COVID-19 CRRSA Monthly Reporting Form for Regulated Child Care Programs

This form is required to report monthly spending in the CRRSA Program for Regulated Child Care Progams. Please submit one report for all of your regulated programs. Questions can be sent to AHS.DCFCRRSAgrant@vermont.gov

Reports are due by the 5th of the month in order to receive the next monthly payment.

Organization Name*

License number (add more if reporting on multiple licenses)*

Contact Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

How did your spend your CRRSA grant payment this month? (Check all categories that apply for the prior month’s spending on all licenses together)*

PPE and other mitigation strategies to prevent the spread of COVID-19Capital Improvement ProjectsOccupancy (rent, insurance, mortgage, utilities, etc.)Materials/SuppliesReplenishment of Lost Revenue and/or Reduced EnrollmentWages/Spot-BonusesProfessional Development/Technical Assistance for Early Childhood Education

Note: Please track monthly spending amounts in these categories, per license, as you will have to submit the total per category, per license, in your final report which will be a culmination of spending amounts in each category for each license.

Check the report you are submitting:*

May 5, 2021 for April expensesJune 5, 2021 for May expensesJuly 5, 2021 for June expensesAugust 5, 2021 for July expensesSeptember 5, 2021 for August expensesOctober 5, 2021 for September expensesNovember 5, for October expensesDecember 5, 2021 for November expenses

The CRRSA Final Report is due December 20, 2021 to document the total amount spent per category, unless your program closed prior to December, then the CRRSA Final Report is due by the 20th of the month the program closed. Please use the CRRSA Final Report Form found at: https://form.jotform.com/210733745638157

By signing

I certify that I have received no other COVID-19 specific state, federal, and/or municipal dollars to offset these associated costs.
I certify that I have spent prior issued funds in one or more of the Categories of Spending.
I certify that if I received funds for more than one licensed program that the funds were spent on the program for which they were awarded.
I certify that I am not using CRRSA funds to replace tuition that I have received or will receive from the Child Care Financial Assistance Program (CCFAP)
I certify that my signature below signifies that I agree to the terms and conditions in the Grant Agreement which was previously sent to me.
I agree that my participation in the CRRSA grant program is subject to an audit, and that I will keep all expenditure details including receipts, payroll documentation, and invoices related to the CRRSA funds I receive. I will provide any documentation related to my participation in the CRRSA grant program within thirty (30) days of a written request from the State, including receipts, payroll records and invoices. Failure to timely respond to a request for records could result in repayment of funds already received and withholding of future grant funds.

Signature*

Print Name*

First NameLast Name

Position Title*

Grantees will also be required to submit the annual sub-grant recipient report, which can be found at https://finance.vermont.gov/forms/grant-recipients.