERTIFICATION BY AUTHORIZED AGENT/DESIGNATED OFFICIAL OF CONTRACTOR/SUB-RECIPIENT: By
signing this report, I certify to the best of my knowledge 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 terms and conditions of the Federal award. I am
aware that any false, fictitious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil or
administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title 18, Section 1001 and Title 31, Sections
3729-3730 and 3801-3812).
TITLE:
SIGNATURE:
GRANT PROGRAM #: PDMC 18-09xxx
SAMPLE
1
MEMA RFF FORM REV: 1/2009
Request for Funds
Instructions:
1 Date of Request
2 Request Number: (ex. #3)
3 Name of Grantee
4 Grant Program Number
5 Vendor Code (if known)
6 Invoice request period (Time period of invoices) THIS IS VERY IMPORTANT FOR FISCAL CONCERNS
7 Grant Amount (Amount of FEMA Grant Award)
Column a: Total approved budget- Fill in amounts from your approved budget
Column b: Enter total of Costs paid to date. This must be a running total
Column c: This is a new column. This is the percentage of federal reimbursement of the approved budget amount (usually 75%, must be
confirmed with application or award letter.) This column should not change. The total of this column should equal grant amount found in the upper
right corner of the form.
Column d: Federal share being requested.
Column e: Total of previous federal payments. This must be a running total
Column f: Balance of grant. Column c minus column d minus column e. This must be a running total.
8 If there is Project/Program income, subtrat from Column B TOTAL OF ALL COSTS PAID ONLY.
2
MEMA RFF FORM REV: 1/2009