Ozone Season Transit Grantee Agency Reimbursement Request Form - Colorado Association of Transit Agencies

Ozone Season Transit Grantee Agency Reimbursement Request

Grant Number(Required)

The grant number can be found on your award letter

Agency(Required)

Reporting Month(Required)

Choose the month for which you are requesting expenses be reimbursed.

How did your agency utilize the grant funds? Check all that apply(Required)

New free transit services (ex. Additional free routes)

Expanded free transit services (expanding service on routes for which the eligible transit agency currently offers free service)

Fare-box revenue replacement

Other expenses necessary to implement the program (including expenses associated with an increase in ridership as a result of the program)

Amount ($) spent on New Free Transit Services

Amount ($) spent on Expanded Free Transit Services

Fare-Box Revenue Replacement Worksheet(Required)

Program/Farebox

Fare Rate

Riders

Subtotal

Please provide the program or route with the rate and riders for the month. Multiple your riders by the rate to provide the subtotal for each program for which you are seeking reimbursement. If all your programs are the same rate then one line will suffice. Press + to add a program/farebox

Amount ($) spent on Fare-box Revenue Replacement

Amount ($) spent on Other Expenses necessary to implement the program

Other expenses necessary to implement the program

Please describe other expenses necessary to to implement the program

Total Reimbursement Request

Please provide a brief (500 word max) narrative to provide context on the use of funds included in the report.(Required)

Expense Receipts and Financial Reports

Drop files here or

Max. file size: 265 MB.

Ridership reports(Required)

Accepted file types: pdf, Max. file size: 256 MB.

Data that you would report to CDOT

Hidden

Ridership reports

Accepted file types: pdf, Max. file size: 256 MB.

Data that you would report to CDOT

Hidden

Ridership reports

Accepted file types: pdf, Max. file size: 256 MB.

Data that you would report to CDOT

Ridership Narrative(Required)

Please provide a summary of changes in ridership during the period that free services were offered compared to previous months, the same month in previous years, and the months after the program concluded.

Lessons Learned and Rider Stories(Required)

Please provide a summary of lessons learned including any unanticipated benefits and challenges.

Email of Submitter

Submitter(Required)

First Last Title

Ozone Season Transit Grantee Agency Reimbursement Request

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