ICDVVA Match Waiver Request Form

ICDVVA Match Waiver Request Form

October 1, 2025 - September 30, 2026
VOCA recipients are required to provide a 20% match share of the overall requested budget (28 CFR 94.118) unless a Match Waiver Request has been approved. Match requirements may be waived for programs that can provide documentation of need as outlined in 28 CFR 94.118(b)(3) of the VOCA Victim Assistance Final Program Guidelines.

Detailed guidelines for Match Waiver approval can be found in the ICDVVA Policies and Procedures Manual located on our website. Requests must be made more than 45 days before the end of the subaward period.
Organization Name*
Contact Name*

First NameLast Name
Email*
example@example.com
I am requesting this waiver more than 45 days from the end of my subaward period:*

yesno
Total amount of VOCA match required for your current award:*
Total amount of VOCA match that you are requesting for ICDVVA to waive:*
Total amount of remaining VOCA match that your organization will provide (assuming waiver is granted):*
Provide the reason why your organization needs match waived. Include such information as: availability of local resources; annual budget changes; past ability or inability to provide match; whether the funding is for new activities; extenuating circumstances such as a natural disaster, public health crisis, national emergency, or other extreme circumstance that is out of the subrecipient’s control; resource constraints (e.g., employee recruitment and retention challenges or limited funding availability); other events or challenges. Please explain how the denial of a match waiver would impact your project.
If your request is approved, which of the following apply?

My organization would likely need another match waiver in the next grant yearMy organization would likely not need another match waiver in the next grant yearMy organization is unlikely to apply for VOCA funding in the next grant year
Signature*
ICDVVA Action:

ApprovedDenied
Reason for denial:
ICDVVA Approval Signature*

Select Image

Cancelof
Date

MonthDayYear
Date
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