I.) Application. The reimbursement application is to be used to request reimbursement from the division by a local government (the claimant). All information is to be clearly typed or printed and ensure that all required documents are submitted with the application. Attach additional pages as necessary to explain responses. A responsible official, such as a local biosolids monitor, shall sign and date the application where indicated. The original signed application with one copy of each of the supporting documents is to be forwarded to the Division. To confirm delivery, it is suggested that applications be mailed certified, return receipt requested. Applications may not be submitted by facsimile or through electronic means. A reimbursement invoice form must be completed before a reimbursement application can be submitted. The invoice form must include all work performed for the reimbursement period.
II.) Application Forms and Submittal. The application for reimbursement must be submitted within 30 days of the last day of the month in which the reimbursable activity occurred. All applications received after this time frame will be ineligible for reimbursement. The following is a description of the application forms and an explanation of their use. The application forms and detailed instructions can be obtained from the Division.
1.) Form 1 - Reimbursement Application. An Invoice Form shall be submitted with each application for reimbursement. The invoice form should list all reimbursable cost information.In order to be reimbursed for eligible corrective action expenses, an applicant must provide documentation to demonstrate that the expenses were incurred. Invoices are acceptable proof of incurred expenses. Include legible copies of invoices from the local biosolids monitor or agent who performed or managed the monitoring activities. All invoices are to include the following:
a.) VDHBUR Permit Number and site identification
b.) (Number) or site address
c.) Biosolids Contractor’s Name d. Date and type of activity monitored e. Name of biosolids monitor f. Elapsed time of activity in hours g. List of reimbursable expenses h. Type of sampling activity performed and associated
laboratory expense vouchers. The application requires the claimant to certify that the responsible official has read and understands the requirements for reimbursement and that the application submitted is not fraudulent. The claimant must attest to the accuracy and completeness of the information provided.2. Form 2 - Multiple Owners Payment Assignment Form. When there are multiple local governments as claimants, a separate, signed and notarized invoice form for each claimant must be filled out and submitted with the first application.
3. Submittal of Application. Submittal of the original completed reimbursement application, including the application worksheets and the appropriate supporting documentation, should be accomplished by mailing these documents to: