Deb Mould, Fiscal Manager
Office (608) 243-5674, Cell (608) 228-8089
2017 County Claim Form (Revised 11-13-17)
2017 Tribal Claim Form (Revised 11-13-17)
Check here whenever you receive a new or amended contract. We will post the revised claim form above as soon as we send the contracts.
Contact us with your questions about funding and grants. We can help with answers to questions like:
- What is the term of the grant?
- What qualifies as an allowable expense for this grant?
- What is the deadline for claims for this grant?
Tips to Submit a Complete Report
1. Use the latest claim form available.
2. Please check your year-to-date totals. Be sure to carry over the
non-calendar contract year-to-date to the new forms.
3. For amended reports:
a. Please use "Amended" in filename.
b. Only enter the numbers that changed in the monthly column
and update year-to-date total.
c. Leave off numbers previously reported in monthly column and
4. Elder Abuse: only report expenses to contract amount.
5. Elder Abuse: please "X" the box if you have overspent
6. Do not report pennies—please round up or down.
7. Manually enter I&A replacement numbers. Divide monthly expenses and year-to-date expenses by 2. Enter 1/2 in the I&A replacement line and the other half down below on the federal match line. NOTE: These 2 numbers should be the same.
8. Clear prior months' numbers in the monthly column if you are not reporting expense for these funds.
9. Please check your monthly totals on the certificate of claim totals. This should agree with the expense reimbursement you are expecting.