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Instruction Sheet for the Reimbursement Request Exhibit a of AsR Award Number The Awazd Number is identified on the Notification of Application Approval letter. Subgrantee The Subgrantee is the agency identified in the original Subgrant application and indicated in the A'ot~cation of Application Approval letter. Do not identify any sub-departments or offices as the Subgrantee. OES ID # The OES ID# is identified on the Notification of Application Approval letter. 1. Reimbursement Indicate the State Fiscal Yeaz (SFY) for which funds are being requested. For reimbursements the Request Period , SFY chosen should represent the SFY in which the Subgrant funds have been expended. Only one SFY can be chosen per reimbursement request and cannot cross SFYs; therefore, separate requests must be submitted for expenditures incurred on or before June 3Q, 2008 and on or a@er July I, 2008. 2. Federal Funds Expended Cumulative Previously Requested Amount (Box A lY In this box include cumulative federal funds previously requested on all previous reimbursement requests. If this is the first reimbursement request submitted, leave this box blank. Current Requested Amount (Box A2)• In this box include current requested fedeml funds for this reimbursement request. Cumulative Amount to Date (Box A31• The amount in this box (A3) should equal box Al plus box A2. Local Subgrant Match Expended Cumulative Previously Requested Amount (Box B 1~ In this box include the cumulative local b Su grant match previously requested on all previous reimbursement requests (Box B 1 equals Box A 1). If this is the first reimbursement request submitted, leave this box blank. Current Requested Amount (Box B21• In this box include the current local Subgrant match expended for this reimbursement request (Box B2 equals Box A2). Cumulative Amount to Date (Box B31• The amount in this box (B3) should equal box Bl plus box B2 (Box B3 equals Box A3). (This ensures compliance with non-federal match requirements.) Total Subgrant Cumulative Amount to Date (Box C~ The amount in this box (C) should equal box A3 plus box B3 Expenditures . (This figure is used to calculate your payment in the Automated Ledger System (ALS). ALS uses the following formula to calculate your payment: Box C divided by 2 minus previous payments =this payment) 3. Total Emergency In this box, indicate all cumulative program funds expended. This includes box C plus all additional Program Expenditures ]ocal non-federal expenditures. Exclude any local expenses that aze being used as a match requirement(s) for other federal programs. Definition of Expenditure For the purpose of this form, expenditure is defined as the actual payment of funds, by subgrantees, to contmc[ors, vendors, employee labor, equipment, etc. Authorized Agent Complete all line items requested and ensure that the form is signed by an Authorized Agent named in Information the Governing Body Resolution, or the State Agency Signature Authority form. Address Changes Indicate a change of address by checking the box shown and noting the address in the area marked "mailing address". The new address will be used to update State OES' records. Page 64 of 80 FY08 EMPG Recipient Subgant Guide for Local Government 46