Form 4921 - Economic Vitality Incentive Program Grant Application (Fy 2012 - Round 2) Page 4
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9Michigan Department of Treasury
4921 (Rev. 07-12), Page 4
Economic Vitality Incentive Program Grant Application
(FY 2012 – Round 2)
Issued under authority of Public Act 107 of 2012 and Public Act 236 of 2012
CONDITIONS CONTINUED
Funds may not be released to the “Primary Local Unit” if any of the local units participating in the
project:
1. Have not filed their annual financial report (F65) or audit per the Uniform Budgeting and
Accounting Act, Public Act 2 of 1968, as amended (MCL 141.421 to 141.440a) or the Uniform
System of Accounting Act, Public Act 71 of 1919, as amended (MCL 21.41 – 21.55), or
2. Have not filed their financial plan (deficit elimination plan) per the Glenn Steil State Revenue
Sharing Act, Public Act 140 of 1971, as amended (MCL 141.921), or
3. Are delinquent in making payments that are due on loans issued pursuant to the Emergency
Municipal Loan Act, Public Act 243 of 1980, as amended (MCL 141.931 to 141.942), or
4. Have a payment due and owing to the state.
For a payment reimbursement, a completed Payment Request Form (form 4923) must be submitted to
the Michigan Department of Treasury.
Source documentation supporting the requested
reimbursement amount must be attached to the Payment Request Form. At a minimum, the source
documentation should include copies of the original invoices, cancelled checks, and any other report
that would support the request.
The “Primary Local Unit’s” Chief Financial Officer must sign and date the Payment Request Form
(form 4923).
Reporting Requirements:
1. Quarterly Narrative and Financial Status Reports – The selected grantee(s) shall submit to the
Department of Treasury quarterly, signed and dated, narrative and financial status reports. The
th
th
; April 30
;
reports are due within thirty (30) days after the end of a quarter (i.e. due by January 30
th
th
July 30
; October 30
).
a. Narrative Report (Form 4971) – should present the following information:
i.
Name of Primary Local Unit and Grant Number.
ii.
Reporting Period (i.e. October 2011 – December 2011 etc.).
iii. The percentage (%) completed of the project work plan.
iv. The estimated project completion date. For the final report, indicate the actual
project completion date.
v. A brief outline of the work accomplished during the reporting period (or grant
period, if this is the final report) relative to the proposed work plan and timeline.
vi. A brief outline of the work to be completed during the subsequent reporting
period.
vii. A brief description of any problems or delays, real or anticipated, experienced.
b. Financial Status Report (FSR) (Form 4972) – should present the following information:
i.
Name of Primary Local Unit and Grant Number.
ii.
Reporting Period (i.e. October 2011 – December 2011 etc.).
iii. The percentage (%) completed of the project work plan.
iv. The estimated project completion date. For the final report, indicate the actual
project completion date.
v. The amount of funds expended through the reporting period (i.e. from the
beginning of the grant project to the end of the reporting period).
vi. The projected future expenditures for the project.
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