FHWA-1575 FHWA TRANSFER REQUEST- Apportioned Funds to a DOT agency

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TEST: FHWA TRANSFER REQUEST - APPORTIONED FUNDS

Type of Transfer Request:

Apportioned Funds to a DOT Agency or Federal Department

0

In accordance with provisions of title 23 U.S.C., the State transportation department indicated below requests that Federal-aid Highway Program contract authority and obligation authority be transferred as shown.

Transfer Request Contact:

Name

Tracking Numbers

Title

State

FHWA

Requesting Agency:

Telephone

Email

Item #

Description of Fund - From

Fiscal Year

Program Code

Demo ID or Urban Area Code

Amount

From Item #

Description of Entity - To

Amount

1

2

3

4

5

6

7

8

9

10

11

TOTAL TRANSFER

$0.00

12

13

For State-to-State transfer of contract authority and obligation authority

14

Has the State entered into an agreement with the agency indicated above to receive, obligate, expend and manage these funds for specified project(s)?

15

Yes

16

No

17

18

OCFO Comments

19

20

#REF!

TOTAL FROM

$0.00

#REF!

Enter Item # (above), Project Description, Urban Area or other additional information

Enter Item # and Project Description, Urban Area or other additional information

STATE DEPARTMENT OF TRANSPORTATION

FHWA DIVISION ADMINISTRATOR CONCURRENCE

I certify that the funds requested for transfer are in accordance with the applicable provisions of title 23 U.S.C.; that the funds are unobligated and uncommitted; and that the percentage of funds to be transferred combined with previous transfers does not exceed the permissible amount eligible for transfer under the affected program categories according to applicable State and Federal laws and regulations. Where applicable, concurrence from affected Metropolitan Planning Organizations and other agencies has been obtained and recorded in this office. Further, I certify that I have the authority to approve the transfer of Federal-aid Highway program funds.

I certify that I have reviewed the request to transfer funds as itemized above; that this request is in accordance with provisions of title 23 U.S.C. and FHWA policy and procedures; and I have the authority to approve transfer of Federal-aid Highway program funds.

Date of Approval

Date of Approval

Title of Approving Official

Title of Approving Official

Submit the completed request (signed by the Division Office) to FHWA's Office of Budget via electronic mail addressed to HCF-10.