REPORT/DOCUMENT | DUE DATE | SEND TO | # OF COPIES |
| Notification of Grant Award (NGA) | Ten (10) days after receipt of grant award. | Carson City ADSD | Signed Original |
Confidentiality Addendum (CA)
-SAMS Users | Ten (10) days after receipt of grant award. | Carson City ADSD | Signed original for each grant award |
| FISCAL REPORTS |
| Request for Funds Form is available online!
Click on the link below.
Request for Funds
(Revised 10/10)
Instructions
(Revised 12/11) | To receive timely payments, Request for Funds should be received by the 15th calendar day of the month preceding the quarter requested. | Mail to your assigned fiscal auditor:
Charlene Foley
Carson City ADSD
Robert Williamson
Las Vegas ADSD | Submit three copies with Original Signatures (in red or blue ink) on each copy. |
Quarterly FinancialForm is available online!
Click on the link below
that is applicable to your grant. Adult Day Care Grants Nutrition Fixed-Fee Grants All Other Categorical Grants All Other Fixed-Fee Grants
| 15th calendar day of the month following the end of a reporting quarter. (You must submit a report for each grant you receive from ADSD, even if you did not spend any of the funding during the reporting period.) | Stephanie Petersen
Las Vegas ADSD | E-mailed to: spetersen@adsd.nv.gov |
October 15
April 15 | January 15
July 15 |
| PROGRAMMATIC REPORTS |
| Social Assistance Management System (SAMS) Client Registration Forms Program Narrative Report | Input monthly data by the 15th calendar day of the following month. | There is no hard copy report to send in. ADSD will pull information directly from SAMS. Send an email to lawilliams@adsd.nv.gov by the 15th day of the following month to notify Lisa Williams that your data has been entered. |
Example: Input January's data by February 15th. |
Monthly Meal Count
-Nutrition ProgramsMonthly Meal Count Form | Due by the 15th calendar day of each month following the month of service. | Vern Dixon
Las Vegas ADSD | One (1) copy E-mailed to:
vdixon@adsd.nv.gov |
| Transportation Report Reporting Form
(Grantees who report ride information to NDOT may alternatively submit the quarterly NDOT report) | 15th calendar day of the month following the end of a reporting quarter.
| Lisa Williams
Las Vegas ADSD andYour RD Specialist | One (1) copy E-mail the spreadsheet to:
lawilliams@adsd.nv.gov and
your assigned RD Specialist |
October 15
April 15 | January 15
July 15 |
| State Transportation Reporting Form | 15th calendar day of the month following the end of a reporting quarter.
| Shirley Chantrill
Elko ADSD | One (1) copy Mailed or e-mailed to:
schantrill@adsd.nv.gov |
October 15
April 15 | January 15
July 15 |
State Volunteer
InstructionsExpense and Service Report Narrative Report
| 15th calendar day of the month following the end of a reporting quarter.
| Melissa Thrower
Las Vegas ADSD | One (1) copy Mailed or e-mailed to:
mthrower@adsd.nv.gov |
October 15
April 15 | January 15
July 15 |
| MIPPA – Reporting Template | Due by the 15th calendar day of each month following the month of service. Report covers 1st day of the month to the last day of the month. | Jeff Doucet
Las Vegas ADSD | One (1) copy E-mailed monthly to:
jsdoucet@adsd.nv.gov |
| Aging and Disability Resource Center (ADRC) Monthly Data Tracking Tool (DTT) Form available at
http://www.nevadaadrc.com | Due by the 15th calendar day of each month following the month of service. | Teresa Sacks,
Sanford Center for Aging
Program Evaluator | Online submission at
http://www.nevadaadrc.com Must register for a login. |
Aging and Disability Resource Center (ADRC) Semi-Annual Reporting Tool (SART) - federal report | Six (6) month report due for review by each ADRC site one week prior to final submission date. Final submission dates by ADSD:
April 30 October 31 | Cheyenne Pasquale,
ADRC Project Manager/
State Lead
Las Vegas ADSD | Online tool located at
http://www.adrc-tae.org Must be authorized by State
Lead to submit SART. SART is available the first week
in April and October. |
| State Health Insurance Assistance Program (SHIP) |
Volunteer Coordinator's Monthly Activity Report due by the 5th of each calendar month following the month of service.Annual Resource Report for Sub-state Areas due by May 1 for prior grant year (April 1 - March 31). Annual Strategic Plan for new grant year (April 1 - March 31) due by January 15th. Year End Progress Report for grant year (April 1 - March 31) due by January 15th of that grant year. Mid-Term Progress Report due September 15 for period April 1 - August 30.
| Wanda Brown,
SHIP Director and
Kathryn Lopan
Las Vegas SHIP
| E-mailed to:
wbrown@adsd.nv.gov kalopan@adsd.nv.gov |
