Form MCSAP-2A Grant Amendment for Fiscal Year 20__

OMB NO: 2126-0010

Expiration Date:

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays
a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0010. Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions, gathering the data needed,
and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information
Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-MMI, Washington, D.C. 20590.

Project No. __________________
Project Amendment No. _______
DUNS # _____________________

U.S. Department of Transportation
Federal Motor Carrier
Safety Administration

GRANT AMENDMENT FOR FISCAL YEAR 20__

Between the Federal Motor Carrier Safety Administration and the (State Agency)
__________________________________________________________________________________________
This amendment shall be attached to and become a part of the referenced grant agreement. This agreement is hereby
revised for the purposes described herein:
[ ] increases
This amendment [ ] decreases
Federal Funding.
[ ] does not change
The prior total cost of this MOTOR CARRIER SAFETY ASSISTANCE PROGRAM was projected to be
$________________________with a Federal share not to exceed $________________________________________.
The revised total program cost is now projected to be: $_______________________________________________.

This Federal share is

[ ] increased
[ ] decreased in amount of $_____________________
[ ] unchanged

providing for a revised total Federal share not to exceed $_____________________________________.
This amendment is for the purpose(s) of _____________________________________________________________
______________________________________________________________________________________________________
_________________________________________________________________________________________________.
All other terms and conditions of this grant remain unchanged.
and expires on ___________________________.

This amendment is effective

(Authorized Representative)

Date:______________

Title:

Federal Motor Carrier Safety Administration

(Authorized Representative)

Title:

FMCSA Form MCSAP - 2A

Division Administrator

Date:_______________