Community Compensation Reporting & Request Form


Welcome to the Community Compensation Reporting and Request Form!


UPDATE: Every single dollar of the Lived Experience Fund has been put to meaningful use—a beautiful milestone in the two years since the Compensation Program began! This achievement wouldn’t be possible without you. To everyone who requested funds, showed us patience as we navigated a new process, and remained dedicated to fair compensation and transformational change—thank you from the bottom of our hearts. Your trust and commitment inspire us every day.



We are pleased to introduce a new payment model to streamline the funding process for compensating Class 1 workgroup members. In collaboration with the Office of Financial Management (OFM), we have developed an allocation process to simplify and expedite access to funding.


Directions:

Please use this form to submit new requests for allocation, quarterly reports, and requests for reimbursement (limited time only).


  • Allocation Requests: There isn't a deadline to submit a request. All requests will be received on a rolling basis. However, funds are limited, and we will prioritize small agencies and statutory workgroups. We will do our best to fulfill all requests when funds are available. Funds are replenished at the start of the biennium (July). Requests submitted earlier in the fiscal year will have a higher probability of receiving funds. We ask that agencies do their best to submit their requests all at once for all workgroups if possible. Please be aware that if an agency establishes a workgroup later in the fiscal year that was not included in the initial request, you can still submit an additional request for allocation.
  • You must also attach a Form 5793 Worksheet with details on each separate workgroup allocation for OFM's review.


  • Quarterly Reporting: At the end of each quarter (see schedule below), agencies must complete this form to update the projected information from the initial request. A finance/budget representative from each agency will coordinate with the program managers overseeing workgroups to gather the updated information. The representative will also need to attach an updated 5793 Tracking Form for each workgroup.

            

*Reminder: A single finance/budget representative from each agency will coordinate with the program managers overseeing workgroups to gather the information needed. When submitting for multiple workgroups, please attach a 5793-tracking form for each anticipated workgroup.


If you have questions about our process, please review our Best Practices document or contact us at LivedExperience@equity.wa.gov.


Quarterly Report Cadence:

                                Q1 - September 15th

                                Q2 - December 15th

                                Q3 - March 15th

                                Q4 - June 15th

Purpose of Request*
Expenditure Fiscal Year*
Which quarter are you reporting on?*

For a more detailed schedule, see Compensation Guidelines or form directions.

Is/did your agency requesting allocation for legislatively mandated workgroups?*

This number should reflect the total number of participants, regardless of community compensation eligibility (ie: lived experience or low-income status).

In order to be eligible to receive compensation, a workgroup member must either have lived experience OR be low income.

Enter the total amount of stipend dollars your agency has dispersed to Community Compensation recipients during this past quarter.

Enter the total amount of reimbursement dollars for travel, lodging, or per diem that your agency has dispersed to Community Compensation recipients during this past quarter.

Enter the total amount of reimbursement dollars for childcare that your agency has dispersed to Community Compensation recipients during this past quarter.

Enter the total amount of reimbursement dollars for elder care that your agency has dispersed to Community Compensation recipients during this past quarter.

Enter the hourly rate paid to Community Compensation-eligible workgroup members.

Enter the amount of money your agency has spent during this past quarter.

Do you need to request additional funding?*

If your agency/workgroup underestimated the total funding needed, please enter the difference below. Make sure to upload documentation to support this request.

The amount entered here should reflect the total amount requested from the initial allocation request.

Upload your Form 5793 Worksheet here. You can also upload any other relevant documents you wish to share here.

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