Form CalRecycle165 "Personnel Expenditure Summary" - California

What Is Form CalRecycle165?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2010;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CalRecycle165 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle165 "Personnel Expenditure Summary" - California

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ST AT E OF C ALI FO R NI A
DE P ART MENT O F RE S OU R C E S RE C Y C LI N G AN D R E C OVE R Y ( Ca l Rec yc l e)
Ca l Rec yc le 1 6 5 ( Re v. 0 2 /1 0 )
P
E
S
ERSONNEL
XPENDITURE
UMMARY
GRANT NUMBER
REPORTING & EXPENDITURE CATEGORY
GRANTEE
EMPLOYER
Total
Task #
Name/Classification
Date
Hours
Hourly Rate
(Hours
Activity
Worked
Worked
(w/benefits)
x Rate)
Totals:
____________________________________________
_____________________________________________________
SUPERV ISOR’S SIGNATURE
GRANTEE SIGNATURE (IF CONTRACTOR TIME CLAIMED)
See reverse for instructions and example.
Clear
Print
ST AT E OF C ALI FO R NI A
DE P ART MENT O F RE S OU R C E S RE C Y C LI N G AN D R E C OVE R Y ( Ca l Rec yc l e)
Ca l Rec yc le 1 6 5 ( Re v. 0 2 /1 0 )
P
E
S
ERSONNEL
XPENDITURE
UMMARY
GRANT NUMBER
REPORTING & EXPENDITURE CATEGORY
GRANTEE
EMPLOYER
Total
Task #
Name/Classification
Date
Hours
Hourly Rate
(Hours
Activity
Worked
Worked
(w/benefits)
x Rate)
Totals:
____________________________________________
_____________________________________________________
SUPERV ISOR’S SIGNATURE
GRANTEE SIGNATURE (IF CONTRACTOR TIME CLAIMED)
See reverse for instructions and example.
ST AT E OF C ALI FO R NI A
DEP ART MENT O F RE S OU R C ES RE C Y C LI N G AN D R EC OVE R Y ( Ca l Rec yc l e)
Ca l Rec yc le 1 6 5 ( Re v. 0 2 /1 0 )
INSTRUCTIONS
Please submit this for m or another for m wit h equi valent infor mati on when requesting rei mbursement for personnel costs.
Grant Number: This is the full number assigned to your grant (found in the upper right corner of your Grant Agreement).
Reporting & Expenditure Categor y: Indicate the budget categor y to which the hours are being billed. Use a separate for m for each
budget categor y.
Grantee: This is the entity that was awarded the grant as shown on the Grant Agreement.
Employer:
Indicate what entit y employs the person(s) l isted on this for m. This will usually be the grantee or a contractor that is
implementing all/part of the grantee’s progr am. Use a separate for m for each employer .
Task #:
Number each tas k to make it easier to refer ence.
Name/ Classification:
Enter the name and classification of the empl oyee.
Date Wor ked: Indicate ever y day each employee wor ked on grant related tas ks. List each date separately.
Hours Wor ked: For each date, indicate how many hours ( whole and partial) each employee wor ked on gr ant related tasks.
Hourl y Rate (w/Benefi ts): Fill -in the pay rate (including benefits) for each employee.
Total (Hours x Rate):
This is the number of hours wor ked multiplied by the hourl y rate.
Activit y:
Indicate the grant related activit y that each employee wor ked on f or each of the dates/hours listed.
Totals: Please total the Hours Worked and Total (Hours x Rate) columns.
Signatures:
For ms must be si gned by the appropriate supervisor(s). Ti mesheet s submitted for contractor personnel must be signed by a
supervisor at the contr acted entity and by the authorized si gnature authority for the grant .
Example:
Total
Task #
Name/Classification
Date
Hours
Hourly Rate
(Hours
Activity
Worked
Worked
(w/benefits)
x Rate)
1
John Doe
8/12/09
2
$10.00
$20.00
Develop newspaper ads for Certified Center Kick-off
Admin. Assistant
2
Jane Doe
9/19/09
5.5
$15.00
$82.50
Staff used oil recycling information booth for Certified Center Kick-off
Used Oil Manager
3
Jane Doe
9/20/09
3.25
$15.00
$48.75
Respond to requests for used oil information gathered at 9/19/09 event
Used Oil Manager
Totals:
10.75
$151.25
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