Common Humanitarian Fund for Central African Republic

CHF Allocation Revision
Instructions:
Complete this request form and submit to the CHF OCHA and UNDP.
Any major changes made to the original allocation as stipulated in the approved project documents must have the endorsement of the cluster coordinator with final approval made by the Humanitarian Coordinator.

1 – Project Details

Organization Name: / Cluster
Organization Acronym: / Contact Name:
Project Code: / Contact Email/Tel No.:
Location: / Allocation Reference:
Duration(start and end date as per contract): / Amount Allocated:
Project Title:

2. Revision Type/Reason for No-Cost Extension

Date of Request
Type of Revision:
Indicate the type (s) of revision being requested. / Details on NCE request:
Indicate reason (s) for no-cost extension.
No. of month requested ____
New end date: ______
Significant change in activities / Change in location / Insecurity / Programmatic delays
Change in outputs / Change in budget / Inaccessibility / Delays in finalizing PPA
Change in target beneficiaries / Change in recipient org / Staffing/recruitment delays / Delays in disbursement of funds
Change in project duration/NCE Other Specify: ______/ Internal admn delays / Delays in organization’s internal transfer of funds
Procurement delays / Delay in securing supplies from pipeline
Other Specify: ______

3 – Level of Completion

Provide information what amount of grant and activities have been implemented. Exact amounts and percentages are not necessary approximate numbers are sufficient.
Amount of Funds Spent as of < type in current end-date > / $ / %
Amount of Funds Unspent as of < type in current end-date > / $ / %
Amount of Funds Committed But Not Spent by <type in current end-date> / $ / %
Percentage of Activities Completed as of < type in current end-date > / %

4 – Revision Description and Justification

Description and justification of requested change
Please describe the requested changes to the original allocation and provide detailed background and justification for the proposed revision. The revision requests have to be submitted to the Humanitarian Coordinator for any significant changes in the following allocation parameters: major activities, implementation targets, location, allocation amount, recipient organization and/or recipient project, and project duration.
Please provide revision details in the revision table in section 5 of this document.
List activities that were implemented during project period: / List outstanding activities:
Revised Project Work Plan.
Please provide your updated project workplan from original project start date to the revised project end date.
Activities / Q3/2014 / Q4/2014 / Q1/2015 / Q2/2014 / Q3/2014
Jul / Aug / Sep / Oct / Nov / Dec / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep
Review remarks by cluster coordinator. / Name of reviewer
Explain the rational to endorse or reject the request
Review remarks by CHF Technical Secretariat: / Name of reviewer

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Common Humanitarian Fund for Central African Republic

Section 5 - Revision Details
Original CHF Allocation(s)
Details of the original CHF allocations (please insert information from allocation tables). / Proposed Revised Allocation(s)
Details on proposed revised allocations.
Output / Output
Key Activities / Key Activities
Locations (specify county): / Locations (specify county):
Beneficiaries: / Beneficiaries:
Duration: / Duration
CHF Budget Summary (Please use CHF Guidance_Redeployment of Funds Request.xls for detailed budget reallocation): / A. Staff and Other Personnel Costs / CHF Budget Summary: / A. Staff and Other Personnel Costs
B. Supplies, Commodities, Materials / B. Supplies, Commodities, Materials
C. Equipment / C. Equipment
D. Contractual Services / D. Contractual Services
E. Travel / E. Travel
F. Transfers and Grants to Counterparts / F. Transfers and Grants to Counterparts
G. General Operating and Other Direct Costs / G. General Operating and Other Direct Costs
Programme Support Costs (PSC) / Programme Support Costs (PSC)
Total: / Total:

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