YYYY. To be submitted to OCHA to release the disbursement of the third instalment at any time once 70% of the previous instalment has been spent Depending on the start date and the risk rating of the Implementing Partner, no later than DD.MM.YYYY. For the Implementing Partner Signature: _________________________________ Name: Title: Place: Date: [OCHA project reference number]
YYYY. Additional Individual and Family Grants will not be considered for an individual until the DDS Individual and Family Grant Program has received proper documentation that the funds approved through this letter were used for the purpose specified above. Unused grant funds or grant funds used for another purpose without the department’s permission must be returned to DDS before another grant can be considered. If you have any questions regarding this grant, please feel free to contact Xxxx Xxxxx at (000) 000-0000. Sincerely, Xxxx X. Xxxxx, MSW Xxxx Xxxxx, MSW Individual and Family Grants Manager Department of Developmental Services 00 Xxxxxxxx Xxxx Xxxxxxxx, XX 00000 (000) 000-0000 CC: «CM_FirstName» «CM_LastName» ATTACHMENT A Department of Developmental Services Individual and Family Grant Agreement and Authorization FYYYYY (July 1, YYYY to June 30, YYYY) Individual’s Name «FirstName» «LastName» DDS # «DDSNum» Grant Request Date «DateReq» Amount Approved $«AmtApproved» Item or Service Approved «DetailedRequest» Case Manager «CM_FirstName» «CM_LastName» Payee: «VendorName» with Social Security # «VendorUnique» If this is not your (the payee’s) correct Social security number or name listed above, please attach a copy of your Social security card to this form
YYYY. Any change to the approved use of the grant funds MUST be submitted to the DDS Individual and Family Grant Manager for review and approval BEFORE any change in the use of funding occurs. If funds are spent prior to the approval for a change, you will be responsible for paying those funds back to DDS. Any special equipment, furnishings, or items purchased under this agreement are the property of the individual and shall be transferred to his or her new residence or program at such time as the individual moves or changes his or her employment opportunity or day services program. Requirements for Expenditure Reporting When paying staff for Respite, Personal Support, or Individualized Home Supports, a DDS Individual & Family Provider Payment Log must be used. Cancelled checks will no longer be accepted. Please write in the date staff worked, number of hours worked, rate of pay, and the total paid for each date. Persons providing the services MUST SIGN each line stating that they have received the payment for their services. For any other purchases, you must submit copies of receipts, cancelled checks, or paid invoices for those items or services purchased along with the Expenditure Report, once all grant funding has been exhausted, but not later than September 30, YYYY. Failure to turn in documentation of how the grant funds were spent may result in an individual not being eligible for future Individual and Family Grants. If Individual and Family Grant funds are not used as intended, or not used at all, grant funds are required to be repaid to the State of Connecticut by the payee. Other: All unspent grant funds must be returned in a check or money order made payable to: Treasurer, State of Connecticut. Please send these to the attention of: DDS Individual and Family Grant Program, 00 Xxxxxxxx Xxxx, Xxxxxxxx, XX 00000. You must keep original receipts, cancelled checks, or DDS Individual and Family Grant Provider Payment Log, if applicable, for three (3) years after receipt of the grant. It is your responsibility to ensure that workers supporting the individual are properly trained to protect the health and safety of the individual, you and your family members. By signing below, I confirm that I have read the agreement, and understand that these grant funds shall be used specifically for <<DetailedRequest>>. __________________________________________ _________________________ Signature Date To expedite payment, please fax signed and dated agreement to the DDS S...
YYYY. 3.3 Срок исполнения обязательств сторонами по настоящему договору: ДД.ММ.ГГГГ.