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

Subgrantee Information

Please refer to the Subgrantee Reimbursement Uniform Guidance when completing this form.

Grant Number(Required)

The grant number can be found on your award letter

Grant Amount(Required)

Refer to you application and Grant Award letter for this amount

Match Amount(Required)

Refer to you application and Grant Award letter for this amount

Subgrantee (Agency)(Required)

Subgrantee (Agency) Invoice Number(Required)

Subgrantee (Agency) Invoice(Required)

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

Reimbursement

Program Start Date(Required)

Program End Date(Required)

Total Program Days(Required)

Please only count days that zero-fare transit was provided (example: if you provided free transit Monday-Friday but not on Saturday or Sunday for 4 weeks the total amount of free transit days would be 20, not 28.)

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

“New Free Transit Service '' includes service that provides additional free routes created for the program, as well as previously operating routes made free for the duration of the program. “Expanded Free Transit Service” means service that provides increased frequency or additional stops on an already free route for the duration of the program. Please check all that apply and provide the amounts below:

New Free Transit Services

Expanded Free Transit Services

New Free Transit Services Expenses (NFTS)(Required)

Please select the type of expense for which grant funds were used during the program:

Expenses Related to Implementing New Free Transit Service

Fare Box Revenue Recovery for New Free Transit Services

1. NFTS - Expenses(Required)

Please provide an itemized accounting for expenses related to implementing the New free transit service. Item description must match the item in the expense documentation.

Item Description

Amount

Match Amount

2. NFTS - Total Expense Amount(Required)

Please input the total amount spent on expenses related to implementing New free transit service

3. NTFS - Total Match Amount(Required)

Please input the to match provided to implement new free transit service

4. NFTS - Expense Narrative(Required)

Please provide a detailed explanation of the expenses including any in kind contributions or match necessary to implement the new transit services made free during the program period. Please provide as much detail as possible.

5. NFTS - Expense Documentation(Required)

Please provide documentation to support expenses related to implementing New Free Transit Service during the Program Period. Acceptable forms of documentation include, receipts and expense reports. Each expenses reported in the form must include supporting documentation. Please use the naming conventions in the Uniform Guidance

Drop files here or

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

1. NFTS Fare-Box Revenue Recovery Worksheet(Required)

Please provide the new free transit service route/program with the rate and riders for each month of your fair free program. Multiply your riders by the rate to provide the subtotal for each program for which you are seeking reimbursement. Each program or route must be present. Please refer to the fare rates established in your application and Subgrantee Agreement when filling out this section Press + to add a program/route

Month

Route/Program

Fare Rate

Riders

Subtotal

2. NFTS - Farebox Revenue Recovery(Required)

Please provide the amount of New Free Transit Services Fare-box Revenue Recovery requested from the subtotal of 1. NFTS.

3. NFTS - Farebox Revenue Recovery Narrative(Required)

Please provide a detailed explanation of the costs associated with fare box recovery and how you calculated fare-box recovery

4. NFTS Ridership 2mo Prior and After(Required)

Please provide the ridership for the 2 months leading up to and after the months your agency provided free transit service. Press + to add a program/route

Month

Route/Program

Riders

5. NFTS Ridership 2mo Prior and After Narrative(Required)

Please provide a detailed analysis of ridership 2 months prior to and after you new fare free program. If you do not have October numbers yet, please provide updated numbers and narrative as early as possible.

A. NFTS - Ridership Documentation(Required)

Please provide your program's ridership documentation that highlights and supports the new free transit service rides during the program period. This report should break down each route/program with riders for each month. Please combine all reports into one file. Please use the names of the route/program reported in the form in the ridership report.

Drop files here or

Accepted file types: pdf, Max. file size: 265 MB.

B. NFTS - Ridership Summary(Required)

Please provide a summary of ridership for the program period, breaking down ridership for each month of the program period and include a comparison of the ridership for the two months leading up to and after the 2023 program with the month(s) of your program. Include any rider stories, lessons learned and unanticipated benefits and challenges.

Expanded Free Transit Services Expenses(Required)

Please select the type of expense for which grant funds were used during the program:

Expenses Related to Implementing Expanded Free Transit Service

1. EFTS - Expenses(Required)

Please provide an itemized accounting for expenses related to implementing the Expanded free transit service. Item description must match the item in the expense documentation.

Item Description

Amount

Match Amount

2. EFTS - Total Expense Amount(Required)

Please input the total amount spent on expenses related to implementing Expanded free transit service

3. ETFS - Total Match Amount(Required)

Please input the to match provided to implement Expanded free transit service

4. EFTS - Expense Narrative(Required)

Please provide a detailed explanation of the expenses including any in kind contributions or match necessary to implement the expanded transit services made free during the program period. Please provide as much detail as possible.

5. EFTS - Expense Documentation(Required)

Please provide documentation to support expenses related to implementing Expanded Free Transit Service during the Program Period. Acceptable forms of documentation include, receipts and expense reports. Each expenses reported in the form must include supporting documentation. Please use the naming conventions in the uniform guidance

Drop files here or

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

6. EFTS Ridership Worksheet(Required)

Please provide the expanded free transit service route/program for each month your agency provided free transit as well as the ridership for the 2 months leading up to and after the months your agency expanded free transit. Press + to add a program/route

Month

Route/Program

Riders

A. EFTS - Ridership Documentation(Required)

Please provide your program's ridership documentation that highlights and supports the expanded free transit service rides during the program period. This report should break down each route/program with riders for each month. Please combine all reports into one file. Please use the names of the route/program reported in the form in the ridership report.

Drop files here or

Accepted file types: pdf, Max. file size: 265 MB.

B. EFTS - Ridership Summary(Required)

Please provide a summary of ridership for the program period, breaking down ridership for each month of the program period and include a comparison of the ridership for the two months leading up to and after the 2023 program with the month(s) of your program. Include any rider stories, lessons learned and unanticipated benefits and challenges.

Totals

Total Reimbursement Request(Required)

Total Match Amount(Required)

Does Total Reimbursement Request match the grant amount?(Required)

Yes

No

Please explain why the Total Reimbursement Request does not match the Grant amount(Required)

Refer to you application and Grant Award letter for this amount

Submitter(Required)

First Last Title

Email of Submitter(Required)

2023 Ozone Season Transit Subgrantee Reimbursement

Subgrantee Information

Reimbursement

Totals

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