Non-UGLG Distribution Templates

Version: 2022.06.02

Template Name: Non-UGLG Distribution Template

Instructions to Reporter: - Do not change the cell formatting - Do not reformat the template - All data should be as text

Field ID

Non_UGLG_County_Name__c

Name

Population_of_Jurisdiction__c

Funds_Received__c

Jurisdiction_Number__c

UEI__c

EIN__c

Address__c

Address_2__c

Address_3__c

City__c

State_Abbreviated__c

Zip__c

Zip_4__c

Jurisdiction_Email__c

Primary_Point_of_Contact_Name__c

Primary_POC_Phone_Number__c

Primary_POC_Email__c

Authorized_Representative_Name__c

Authorized_Representative_Email__c

Decline_and_Transfer_Funding_Y_N__c

Notes__c

Required/Optional

Required

Required

Required

Required

Required

Optional

Optional

Required

Optional

Optional

Required

Required

Required

Optional

Optional

Optional

Optional

Optional

Optional

Optional

Required

Optional

Field Name

Non-UGLG County Name

Jurisdiction Name

Population of Jurisdiction

Allocation amount

Jurisdiction Number

Jurisdiction UEI number

Taxpayer Identification Number (TIN)

Jurisdiction Address 1

Jurisdiction Address 2

Jurisdiction Address 3

Jurisdiction City

Jurisdiction State

Jurisdiction Zip Code

Jurisdiction Zip +4

Jurisdiction Email Address

Jurisdiction Point of Contact Name

Jurisdiction Point of Contact Phone Number

Jurisdiction Point of Contact Email

Authorized Representative Name

Authorized Representative Email

Did the jurisdiction decline and transfer funding to the state? (Yes / No)

Notes

Help Text

Provide the name of the Non-UGLG County

Provide the name of the UGLG jurisdiction within the non-UGLG county

Provide the population of the jurisdiction, No comma's

Provide the amount of funds allocated to the jurisdiction. DO NOT include a "$" sign when entering Amounts.

Include the Jurisdiction Recipient Number assigned by the State to the Jurisdiction (e.g., AZ0013)

Include the Jurisdiction UEI number, (Valid Format XXXXXXXX)

Taxpayer Identification Number (TIN) (Valid Format XXXXXXXX)

First line of the Jurisdiction Address

Second line of the Jurisdiction Address

Third line of the Jurisdiction Address

Jurisdiction City

United States Postal Service (USPS) two-letter abbreviation for the state or territory in which the Jurisdiction is located. Valid Response: (AL, AK, AS, AZ, AR, CA, CO, CT, DE, DC, FM, FL, GA, GU, HI, ID, IL, IN, IA, KS, KY, LA, ME, MH, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, MP, OH, OK, OR, PW, PA, PR, RI, SC, SD, TN, TX, UT, VT, VI, VA, WA, WV, WI, WY)

United States ZIP code (five digits) associated with the Jurisdiction's address. Format XXXXX, 5 numeric characters.

Zip Plus4 (four digits) with Jurisdiction's zip code will be accomplished. Format XXXX, 4 numeric characters.

Include the Jurisdiction primary email address. If there is no primary email address, please provide the point of contact's email address.

Jurisdiction Point of Contact Name

Jurisdiction Point of Contact Phone Number

Jurisdiction Point of Contact Email

Include the Jurisdiction authorized representative name. If the primary point of contact is also the authorized representative, please provide the name again.

Include the Jurisdiction authorized representative email address. If the primary point of contact is also the authorized representative, please provide the email again.

Select "Yes" or "No"

Include any additional notes required to explain the Jurisdiction distribution summary line items, as applicable