Form 5199, FDCVT Reimbursement Request - State of Michigan - michigan-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part 1: Proposal Information. Fill in the Grant Number, Proposal Title, and Request Number as indicated. Ensure you enter the correct Period Start and End Dates.
3. Select the Request Type by checking either 'Partial' or 'Final'. Enter your Grantee FEIN, Grantee Name, Telephone Number, and Payment Mailing Address accurately.
4. Move to Part 2: Expenditure Detail. For each budget category listed from lines 11 to 21, input the eligible costs incurred during the period. Round amounts to the nearest dollar.
5. Complete Columns B through E for each category based on your incurred costs and funding percentages from your Grant Agreement.
6. In Part 3: Certification, ensure that all information is complete and accurate. Sign and date where required.
7. Finally, review all entries for accuracy before submitting your completed request along with necessary documentation.

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