Reimbursement Submission

Please fill out the information for your reimbursement.

Email Address of Point of Contact*

Please provide the email address of the primary point of contact.

Subrecipient*

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Invoice # or EMD Form*

Please provide your Invoice # or EMD Form

FY 20 EMPG-S Eligible Reimbursement Items*

Please check all items seeking reimbursement.

Select

Cost Description*

Please provide a brief description of what is being requested for funding under the FY 20 EMPG-S.

Reimbursement Packet Amount*

What is the amount of the project seeking reimbursement under FY 20 EMPG-S? This grant requires a 50% match so the Total Project Cost should be double this amount. (Example: EMPG-S Funds: $4,000, Total Project Cost: $8,000). Cannot exceed awarded amount in Grant Agreement. Only enter the EMPG-S funded amount in this field.

Payable

Reimbursement Packet*

Please attach all your reimbursement documents here. This should include a reimbursement cover sheet (EMD-54) as well as an EMD-56 for supplies/equipment or EMD-55 for Personnel Overtime, EMPG-S Attachment A, all invoices, and all proof of payments.

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