Description
The Request for Payment is required in order to receive payment. This form must be certified by your organization and it must be accompanied with relevant supporting documentation (i.e. contracts, bills, invoices, purchase orders, etc.) prior to submitting to the CDBG Program Office.

The final Request for Payment for grant funds must be accompanied with its supporting documentation along with the following documents:
• Non-Gratuity Affidavit
• Final Payment Certification
• Hawaii State and IRS Tax Clearance Certificates or Certificate of Vendor Compliance, not more than 2 months old (for contracts of $25,000 or more)
• Certified copy of owner’s notice of completion (for construction projects)

Required Approvals
The Request for Payment forms will be reviewed and approved by the CDBG Program Office.

How to Submit the Form
The completed Request for Payment Forms are to be submitted to the CDBG Program office.

Contact Information
Community Development Block Grant Program Office
200 S. High St.
Wailuku, HI 96793
Ph: (808) 270-7213
Fax: (808) 270-7159
Email

Disclaimer
These forms are to be used by CDBG Subrecipients that have executed agreements with the CDBG Program Office. All forms submitted to the CDBG Program Office must be original documents. For assistance in completing these forms, please call (808) 270-7213.