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					NC HPRP Requisition for NCHFA
Client Requisition
                                                                      Grantee:
                                                            Date of requisition:
                                                               CHIN client ID:
                                         Prevention or Rapid ReHousing client:

Documentation for each individual must be submitted separately. This requisition can only contain information for 1 household.

                                     Documentation      Assistance covers
                      Dollars        submitted with     this period
                      Requested      requisition        (MM/DD/YYYY)               Documentation included in the participant's file
Rent Assistance,                     Receipt or invoice      from:                 * rent reasonableness form (NCHousingSearch.com form or manual form)
current or in                        or copy of issued          to:                * 3-month income certification form (if received >3 months assistance of any
arrears                              check.                                        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 or copy of        from:               * rent reasonableness form (NCHousingSearch.com form or manual form)
                                     issued check.                to:              * 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 or invoice        from:               * 3-month income certification form (if received >3 months assistance of any
current or in                        or copy of issued            to:              kind). Not required if only received rent arrears.
arrears                              check.                                        * 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 or copy of        from:               * lead-based paint form (if pre-78 house with child <6 yrs old), completed by
                                     issued check.                to:              certified person. Not required on former unit if only received rent arrears.


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


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




page 1 of 1                                                             NC HPRP Client Requisition                                                      Rev. 11/20/2009
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.


                                                                                                                                                                           Org:    req date:




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
                                                                                                                                                                          Org:     req date:




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

				
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