Clone of 2023-2024 HPNAP Capital Equipment Expense Documentation (Grant Claim) Form

2026-2027 HPNAP Period 4 Capital Equipment Documentation
Food Bank Contact: Michael Watrous mwatrous@foodbankcny.org
IMPORTANT INSTRUCTIONS

Eligible Expenses

Submission Requirements

Eligible Period

The grant period is from July 1, 2026, to June 30, 2027. However, all awards must be documented by May 31, 2027, to meet NYS reimbursement requirements. It is likely your organization won't be able to include some of May and all of June 2027 expenses; please plan accordingly.

Reimbursement

Agencies can expect reimbursement to be made within ten (10) business days of submitting a completed grant claim form. If the grant claim form does not meet NYS's accepted accounting standards, or if the form is incomplete, it will not be reimbursed within that ten-day window, and you may have to supply additional information.

Equipment Specific Restrictions

Only equipment listed in the original grant and identified on the Award Agreement is eligible for reimbursement.

Equipment must be full reimbursed. HPNAP funds cannot be used for matching or partial payments towards equipment.

All equipment remains the property of New York State Department of Health for the equipment's expected lifespan.

It is the responsibility of the awarded organization to maintain and repair the equipment for it's expected lifespan.

Equipment may not be disposed without prior, written, authorization from the Food Bank and the New York State Department of Health.

Proof of Payment

You are strongly advised to provide "clean" invoices or receipts with your submission.
I have read the instructions above.

Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Account Number / HPNAP ID
Five digit Food Bank account number.
Food Program Name
Name of Person Completing Submission

First NameLast name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Please list each piece of equipment purchased.

Rows	Equipment Type	Unit Cost	Make Model	Serial Number
Equipment 1
Equipment 2
Equipment 3

Delivery Fee
Requested Reimbursement
Receipt Attachment

Please attach your receipt in pdf or jpg. format.
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Proof of Payment

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By signing, you certify that the information presented here is accurate and complete to the best of your knowledge. You also acknowledge that discrepancies in reporting may result in the awardee not-for-profit organization reimbursing Food Bank of Central New York and/or The New York State Department of Health.
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2026-2027 HPNAP Period 4 Capital Equipment Documentation