APPENDIX A: GRANT APPROVAL AND ADMINISTRATIVE POLICY CHECKLISTS

   
Request to Apply for a Grant
Date:
Department:
Name:
Contact Info:
Grant Due Date:
Grant Name and Funding Agency:
Grant Summary:
Request Received by Auditor         on         by
Copied to Commissioners         on         via
Copied to Council               on         via
Copied to County Attorney         on         via
Authorized to Proceed on by
with Grant Application            on         by
Authorized to Proceed on by with
Grant Application               on         by
DESCRIPTION
Paid by Grant
Paid by County
N/A
DESCRIPTION
Paid by Grant
Paid by County
N/A
Salary
INPRS
Social Security (wage x 6.20%)
Medicare (wage x 1.45%)
Who will cover unemployment expense?
Who will cover worker’s compensation insurance?
Employer’s Share of Insurance Coverage
Dental
Vision
Supplemental Pay
Insurance Expense over Excess Loss
What tools will the Grant require?
Training Expense?
Personal Computer, Software, Internet and Email
Vehicle/Fuel
Does the Grant require matching funds?
What is the Grant start date?
When does the Grant expire?
Can a Grant administration fee be charged?
 
   Grant Summary
Local Project Name                     -----------------------------------------------------------
Award Number                     -----------------------------------------------------------
Award Name                        -----------------------------------------------------------
Award Method Advanced/Reimbursement/Other*(see note)
                           -----------------------------------------------------------
Fund Name/Number                  -----------------------------------------------------------
Initiating Office/Department               -----------------------------------------------------------
Contact Person Name                  -----------------------------------------------------------
Contact Person Phone                  -----------------------------------------------------------
Contact Person E-Mail                  -----------------------------------------------------------
Pass-Through Agency                  -----------------------------------------------------------
Contact Person Name                  -----------------------------------------------------------
Contact Person Phone                  -----------------------------------------------------------
Contact Person E-Mail                  -----------------------------------------------------------
Federal Grant?                     Yes/No
Federal Agency                     -----------------------------------------------------------
Federal Program/Project Title               -----------------------------------------------------------
CFDA Number                     -----------------------------------------------------------
Passed to Sub-recipients                  Yes/No
Notes:                           -----------------------------------------------------------
                           -----------------------------------------------------------
                           -----------------------------------------------------------
*noncash, loan, income