Section 319 Project - Reimbursement Requests
This information is provided by the Nebraska Department of Environmental Quality  
to assist the public and regulated community .

Form #:  WAT136
Applications and Forms
Revised: 3/3/17

Please remember to save your file after each update!

Setting Up the Worksheet:  Begin on the Template tab by entering:

1)  Project name and 319 project number (56-xxxx) at the top of the page.
2)  Budget Categories (Personnel, Travel and Indirect Cost categories as listed in the approved Project Implementation Plan budget).
3)  Beginning Budget Balances for 319 funds (column B) and matching funds (column F), (as listed in the approved Project Implementation Plan budget).
4)  Name of Sponsor
5)  Contact Name for Sponsor
6)  Street Address or P.O. Box (whichever is preferred)
7)  City, State, Zip Code

Submitting a Reimbursement Request: 

Please begin at the "Request#1" tab for your first reimbursement request/matching report

1)  Enter, at the top of the page, the period of time that the form covers; e.g., January 1 to February 28, 2015.
2)  Enter the 319 grant fund expenditures (in Column C) for which you are requesting reimbursement.
3) Enter the matching funds (Column G ) for each category that have been expended during this time period.

If a category had no expenditure(s), please enter zero.

4)  Enter the current date at the bottom of the form.
5)  Save the worksheet file.
6)  Print off the current reimbursement form.
7)  Signature:  -> The form must be signed by an authorized sponsor signatory.
8)  Per the grant agreement, reimbursable costs and nonfederal match claims are to be related to the budget items as identified   in the approved Project Implementation Plan and are to be properly documented.  Documentation may include receipts, signed time records, and/or similar verification of expenditures. Copies of documentation should be sent with each reimbursement request.

   You are responsible for keeping all original receipts and documents pertaining to the expenditures (including matching funds).

 9)  Please mail, or e-mail a scan, of the SIGNED form accompanied by the proper documentation to:

ATTN:  Nonpoint Source Coordinator
1200 N Street, PO Box 98922
Lincoln, NE 68509-8922

10) All requests for reimbursement of costs incurred will be reviewed pursuant to the provisions of the Nebraska Prompt Payment Act.
11) Approved reimbursements will be electronically deposited into the sponsor's designated account per the ACH enrollment form currently on file with the State of Nebraska.
12) Please use the "Request#2" tab for your second reimbursement request and so on for future requests following the same procedure as your first request.