CDBG_Reimbursement_Form.pdf

This is a Lake County Housing and Community Services CDBG (Community Development Block Grant) Reimbursement Request Form designed for tracking and documenting expenses related to a specific project funded through CDBG funds. The form provides a structured template for subrecipients to request reimbursement for various project expenditures, including payroll, invoices, equipment, and other contracts. It requires detailed documentation such as authorized timesheets, copies of disbursed checks, procurement information, and contract copies to substantiate the reimbursement request.

The form is specifically intended for use with CDBG funds and includes multiple review levels, with signature lines for Housing & Community Services staff, CDBG Program Supervisor, and the Housing & Community Services Director. The document includes a section to indicate whether the account is subject to program income, and provides space for additional notes. Notably, all monetary amounts are left blank, indicating that the specific financial details will be filled in by the subrecipient when submitting their reimbursement request. The form is part of Lake County's financial documentation and oversight process for managing federally funded community development projects.