2018-19 NHAP BILLING SIGNATURE PAGE QUARTER (check one) 1st Quarter (Jul/Aug/Sep) due Oct 31 3rd Quarter (Jan/Feb/Mar) due Arp 30 2nd Quarter (Oct/Nov/Dec) due Jan 31 4th Quarter (Apr/May/Jun) Due Jul 31 Agency Name: Street Address: City, State, Zip+4: Agency NHAP Number (3 digits): Print this document, obtain the necessary signature and e-mail it with the completed NHAP Billing Form spreadsheet and your agency’s NHAP Billing Cover Sheet to Kim Jasa at CHECK IF BILLING REQUEST INCLUDES AUDIT COST AMOUNT: I hereby certify that to the best of my knowledge, the attached NHAP Billing and Billing Cover Sheet forms contain accurate information and reflect actual and allowable costs. Print Name of Authorized Official: Email Address: Phone Number: Signature of Authorized Official Date
2018-19 NHAP BILLING SIGNATURE PAGE QUARTER (check one) 1st Quarter (Jul/Aug/Sep) due Oct 31 2nd Quarter (Oct/Nov/Dec) due Jan 31 3rd Quarter (Jan/Feb/Mar) due Arp 30 4th Quarter (Apr/May/Jun) Due Jul 31 Agency Name: Street Address: City, State, Zip+4: Agency NHAP Number (3 digits): Print this document, obtain the necessary signature and e-mail it with the completed NHAP Billing Form spreadsheet and your agency’s NHAP Billing Cover Sheet to Kim Jasa at CHECK IF BILLING REQUEST INCLUDES AUDIT COST AMOUNT: I hereby certify that to the best of my knowledge, the attached NHAP Billing and Billing Cover Sheet forms contain accurate information and reflect actual and allowable costs. Print Name of Authorized Official: Email Address: Phone Number: Signature of Authorized Official Date