The State Aid Voucher (AC 1171) that goes on top of every DHSES claim — originating agency pre-filled as DHSES with agency code 01077, then the payee's SFS Vendor ID, legal name and address, the contract number in the Ref/Inv. No. line, a description line and the amount requested — the cash request on line 12 of the Fiscal Cost Report, which for an ordinary reimbursement quarter is the total of column C — with the payee certification and signature block.
DHSES publishes the State Aid Voucher (AC 1171, Rev. 10/96) as a legacy .xls workbook. We converted it record-for-record to .xlsx — cells, number formats, merges, column widths and print setup carried over and verified against the original — so it opens in current Excel and Google Sheets, and cleared the file's author metadata. Nothing else was changed; the original .xls is on dhses.ny.gov/grant-reporting-forms if you would rather file from it, and the PDF version DHSES publishes alongside it is in the packet list below.
Rest of the claim packet
The rest of the claim packet — the Fiscal Cost Report and the Detailed Itemization Forms have their own pages; the PDF version of this voucher downloads here.
Every NYS DHSES sub-recipient filing a reimbursement request — the NSGP houses of worship, schools and community nonprofits above all — one voucher per Fiscal Cost Report.
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
DHSES's guidance for the voucher is short: the contract number, the legal name and address exactly as they appear on the SFS vendor record, the SFS number from page 1 of the contract, and the amount being sought — which has to equal the cash request on line 12 of the Fiscal Cost Report in the same package (Quarterly Progress and Fiscal Reporting, 11/2025).
Payment is electronic through the Statewide Financial System — a contractor that has not enrolled in the SFS Vendor Portal is not paid on any voucher under the contract, whatever the form says (Appendix C, Payment and Reporting Schedule, VER 08/2024).
The voucher is due within 30 calendar days after the end of the period claimed, and the final one within 60 days of the contract end date on a federally funded contract — a late final voucher can forfeit the balance.
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.