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									NC HPRP Requisition for NCHFA
Client Requisition
                                                                       Grantee:
                                                             Date of requisition:
                                                                CHIN client ID:
                                          Prevention or Rapid ReHousing client:                                                                                     prevention
                                                                                                                                                                    rapid rehousing
Documentation for each individual must be submitted separately. This requisition can only contain information for 1 household.

                                    Documentation     Assistance covers this
                      Dollars       submitted with    period
                      Requested     requisition       (MM/DD/YYYY)           Documentation included in the participant's file
Rent Assistance,                    Receipt, invoice,     from:              * rent reasonableness form (NCHousingSearch.com form or manual form)
current or in                       or copy of check.        to:             * 3-month income certification form (if received >3 months assistance of any
arrears                                                                      kind). Not required if only received rent arrears.
                                                                             * HQS inspection form HUD 52580-A (if moving). Not required on former unit
                                                                             if only received rent arrears.
                                                                             * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
                                                                             certified person. Not required on former unit if only received rent arrears.
                                                                             * copy of the tenant's lease
                                                                             * HAP agreement
                                                                             * Documentation of debt (e.g., a demand letter) if the assistance is for rent
                                                                             arrears in a unit they no longer occupy.


Security deposit                    Receipt, invoice,         from:                 * rent reasonableness form (NCHousingSearch.com form or manual form)
                                    or copy of check.            to:       NA       * HQS inspection form HUD 52580-A (if moving). Not required on former unit
                                                                                    if only received rent arrears.
                                                                                    * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
                                                                                    certified person. Not required on former unit if only received rent arrears.
                                                                                    * copy of the tenant's lease


Utility payment(s),                 Receipt, invoice,         from:                 * 3-month income certification form (if received >3 months assistance of any
current or in                       or copy of check.            to:                kind). Not required if only received rent arrears.
arrears                                                                             * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
                                                                                    certified person. Not required on former unit if only received rent arrears.
                                                                                    * copy of utility bill


Utility deposit                     Receipt, invoice,         from:                 * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
                                    or copy of check.            to:       NA       certified person. Not required on former unit if only received rent arrears.



Moving cost                         Receipt, invoice,         from:                 * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
assistance                          or copy of check.            to:                certified person. Not required on former unit if only received rent arrears.



Motel/Hotel                         Receipt, invoice,         from:                 * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
voucher                             or copy of check.            to:                certified person. Not required on former unit if only received rent arrears.
                                    address:
                                                                                    Note: A household is only eligible for this assistance if they have a unit
                                                                                    secured and are awaiting the day when the unit is available for move-in.
                                    move-in date:

Contracted service for this participant:                                            * invoice for the service.
                                    Receipt, invoice,         from:
      credit repair
                                    or copy of check.            to:
    legal services                  Receipt, invoice,         from:
                                    or copy of check.            to:
              case                  Receipt, invoice,         from:
     management                     or copy of check.            to:
          housing                   Receipt, invoice,         from:
         search &                   or copy of check.            to:
     outreach and                   Receipt, invoice,         from:
     engagement                     or copy of check.            to:

Requisition Totals

                                    Prevention           Rapid Rehousing
          Financial Assistance                  $0.00              $0.00
             Housing Services                   $0.00              $0.00
              Data/Evaluation                            NA
               Administration                            NA

                            Total                       $0.00
          NC HPRP Requisition for NCHFA
          NonClient Requisition (Staff Time & Operating Expenses)
                                                                                                                                               Grantee:
                                                                                                                                     Date of requisition:
          Staff Time & Travel
          All staff time spent on HPRP should appear in one of the below "staff time" rows, and should be documented with timesheets.
          This requisition (unlike the Client Requisition) covers time and activities for multiple households, and time that cannot be tied to individual households.
                                                                                                                               for Rapid
                                                                                                              for Prevention Rehousing
          FINANCIAL ASSISTANCE                                                                                Households       Households        Documentation submitted with requisition
          Staff time for Financial Assistance.                                                                 hours spent:     hours spent: Timesheets for each staff person that spent time on
          This includes:                                                                                                                         Financial Assistance.
          (a) time for processing financial assistance payments (for rent assistance, security deposits,       $ requested:     $ requested:
          utility payments, moving cost assistance, motel/hotel vouchers).                                                                       These timesheets must indicate what time (on the
          (b) time for performing housing inspections or paying fees-for-service for housing inspections,                                        timesheet) was spent on HPRP Financial Assistance.
          including travel time.                                                                                                                 The timesheet must indicate what time was for
          (c) time for preparing and submitting requisitions for reimbursement for these activities.                                             Prevention households and what time was for Rapid Re-
          (d) time for making disbursements to partner organizations for these activities.                                                       housing households.
          (e) other time spent in order to accomplish Financial Assistance activities.


          Other expenses for Financial assistance                                                            $ requested:   $ requested:    Appropriate documentation is what your agency already
          Includes travel, lodging, mobile phone expenses, etc.                                                                             uses internally (expense reports, receipts, invoices) to
          Describe the expenses that are included in this line of this requisition.                                                         justify payments or reimbursements. These will vary
                                                                                                                                            according to what the expense is for.




          HOUSING RELOCATION & STABILIZATION SERVICES                                                                                       Documentation submitted with requisition
          Staff time for Housing Relocation & Stabilization Services.                                        hours spent:   hours spent:    Timesheets for each staff person that spent time on
          This includes:                                                                                                                    Housing Relocation & Stabilization Services.
          (a) time for performing outreach & engagement, housing search & placement, credit repair           $ requested:   $ requested:
          services, and legal services.                                                                                                     These timesheets must indicate what time (on the
          (b) time for performing case management (including intake and eligiblity screening, financial                                     timesheet) was spent on HPRP Housing Services. The
          assistance determination, case management, eligibility monitoring and recertification,                                            timesheet must indicate what time was for Prevention
          participant file maintenance), including travel time.                                                                             households and what time was for Rapid Re-housing
          (c) time for submitting requisitions for reimbursement for these activities.                                                      households.
          (d) time for making disbursements to partner organizations for these activities.
          (e) other time spent in order to accomplish Housing Relocation & Stabilization Services                                           Note: Whatever portion of this time was used for a
          activities.                                                                                                                       particular client should be indicated in that client's CHIN
                                                                                                                                            record, but it does not need to be in that client's
                                                                                                                                            participant file.
          Other expenses for Housing Relocation & Stabilization Services                                     $ requested:   $ requested:    Appropriate documentation is what your agency already
          Includes travel, lodging, mobile phone expenses, etc.                                                                             uses internally (expense reports, receipts, invoices) to
          Describe the expenses that are included in this line of this requisition.                                                         justify payments or reimbursements. These will vary
                                                                                                                                            according to what the expense is for.




          DATA & EVALUATION                                                                                                                 Documentation submitted with requisition
          Staff time for Data & Evaluation.                                                                  hours spent:                   Timesheets for each staff person that spent time on Data
          This includes time for:                                                                                                           & Evaluation.
          (a) doing CHIN data entry and monitoring CHIN data entry.                                          $ requested:
          (b) performing grant management and oversight related to data and to program evaluation.                                          These timesheets must indicate what time (on the
          (c) submitting requisitions for reimbursement for these activities.                                                               timesheet) was spent on HPRP Data & Evaluation.
          (d) making disbursements to partner organizations for these activities.
          (e) other time spent in order to accomplish Data & Evaluation activities.

          Other expenses for Data & Evaluation                                                               $ requested:                   Appropriate documentation is what your agency already
          Includes travel, lodging, mobile phone expenses, etc. Specific examples include CHIN user                                         uses internally (expense reports, receipts, invoices) to
          fees, equipment (e.g., computer), & internet access.                                                                              justify payments or reimbursements. These will vary
          Describe the expenses that are included in this line of this requisition.                                                         according to what the expense is for.

                                                                                                                                            If the Grantee purchases computer equipment, it must
                                                                                                                                            include a defense of why the Grantee opted for purchase
                                                                                                                                            vs. lease of equipment.




page 2 of 2                                                                       NC HPRP NonClient Requisition                                                                Rev. 11/20/2009
          ADMINISTRATION                                                                                                                       Documentation submitted with requisition
          Staff time for Administration.                                                                      hours spent:                     Timesheets for each staff person that spent time on
          This includes time for:                                                                                                              HPRP Administration.
          (a) doing grant accounting and bookkeeping.                                                         $ requested:
          (b) performing grant management and oversight related to program compliance and                                                      These timesheets must indicate what time (on the
          effectiveness.                                                                                                                       timesheet) was spent on HPRP Administration
          (c) submitting requisitions for reimbursement for these activities.
          (d) making disbursements to partner organizations for these activities.
          (e) other time spent in order to accomplish Administration activities.
          Other expenses for Administration                                                                   $ requested:                     Appropriate documentation is what your agency already
          Includes travel, lodging, mobile phone expenses, etc.                                                                                uses internally (expense reports, receipts, invoices) to
          Describe the expenses that are included in this line of this requisition.                                                            justify payments or reimbursements. These will vary
                                                                                                                                               according to what the expense is for.




                                                                                                                       $ Requested
          Other Operation Expenses                                                                            for Prevention for Rapid
                                                                                                              Households     Rehousing
                                                                                                                             Households        Documentation submitted with requisition
          Office supplies specifically for HPRP (e.g., scanner)                                                                                receipt
                                                                                  financial assistance share $           -      $       -
                                                                                     housing services share $            -      $       -
          Office space (HPRP share)                                                                                                            1) description of square footage with ratio
                                                                                  financial assistance share $           -      $       -      2) copy of rent bill
                                                                                     housing services share $            -      $       -
          Office utilities (HPRP share)                                                                                                        1) description of square footage with ratio
                                                                                  financial assistance share $           -      $       -      2) copy of utilities invoice
                                                                                     housing services share $            -      $       -

          Requisition Totals                                                                                                       Rapid
                                                                                                                  Prevention     Rehousing
                                                                                       Financial Assistance             $0.00          $0.00
                                                                                          Housing Services              $0.00          $0.00
                                                                                           Data/Evaluation                  $0.00
                                                                                             Administration                 $0.00

                                                                                                      Total                  $0.00




page 3 of 2                                                                       NC HPRP NonClient Requisition                                                                  Rev. 11/20/2009
Date of requisition:



ed to individual households.


       Documentation submitted with requisition
       Timesheets for each staff person that spent time on
       Financial Assistance.

       These timesheets must indicate what time (on the
       timesheet) was spent on HPRP Financial Assistance.
       The timesheet must indicate what time was for
       Prevention households and what time was for Rapid Re-
       housing households.




       Appropriate documentation is what your agency already
       uses internally (expense reports, receipts, invoices) to
       justify payments or reimbursements. These will vary
       according to what the expense is for.




       Documentation submitted with requisition
       Timesheets for each staff person that spent time on
       Housing Relocation & Stabilization Services.

       These timesheets must indicate what time (on the
       timesheet) was spent on HPRP Housing Services. The
       timesheet must indicate what time was for Prevention
       households and what time was for Rapid Re-housing
       households.

       Note: Whatever portion of this time was used for a
       particular client should be indicated in that client's CHIN
       record, but it does not need to be in that client's
       participant file.
       Appropriate documentation is what your agency already
       uses internally (expense reports, receipts, invoices) to
       justify payments or reimbursements. These will vary
       according to what the expense is for.




       Documentation submitted with requisition
       Timesheets for each staff person that spent time on Data
       & Evaluation.

       These timesheets must indicate what time (on the
       timesheet) was spent on HPRP Data & Evaluation.




       Appropriate documentation is what your agency already
       uses internally (expense reports, receipts, invoices) to
       justify payments or reimbursements. These will vary
       according to what the expense is for.

       If the Grantee purchases computer equipment, it must
       include a defense of why the Grantee opted for purchase
       vs. lease of equipment.

                                                              Org:
                                                          1/0/1900




                       page 4 of 2                                   NC HPRP NonClient Requisition   Rev. 11/20/2009
Documentation submitted with requisition
Timesheets for each staff person that spent time on
HPRP Administration.

These timesheets must indicate what time (on the
timesheet) was spent on HPRP Administration




Appropriate documentation is what your agency already
uses internally (expense reports, receipts, invoices) to
justify payments or reimbursements. These will vary
according to what the expense is for.




Documentation submitted with requisition
receipt


1) description of square footage with ratio
2) copy of rent bill

1) description of square footage with ratio
2) copy of utilities invoice




                                                     Org:
                                                 1/0/1900




             page 5 of 2                                    NC HPRP NonClient Requisition   Rev. 11/20/2009

								
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