COVID-19 Impact Assessment Tool - Initial Assessment

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* 1. Government Entity

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* 2. Contact Information

Name

Phone

Email

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* 3. What are your estimated annual revenues

Property Taxes

Sales Tax

State Shared Revenue

Federal Reimbursement

Charges for Fees/Service

Motor Fuel Tax

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* 4. What are your estimated annual expenditures

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* 5. What percentage of your annual expenditures do you have in unrestricted reserves?

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* 6. Have you expended funds in responding to COVID-19

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* 7. If you have expended funds, approximately how much ending March 31

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* 8. Any immediate concerns or needs

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* 9. Are you an incorporated town/village/city?