Vaccine Transportation Weekly Progress Report & Claims Submission

Transit System Providers, As the effort to help provide transportation to vaccine sites gets underway, tracking the amounts of trips, miles traveled, riders taken to vaccine sites and amount of DHHS CARES money used to complete this effort could not be more important. We have created a data entry tool that will allow you to submit both your data and your claim documentation together or separately. You will need to make your entries on a weekly basis for period ranging from Saturday through the next Friday. The due dates for the weekly report are as follows: • Data - submitted by Close of Business every Tuesday. • Claims - turn in your claims as soon as you can. • Note - It is preferred that you submit them at the same time if you are able. For this initial submission period, please submit all previous weeks of data and claims for trips already provided to vaccine sites as soon as you can. Please follow these instructions going forward: 1. Select the Entry Survey link 2. The Form starts out with one question you will need to choose from: a. I am Reporting Data Only b. I am Submitting Claims Only c. I am Reporting Data and Submitting Claims (Once again, if you have enough information in order to do both, that is preferred. If you have your data, but not enough info to submit claims, please at least submit the data and come back to add your claims when you are able.) 3. For the data portion, the following data is requested: a. Total Miles – by Tier b. Total Trips – by Tier c. Total Riders – by Tier d. Total Riders giving assistance (not vaccinated) e. Hours Operated f. Vehicles Dedicated (Optional) g. Estimated Expenditures (only if you are not also submitting your claims yet) 4. For submitting claims, (only for DHHS CARES funds) the following supporting documentation must be attached: a. Cover Letter b. DHHS Claim Form (if using DHHS CARES Funds) – Use appropriate trip tier(s) Budget Lines 25-27, only. c Revised NCDOT Claim Coversheet – Certifying trips not paid for by other funds d. DBE Form e. Additional Supporting Documentation f. Back-up Report from Scheduling Software g - Certification Letter for Retroactive Rural Trip Reimbursement (Tiers 2 & 3) (as needed) 5. For submitting both together, the requested info is the all of the above with exception to duplicative questions. *Remember you will only use the claims portion for DHHS CARES claims only. If you use other funds (FTA CARES, traditional funds, etc.), you will use the normal claims process!! **It must be certified that trips have not been paid for by other funding. IMD reserves the right to audit claims submitted. Please refer to page 6 of the Revised DHHS Guidance Coronavirus Relief Fund – Vaccine Transportation for additional information. Please also feel free to visit our webpage Transportation to COVID-19 Vaccine Sites (https://connect.ncdot.gov/business/Transit/Pages/Transportation-COVID-19-Vaccine-Sites.aspx) to access more resources about this effort. If you have any questions, please contact your Regional Grant Specialist.

What is your Transit System's Name?*

Please choose from the list.

Select

Please choose if you are submitting Data Only, Claims Only or both.*

Please choose one. Reminder: The Claiming Period is only available up to September 29th, 2021

I am Reporting Data Only

Weekly Data Report Submission

Please choose the week you are reporting data for in the pull-down list.*

Select or enter value

Please choose the Tier or Tiers you are submitting for:*

• Tier 1 – Trips to/from vaccination appointments.

Select

Tier 1 Trips: How many total miles were traveled transporting citizens to vaccine sites in the reporting week?*

Reporting week is Saturday to Friday.

Tier 1 Trips: How many total trips were made transporting citizens to vaccine sites in the reporting week?*

Reporting week is Saturday to Friday. Trips are defined as one way trips, so a trip to a vaccine site is 1 trip, the trip back will be another trip.

Tier 1 Trips: How many total riders were transported to vaccine sites within the reporting week?*

Reporting week is Saturday to Friday.

How many riders were transported to vaccine sites that were giving assistance to others riders?*

These are riders not getting vaccinated, but were riding with someone that is.

How many operating hours were spent transporting citizens to vaccine sites in the reporting week?*

Reporting week is Saturday to Friday.

How many total Healthcare Riders did you transport in the reporting week?

This would apply if your system transported Healthcare workers to a vaccine site, a healthcare facility or to a residence in order to administer vaccines.

If you are dedicating vehicles for vaccine trips, how many vehicle days are dedicated (this is an optional approach)?

For example, 1 vehicle per day for 5 days in a week would be '5'. 2 vehicles for 3 days plus 1 vehicle for 2 days would be '8'. If none, type 0.

Do you have any comments, Lessons Learned and/or 'Best Practices' you wish to share related to this effort in the reporting week?

Send me a copy of my responses

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