The Detailed Itemization Form for the Fringe Benefits category of a DHSES claim — the same header as the Personnel form, then for each employee the contract budget line, payroll period dates, name, salary charged to the grant, fringe rate, the total fringe allotted the form computes from them, and the fringe actually charged to the grant, federal/state and match, with the certification block.
The agency's own published blank, downloaded from the agency and untouched apart from clearing the file's author metadata. Columns, categories, formulas and protection are exactly as issued — check the agency's site for a newer release before you file.
Rest of the claim packet
Files this itemization travels with — the Fiscal Cost Report and State Aid Voucher have their own pages.
DHSES grantees claiming fringe on Personnel — on an NSGP contract that means fringe on M&A time for the organization's own staff; the salary side goes on the Personnel Itemization in the same package.
Key requirements
Funder
New York State Division of Homeland Security and Emergency Services — Nonprofit Security Grant Program (NSGP)
Jurisdiction
New York State
Fringe range
Not a fringe-driven grant — NSGP pays for equipment, planning, training, exercises, contracted security and construction/renovation; when payroll staff do M&A work above their normal hours, the Fringe Benefits itemization carries the rate from your executed Appendix B budget
Indirect cost basis
The FY2026 NSGP RFA is silent on indirect cost rates — it caps Management and Administration at five percent (5%) of the NSGP funds awarded, on actual expenses rather than a simple percentage, and requires 2 CFR Part 200 compliance; confirm any indirect charge with DHSES against your contract's Appendix B budget before budgeting a rate
What gets this form kicked back
The form asks you to show the calculation for fringe per the contract budget, Appendix B — the rate on each row is the one in your executed budget, and the salary it applies to is the salary charged to the grant on the Personnel Itemization for the same period.
Fringe charged cannot exceed the total fringe allotted the form computes (salary charged × rate), and the total flows to the Fringe Benefits line of the Fiscal Cost Report — the two have to agree.
Seven employee rows fit on the form, and the totals are written as the sum of exactly those seven rows (AP15 through AP21) — a row inserted above the total is not picked up, so use a second form for an eighth employee rather than editing the layout.
Allowable OTPS categories
The categories NYS DHSES recognizes on a budget or voucher. Using wording outside this list is a routine cause of returned submissions.
All Other (training, exercises, maintenance, warranties, licenses)
Unallowable costs
Costs NYS DHSES will not reimburse under this contract.
Organization costs and operational overtime
Hiring of public safety personnel
General-use expenditures
Overtime and backfill
Organizational operating expenses
Reimbursement of pre-award security expenses
Cameras for license plate readers or facial recognition software
Weapons or weapons-related training
Knox boxes
Equipment purchased for contracted security
Training overtime, backfill or travel
Rules worth knowing before you file
A reimbursement request is a fixed packet: the signed State Aid Voucher (AC 1171), the Fiscal Cost Report, a Detailed Itemization Form for every budget category claimed, itemized invoices and proof of payment — plus the Consultant Agreement whenever consultant costs are claimed — e-mailed to the DHSES fiscal mailbox with the organization name and contract number in the subject line; electronic or ink signatures only, no photographs of documents (Appendix C, Payment and Reporting Schedule, VER 08/2024; DHSES Quarterly Progress and Fiscal Reporting, 11/2025)
Fiscal Cost Reports are due on calendar quarters — January–March by April 30, April–June by July 30, July–September by October 30, October–December by January 30 — and a $0 FCR is filed for a quarter with no costs; FCR numbers run sequentially including the $0 ones, column A must match the executed budget in E-Grants, column B repeats the previous FCR's column D, and the header of every itemization (grantee, FCR #, DHSES number, contract number) must match the FCR in the same package
Every voucher is due within 30 calendar days after the end of the period claimed; obligations must be incurred before the contract end date, and the final claim on a federally funded contract has 60 calendar days after the end date (90 if state-funded) — the State may withhold up to 15% of the contract as security, disallowed costs may reduce a later voucher, a 15-business-day inspection period precedes payment, and overdue progress reports make a voucher ineligible for prompt payment
Personnel is claimed on Method A (salary × percent of time) or Method B (hourly rate × hours), never both on one row, and personnel may be charged to M&A only when payroll staff work above their normal hours on M&A at their regular rate — DHSES does not reimburse overtime
Equipment rows need a serial number or unique ID for any single item of $10,000 or more, with the date ordered and date received in chronological order and inside the contract period, tied to the invoice in the grant file; consultant rows carry the check or EFT number, a rate matching the Consultant Agreement and dates inside both the contract and the agreement; travel is reimbursed at the lesser of the organization's written policy, OSC guidelines or GSA rates, with no out-of-state travel without prior approval
Management and Administration is capped at five percent (5%) of the NSGP funds awarded, must be based on actual expenses or known contractual costs (requests that are simple percentages of the award without justification are not allowed), and is the only administrative charge the RFA names
Equipment is limited to select Authorized Equipment List (AEL) items; installation may trigger Environmental Planning and Historic Preservation (EHP) review, and construction or renovation needs FEMA's prior written approval, SF-424C/SF-424D, EHP review, and may not exceed the greater of $1 million or 15% of the award
Training is limited to attendance fees, materials, supplies and equipment — overtime, backfill and travel are not allowable; contracted security personnel are allowed but NSGP funds may not buy their equipment
Compliance stack: 2 CFR Part 200 including Subpart D procurement (§§200.317–.327) plus General Municipal Law 5A, an organization-wide Single Audit when $1,000,000 or more in federal funds is expended in a fiscal year, and a 30% MWBE participation goal (15% MBE, 15% WBE)
Maintenance contracts, warranties, repair or replacement costs, upgrades, licenses and user fees are allowable and may run past the period of performance when bought incidental to the original equipment purchase
Free voucher checker: upload a completed copy of this form and it flags unallowable costs, fringe above the ceiling, allocations that don't total 100% and totals that don't reconcile before you file. No signup; the file never leaves your browser.
Why vouchers get returned: the six checks behind most returned vouchers, and what each one looks like in a real file.
Stop filling this in by hand
Prove It Financials generates this exact form every month, populated from your own budget, payroll and invoices — with allocation percentages, fringe, and indirect already calculated and validated against NYS DHSES's own rules.