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Home My Public Portal AboutAIP 033 Outlay Report and Request 2022OMB Number: 4040-0011 Expiration Date: 01/31/2025 OUTLAY REPORT AND REQUEST FOR REIMBURSEMENT FOR CONSTRUCTION PROGRAMS 1. TYPE OF REQUEST ❑ FINAL ® PARTIAL 2. BASIS OF REQUEST ® CASH ❑ ACCRUAL 3. FEDERAL SPONSORING AGENCY AND ORGANIZATIONAL ELEMENT TO WHICH THIS REPORT IS SUBMITTED FAA - Helena ADO 4. FEDERAL GRANT OR OTHER IDENTIFYING NUMBER ASSIGNED BY FEDERAL AGENCY AIP 3-16-0023-033-2022 5. PARTIAL PAYMENT REQUEST NUMBER FOR THIS REQUEST Year End 6. EMPLOYER IDENTIFICATION NUMBER 82-6000022 7. FINANCIAL ASSISTANCE IDENTIFICATION NUMBER DOT-FA22NM-2025 8. From: PERIOD COVERED BY THIS REQUEST 10/01/2020 To: 09/30/2022 9. RECIPIENT ORGANIZATION Name: City of McCall Street1: 1216 East Park Street Street2: City: County: State: Province: Country: McCall Valley ID: Idaho USA: UNITED STATES ZIP / Postal Code: 83638-3832 10. PAYEE (Where check is to be sent if different than item 9) Name: Street 1: Street2: City: County: State: Province: Country: ZIP / Postal Code: 11. STATUS OF FUNDS CLASSIFICATION PROGRAMS FUNCTIONS ACTIVITIES TOTAL (b) (C) (a) T$xlway E. a. Administrative expense $ $ $ $ J b. Preliminary expense c. Land, structures. right-of-way d. Architectural engineering basic fees e. Other architectural engineering fees f. Project inspection fees 74, 534. 41 74,534.41 g. Land development h. Relocation expense i. Relocation payments to individuals and businesses j. Demolition and removal , k. Construction and project improvement cost 1, 76b, 079.62 1,766,074.62 1. Equipment m. Miscellaneous cost n. Total cumulative to date (sum of lines a thrtl m) 1,849,614A3 1, 840, 614.03 o. Deductions for program income - -- p. Net cumulative to date (line n minus line o) 1, 840, 614.03 1, 840, 614.03 q. Federal share to date 1, 656. 552.63 1, 656. 552.63 r. Rehabilitation grants (100% reimbursement) s. Total Federal share (sum of lines q and r) 1, 656, 552.63 1, 656, 552.63 t. Federal payments previously requested u. Amount requested for reimbursement $ ] $ $ $ v. Percentage of physical completion of project 12/27/2022 INSTRUCTIONS Public reporting burden for this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and complet.ng and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project {0348-0004), Washington, DC 20503. PLEASSE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY'fHE SPONSORING AGENCY. Please type or print legibly. Items 3, 4. 5, 8, 9, 10 11 s and 11 v are self explanatory; spec fic instructions for other items are as follows Item Entry 1 Mark the appropriate box. If the request is final the amounts billed should represent the final cost of the project. 2 Show whether amounts are computed on an accrued expenditure or cash disbursement basis 6 Enter the Employer Identification Number (EIN) assigned by the U.S. Internal Revenue Serv'ce or FICE (institution) code if requested by the Federal agency. 7 This space is reserved for an account number or other identify;ng number that may be assigned by the recipent. 11 The purpose of vertical columns (a) through (c) is to provide space for separate cost breakdowns when a large project has been planned and budgeted by program, function or activity. If additional columns are needed, use as many additional forms as needed and indicate page number in space provided in upper right, however, the summary totals of all programs, functions or activities should be shown in the total" column on the first page. All amounts are reported on a cumulative bass. 11a Enter amounts expended for such items as travel, legal fees rental of vehicles and any other administrative expenses Include the amount of interest expense when authorized by program legislation. Also show the amount of interest expense on a separate sheet. lib Enter amounts pertaining to the work of locating and designing making surveys and maps, sinking test holes, and all other work required prior to actual construction. 11c Enter all amounts directly associated with the acquisition of land, existing structures and related right-of-way. 11d Enter basic fees for services of architectural engineers. 11e Enter other architectural engineering services. Do not include any amounts shown on line d. 11f Enter inspection and audit fees of construction and related programs. 11 g Enter all amounts associated with the development of land where the primary purpose of the grant is land improvement. The amount pertaining to land development normally associated with major construction should be excluded from ths category and entered on line k. 11h Enter the dollar amounts used to provide relocation advisory assistance and net costs of replacement housing (last resort). Do not include amounts needed for relocation administrative expenses; these amounts should be included in amounts shown on line a. 11i Enter the amount of relocation payments made by the recipient to displaced persons, farms, business concerns and nonprofit organizations, Item Entry 11j Enter gross salaries and wages of employees of the recipient and payments to third party contractors directly engaged in performing demolition or removal of structures from developed land. All proceeds from the sale of salvage or the removal of structures should be credited to this account; thereby reflecting net amounts if required by the Federal agency. 11 k Enter those amounts associated with the actual construction of, addition to, or restoration of a facility. Also, include in this category, the amounts for project improvements such as sewers, streets, landscaping, and lighting. 111 Enter amounts for all equipment, both fixed and movable, exclusive of equipment used for construction. For example, permanently attached laboratory tables, built-in audio visual systems, movable desks, chairs, and laboratory equipment. 11 m Enter the amounts of all items not specifically mentioned above. 11 n Enter the total cumulative amount to date which should be the sum of lines a through m. 110 Enter the total amount of program income applied to the grant or contract agreement except income included on line j. Identfy on a separate sheet of paper the sources and types of the income. 11 p Enter the net cumulative amount to date which should be the amount shown on line n minus the amount on line o. 11q Enter the Federal share of the amount shown on line p. 11 r Enter the amount of rehabilitation grant payments made to individuals when program legislation provides 100 percent payment by the Federal agency lit Enter the total amount of Federal payments previously requested if this form is used for requesting reimbursement. 11 u Enter the amount now being requested for reimbursement. This amount should be the difference between the amounts shown on lines s and t. If different explain on a separate sheet. 12a To be completed by the official recipient official who is respons ble for the operation of the program. The date should be the actual date the form is submitted to the Federal agency. 12b To be completed by the official representative who is certifying to the percent of project completion as provided for .n the terms of the grant or agreement.