RR: 2 Local Agency Cost Reimbursement Reporting

Effective Date: 06/94 Downloads: PDF Version    Revised Date: 01/11


Ensure the accurate reporting for reimbursement of local agency for providing services to Participants.



The Subgrantee is required to submit reimbursement reports within 15 days after the end of the month.


The request is to be submitted on Health Division, Request for Reimbursement/Advance form with the amount requested conforming to subgrant cost categories specified in Section B, Detailed Budget table included in the subgrant.


Reimbursement amounts will be based upon subgrant specified rate per participant times the number of participants served as reflected in official state records. This amount will be included in the reimbursement form cost category “Other.”


If the subgrant detailed budget provides for reimbursement of additional amounts being invoiced in cost categories except “Other” the requested reimbursement requested must have supporting evidence attached to the Request for Reimbursement.


The summary sheet Monthly Time and Effort study for the month being invoiced must be attached to the Reimbursement Form.. See Policy and Procedure RR7 for instructions associated with preparation of the Monthly Time and Effort Study.


The Subgrantee will use their internal accounting records of cost incurred in performing services to the WIC program in preparing the WIC Unit Breakdown form.  Instructions to prepare the WIC Unit Breakdown form are:

RR 2


Cost Category Descriptions

Salary:  Total WIC Operating salaries incurred during the month will be allocated in accordance with the percentages determined during Monthly Time and Effort Study [See Records and Reports RR-7].


Travel:  General travel will be allocated based on the Time and Effort Study percentage results. Travel for specific WIC Unit Breakdown functions will be charged to the benefiting function.



Facility cost is a collection of rent, utilities, pest control, security, building maintenance, and janitorial type expenses. Unless you have a clinic specific study approved by WIC state office that results in a different percentage the following percentages will be used. Client Services 50%, Nutrition Education `25/0%, Breastfeeding Promotion 12.5% and Other Admin 12.5%.


Medical Supply cost is always considered client services and should be assigned to Client Service.


Operating costs are considered office supplies, phone, printing, copying, postage and should be allocated in accordance with the percentages determined during Monthly Time and Effort Study for the month.


Equipment Purchases are allocated by the Time and Effort percentage unless the item only benefits a specific Time and Effort Study category in which case it is charged to that category.


Expenses are exceptions/miscellaneous categories of cost for items that may be broken into Time and Effort Study functions according to the benefiting function.


Contract is for contracted labor. Interpreters are allocated on the base percentages from the monthly time and effort study. Dieticians and Nutritionist are charged to the Nutrition Education column to, bookkeeping is charged to Other-Admin column.