Lost Wages Claimant Summary & Admin Costs_3 weeks.xlsx

XLSX spreadsheet 21 KB Posted

Attached to
Other Needs Assistance - Lost Wages
Opportunity number
DHS-20-ONA-050-00-99
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Lost Wages Claimant Summary & Admin Costs_3 weeks.xlsx

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State submission

Box 1: Claimant Summary - [INSTERT STATE/TERRITORY NAME]Number of eligible claimants (actual or estimated)Fed-share per eligible claimantLost Wages Benefit (fed-share)
Week ending 8/1/20
Regular Unemployment$300$0
Unemployment Compensation for Federal Employees (UCFE)$300$0
Unemployment Compensation for Ex-Service members (UCX)$300$0
Pandemic Emergency Unemployment Compensation$300$0
Pandemic Unemployment Assistance$300$0
Extended Benefits$300$0
Short-Time Compensation$300$0
Trade Readjustment Allowance$300$0
Payments under the Self-Employment Assistance program$300$0
SUBTOTAL0$0
Week ending 8/8/20
Regular Unemployment$300$0
Unemployment Compensation for Federal Employees (UCFE)$300$0
Unemployment Compensation for Ex-Service members (UCX)$300$0
Pandemic Emergency Unemployment Compensation$300$0
Pandemic Unemployment Assistance$300$0
Extended Benefits$300$0
Short-Time Compensation$300$0
Trade Readjustment Allowance$300$0
Payments under the Self-Employment Assistance program$300$0
SUBTOTAL0$0
Week ending 8/15/20
Regular Unemployment$300$0
Unemployment Compensation for Federal Employees (UCFE)$300$0
Unemployment Compensation for Ex-Service members (UCX)$300$0
Pandemic Emergency Unemployment Compensation$300$0
Pandemic Unemployment Assistance$300$0
Extended Benefits$300$0
Short-Time Compensation$300$0
Trade Readjustment Allowance$300$0
Payments under the Self-Employment Assistance program$300$0
SUBTOTAL0$0
TOTAL (3 weeks of Lost Wages benefit payments, fed-share)0$0

Box 2: Administrative Costs Instructions to State/Territory: Enter the total estimated administrative costs, as outlined on your SF-424A, in the box to the right.

Calculations

Award Calculations- [INSTERT STATE/TERRITORY NAME]

Lost Wages Benefit Payments
Total Benefits
($400/claimant)Federal Share
($300/claimant)Non-federal share

($100/claimant)

Number of eligible claimants for week ending 8/1/200$0$0$0
Number of eligible claimants for week ending 8/8/200$0$0$0
Number of eligible claimants for week ending 8/15/200$0$0$0
Lost Wages benefit payments subtotal0$0$0$0

Lost Wages Administrative Costs Reviewer instructions for Admin Costs:

1) Confirm that the state/territory entered their admin costs, as reflected in the SF-424A, into "Box 2" of the "State submission" tab.

2) Compare the "FEMA-calculated administrative costs" to the "State-submitted administrative costs", and enter the lesser of the two amounts in the bright green box.

Total Admin CostsFederal ShareNon-federal share
FEMA-calculated administrative costs1.00%$0$0$0
State-submitted administrative costsERROR:#DIV/0!$0$0$0
Lost Wages administrative costs (lesser of the two)$100$75$25
Total Award: Lost Wages Benefits + Administrative Costs
Total Award
(Benefits + Admin Costs)Federal ShareNon-federal share
Lost Wages benefit payments for 3-week period
(weeks ending 8/1, 8/8, and 8/15)$0$0$0
Lost Wages administrative costs (lesser of the two)$100$75$25
TOTAL$100$75$25

Table for Award Letter The table below is formatted so that it may be copied and pasted into the award letter template.

All reviewers should double check that $$ figures copy and paste into the award letter accurately.

Total
Lost Wages Payments for the week ending 8/1/20$0
Lost Wages Payments for the week ending 8/8/20$0
Lost Wages Payments for the week ending 8/15/20$0
Administrative Costs$75
Total$75

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