Instructions for BSPE 705 ATTACHMENT A 1. Warrant Issued To: The applicant agency and address as it appears on the agreement. This is where the check will be mailed. 2. Claim Number: Number of this claim, i.e. Claim No. 1 Progress, then Claim No. 2 Progress and so on until Claim – – No. ___ Final. 3. Prepared By: Name, telephone number and e-mail address of individual who prepared the claim. The same number as on Page 1 of the Cycle Rider Safety Training Program (CRSTP) Project Number and Type: Uniform Intergovernmental Grant Agreement. 5. Period Covered: Dates covered by this claim. Include the year. 6. Location of Records: The agency and address student registration, training attendance, and other fiscal records will be kept for three years after the final claim has been reimbursed. *Please note: All waiver forms shall be retained for a period of 7 years following the students’ completion of the course. 7. Project Costs by Budget Category: A Approved Budget: Enter the approved federal amount from Page 1 of the Cycle Rider Safety Training – Program (CRSTP) Uniform Intergovernmental Budget Template. Reflect any approved revision to the budget that occurred among line items. B Expended this Period: Summarize the expenditures incurred during this claim period. – C Expended to Date: Calculate expenditures to date; this claim plus previous claims. – 8. Amount of Claim: Enter the total amount to be reimbursed for the claim. The Program Director and Authorizing Representative, as shown within the Cycle Rider Safety Training Program (CRSTP) Uniform Intergovernmental Grant Agreement must sign and date the claim form. Mail the original claim form (with appropriate signatures) and the supporting source documents to: Illinois Department of Transportation Bureau of Safety Programs and Engineering Attn: Rider Safety Training Program 2300 South Dirksen Parkway Springfield, IL The final claim for reimbursement must be received by the Bureau of Safety Programs and Engineering within 90 days of the contract/agreements end date. Allow 4-6 weeks for processing and payment of claims.
Instructions for BSPE 705 ATTACHMENT A 1. Warrant Issued To: The applicant agency and address as it appears on the agreement. This is where the check will be mailed. 2. Claim Number: Number of this claim, i.e. Claim No. 1 – Progress, then Claim No. 2 – Progress and so on until Claim No. ___ Final. 3. Prepared By: Name, telephone number and e-mail address of individual who prepared the claim. Project Number and Type: The same number as on Page 1 of the Cycle Rider Safety Training Program (CRSTP) Uniform Intergovernmental Grant Agreement. 5. Period Covered: Dates covered by this claim. Include the year. 6. Location of Records: The agency and address student registration, training attendance, and other fiscal records will be kept for three years after the final claim has been reimbursed. *Please note: All waiver forms shall be retained for a period of 7 years following the students’ completion of the course. 7. Project Costs by Budget Category: A – Approved Budget: Enter the approved federal amount from Page 1 of the Cycle Rider Safety Training Program (CRSTP) Uniform Intergovernmental Budget Template. Reflect any approved revision to the budget that occurred among line items. B – Expended this Period: Summarize the expenditures incurred during this claim period. C – Expended to Date: Calculate expenditures to date; this claim plus previous claims. 8. Amount of Claim: Enter the total amount to be reimbursed for the claim. The Program Director and Authorizing Representative, as shown within the Cycle Rider Safety Training Program (CRSTP) Uniform Intergovernmental Grant Agreement must sign and date the claim form. Mail the original claim form (with appropriate signatures) and the supporting source documents to: Illinois Department of Transportation Bureau of Safety Programs and Engineering Attn: Rider Safety Training Program 2300 South Dirksen Parkway Springfield, IL The final claim for reimbursement must be received by the Bureau of Safety Programs and Engineering within 90 days of the contract/agreements end date. Allow 4-6 weeks for processing and payment of claims.
BSPE%20705.docx