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Public Assistance Quarterly Subrecipient Monitoring

Public Assistance Quarterly Subrecipient Monitoring

Step 1 of 4

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Disaster (DR) Number*
Please select the disaster that you are reporting on.

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Contact Information
Subrecipient Name (Municipality/Entity Name)*
Primary Point of Contact (POC)*
First Last
Primary POC Email*
Enter Email Confirm Email
Primary POC Phone*
Quarterly Progress Report
Project Information
Performance Period Reporting On*
How many projects are you reporting on?*
- 1
- 2
- 3
Project #1 – Reporting
Project #1: Title*
Project #1: EMMIE Number*
Please enter a number less than or equal to 500.
Project #1: Grants Portal Project Number*
Please enter a number less than or equal to 999999.
Project #1: Category of Work*
Project #1: Current Project Status*
Project #1: Projected Completion Date*
MM slash DD slash YYYY
Project #1: Actual Completion Date*
Completion Date should be on or before the Period of Performance (POP) date (see table below). If the completion date is after the POP and the project does not have an approved extension, please contact your HSEM Field Representative or HSEMPlanning@dos.nh.gov as soon as possible.
MM slash DD slash YYYY
Project #1: Percentage of Scope of Work Completed*
Please enter a number from 0 to 100.
Project #1: Describe what significant activities have occurred that detail the progress and status of the project during this quarter.*
Project #1: Describe in detail any problems, delays, or other issues that may have been encountered and you may require assistance on.*
This could include delays caused by permitting, environmental, historical or other reasons.
Project #1: Upload a current picture showing the progress of your project., if applicable.
Drop files here or

Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Project #1: Funds Expended to Date*
Total cost amount spent by the Applicant to date (includes the federal and non-federal share).
Project #1: Provide an analysis of expenditures during this quarterly report performance period*
Project #2 Reporting
Project #2: Title*
Project #2: EMMIE Number*
Please enter a number less than or equal to 500.
Project #2: Grants Portal Project Number*
Please enter a number less than or equal to 999999.
Project #2: Category of Work*
Project #2: Current Project Status*
Project #2: Projected Completion Date*
MM slash DD slash YYYY
Project #2: Actual Completion Date*
Completion Date should be on or before the Period of Performance (POP) date (see table below). If the completion date is after the POP and the project does not have an approved extension, please contact your HSEM Field Representative or HSEMPlanning@dos.nh.gov as soon as possible.
MM slash DD slash YYYY
Project #2: Percentage of Scope of Work Completed*
Please enter a number from 0 to 100.
Project #2: Describe what significant activities have occurred that detail the progress and status of the project during this quarter.*
Project #2: Describe in detail any problems, delays, or other issues that may have been encountered and you may require assistance on.*
This could include delays caused by permitting, environmental, historical or other reasons.
Project #2: Upload a current picture showing the progress of your project., if applicable.
Drop files here or

Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Project #2: Funds Expended to Date*
Total cost amount spent by the Applicant to date (includes the federal and non-federal share).
Project #2: Provide an analysis of expenditures during this quarterly report performance period*
Project #3 Reporting
Project #3: Title*
Project #3: EMMIE Number*
Please enter a number less than or equal to 500.
Project #3: Grants Portal Project Number*
Please enter a number less than or equal to 999999.
Project #3: Category of Work*
Project #3: Current Project Status*
Project #3: Projected Completion Date*
MM slash DD slash YYYY
Project #3: Actual Completion Date*
Completion Date should be on or before the Period of Performance (POP) date (see table below). If the completion date is after the POP and the project does not have an approved extension, please contact your HSEM Field Representative or HSEMPlanning@dos.nh.gov as soon as possible.
MM slash DD slash YYYY
Project #3: Percentage of Scope of Work Completed*
Please enter a number from 0 to 100.
Project #3: Describe what significant activities have occurred that detail the progress and status of the project during this quarter.*
Project #3: Describe in detail any problems, delays, or other issues that may have been encountered and you may require assistance on.*
This could include delays caused by permitting, environmental, historical or other reasons.
Project #3: Upload a current picture showing the progress of your project., if applicable.
Drop files here or

Accepted file types: pdf, jpg, gif, xslx, doc, docx, ppt, pptx, xsl, Max. file size: 1 GB.
Project #3: Funds Expended to Date*
Total cost amount spent by the Applicant to date (includes the federal and non-federal share).
Project #3: Provide an analysis of expenditures during this quarterly report performance period*
Project #3: Explain reason for cost overrun, including cost overrun amount.*

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Quarterly Subrecipient Monitoring
If applicable, do not report on projects already reported on the Quarterly Progress Report.
Do you have any projects under this disaster that are currently experiencing or are anticipated to experience a delay?*
Do not report on projects already reported on the QPR, if applicable.
- Yes (additional questions will appear below)
- No
Please list the project number(s) and explain the reason for the delay.*
Do you have any projects under this disaster that are experiencing or are anticipated to experience environmental, historical, or permitting issues?*
Do not report on projects already reported on the QPR, if applicable.
- Yes (additional questions will appear below)
- No
Please list the project number(s) and explain the reason for the environmental, historical, or permitting issue(s).*
Do you have any projects that are currently experiencing or are anticipated to experience any other type of project issue (i.e. scope of work change, procurement, documentation, etc.)?*
Do not report on projects already reported on the QPR, if applicable.
- Yes (additional questions will appear below)
- No
Please list the project number(s) and explain the other project issues that you are experiencing/anticipate.*
Are you in regular communication with your HSEM Field Representative?*
- Yes
- No
Please explain current barriers in your communication with the HSEM Field Representative*
Are you in regular communication with your FEMA Program Delivery Manager (PDMG)?*
- Yes
- No
Please explain current barriers in your communication with the FEMA Program Delivery Manager (PDMG).*
Is there currently a person in your office assigned/dedicated to Public Assistance and this disaster?*
- Yes (I am the dedicated Public Assistance Point of Contact)
- Yes (Someone else other than myself is the dedicated PA POC)
- No (We do not currently have a person dedicated to PA and this disaster)
Name of Public Assistance POC*
POC: Point of Contact
First Last
Email of Public Assistance POC*
Enter Email Confirm Email
Public Assistance POC Phone Number*
OPTIONAL: Please explain any challenges you face in appointing a person dedicated to the Public Assistance Program in your community/agency.
Would you like a conference call or an in person meeting to discuss any of the items mentioned above?*
- Yes (We will reach out to you to schedule a date and time)
- No, not at this time

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Certification and Submission
The person completing the report is the same as the Primary POC.*
- Yes
- No
Name of Person Completing Report*
First Last
Email of Person Completing Report*
Enter Email Confirm Email
Phone Number of Person Completing Report*
By checking the box below and entering my name, I agree that I understand that these forms are required to be submitted on a quarterly basis. I understand that failure to report by the deadline or providing any false information may result in the inability to distribute any further monies or benefits related to this project until a complete and accurate report has been sent to NH HSEM. In addition, failure to report on time may result in the loss of future funding/grant awards.*
- I understand and Agree
Name*
First Last
Comments
Provide any additional comments or notes that you would like to share with HSEM regarding this project.
Phone
This field is for validation purposes and should be left unchanged.

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