5199, Financially Distressed Cities, Villages, and Townships (FDCVT) Reimbursement Request-2026

1. Click ‘Get Form’ to open the 5199 reimbursement request in the editor.
2. In Part 1, enter the Grant Number, Project Title, Request Number, Period Start Date, and Period End Date. Select whether this is a partial or final reimbursement request.
3. Fill in the SIGMA Vendor Number and Grantee Name. Provide your telephone number and complete the Payment Mailing Address section.
4. Move to Part 2: Expenditure Detail. For each budget category listed from lines 11-22, input the Grant Award Amount, Previous Reimbursements, and Current Request Amount. The Remaining Balance will auto-calculate based on your entries.
5. In Part 3: Certification, ensure you certify that all information is accurate by entering your printed name, title, signature, and date.
6. Review all sections for completeness before submitting your request via email or fax as indicated in the instructions.

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