WA ST Dept of Commerce 8/3/2020 - Laserfiche WebLink

Attachment D CRF A-19 Activity Report INSTRUCTIONS INSTRUCTIONS: A completed CRF A-19 Certification and Activity Report must be submitted with each A-19 reimbursement request. The A-19 Activity Report must be submitted as an Excel spreadsheet,not a PDF.You must also include a detailed breakdown of the individual expenditures reported in Column F for each applicable sub-category included on the A-19 Activity Report. There are 6 primary budget categories; 1.Medical Expenses 2 Public Health Expenses 3. Payroll expenses for public employees dedicated to COVID-19 4. Expenses to facilitate compliance with COVID-19-measures 5. Economic Supports 6 Other COVID-19 Expenses Each primary budget category includes sub-categories and provides an option to add''other"sub-categories not listed Follow the below instructions when completing the A-19 Activity Report: 1 REPORT PERIOD-Enter the report period into Cell D1 of the A-19 Activity Report. a This should match the report period entered on the corresponding A-19. b Report period should include MMIYY to MMIYYYY,i.e.03/20,March 2020,03/2020,etc. 2 COLUMN E- Enter the total amount of all previous reimbursement requests submitted to Commerce for each applicable sub-category. 3 COLUMN F- Enter the total amount being requested in the current reimbursement request for each applicable sub-category. 4 COLUMN H:USE OF FUNDS-You must include a general description of the use of the funds being requested for each applicable sub-category.Keep descriptions as concise as possible,but include adequate context to demonstrate how these funds helped address the COVID-19 emergency if applicable;please consider a Providing a brief description of the specific activities performed. b Identifying specific populations served. c Identifying specific programs created or utilized. d Including any known or intended outcomes,results,or community impacts. 5 OTHER SUB-CATEGORIES-Budget categories 1-5 include a placeholder to add an additional sub-category if necessary. a Enter a Title for other expenses added within the appropriate budget category. b Enter titles into Cells:D10,D19,D27, D36,and D41. c There is only one"other"placeholder in each budget category section. Please combine multiple"other"sub- categories added to the same budget category. 6 OTHER BUDGET CATEGORIES-Budget category 6 is where you should include any eligible expenditures that don't fall under budget categories 1-5. a Enter a Title for these"other"expenses within budget category 6. b Enter titles into Cells D44-D48. c There are only 5 entry fields available within Budget Category 6. State of Washington Interagency Agreement Version 072019 Department of Commerce Page 15