Reporting Requirement - State Unexpected Carryover Funds Table and Statement

OMB Control Number: 1024-0038

Expiration Date: November 30, 2007

EXHIBIT 25-C CARRYOVER STATEMENT

Each State must complete the Carryover Statement and the Table of Unexpended Carryover Funds as part of the End-of-Year Report. Only the Federal Share should be included.

OMB Control Number 1024-0038 Expiration Date: November 30, 2007 Carryover Statement
Item	Amount (Federal Share)
Costs Incurred First Fiscal Year	$
Committed Subgrants/Contracts Unexpended Balance to be Carried Over	$
Uncommitted Carryover	$
Total (Should Equal Grant Award)	$ 0.00
The total uncommitted dollar amount awarded in FY (just completed fiscal year) to be carried over into FY (current fiscal year) that is not committed to subgrants/contracts is $ ." Please check and complete one of the following sentences (choose the one that applies): This amount does not exceed 25% of the amount apportioned by NPS, as demonstrated by the attached Unexpended Carryover Funds Table. OR As demonstrated by the attached Unexpended Carryover Funds Table, this amount exceeds 25% of the amount apportioned by NPS by $ . I am seeking a waiver for this amount to carry these funds over into the next Federal Fiscal Year for the reasons attached. Signature of SHPO Date Comments:

If the proposed uncommitted carry over amount exceeds 25%, see Chapter 3, Sections D.6. and K. which discuss Waivers and the Carryover (Use or Lose) policy on HPF funds.

OMB Control Number: 1024-0038

Expiration Date: November 30, 2007

EXHIBIT 25-D UNEXPENDED CARRYOVER FUNDS TABLE

OMB Control Number 1024-0038 Expiration Date: August 31, 2000 Unexpended Carryover Funds Table
Subrecipient (Subgrantee or Contractor)	Certified Local Government?	Federal Share of Subgrant/ Contract Award	Federal Share Cost not Incurred as of 9/30/XXXX
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
		$	$
CLG SUBGRANT TOTAL
GRAND TOTAL		0.00	0.00

Enter with a check mark, or “yes” all subgrants that are passed through to a Certified Local Government in the second column. All of the subgrants/contracts listed in the Project/Activity Database Report must be included in the Unexpended Carryover Funds Table.

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