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

This form is required to report the spending in the CRRSA Program for Regulated Child Care Progams.

This report is for one license only, if you have multiple licenses please complete multiple reports.

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.

Send questions to AHS.DCFCRRSAgrant@vermont.gov

Organization Name*

License Number (Submit one report per license)*

Contact Name*

First NameLast Name

Phone Number*

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

Email*

example@example.com

What Categories Did You Spend the Funds on?*

Rows	Total amount spent in each category for the entire grant for this specific licensed program
PPE and other mitigation strategies to prevent the spread of COVID-19
Capital Improvement Projects
Occupancy (rent, insurance, mortgage, utilities, etc.)
Materials/Supplies
Replenishment of Lost Revenue and/or Reduced Enrollment
Wages/Spot-Bonuses
Professional Development/Technical Assistance for Early Childhood Education

Total Grant Spending for this Licensed Program (must match the total received for the entire grant for this licensed program)

This field is totaled from the categories above, to change the amount change the categories above.

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.

COVID-19 CRRSA Final Report Form for Regulated Child Care Programs