FHWA 1576 FHWA Transfer Request State to Other - FHWA 1576

Fund Transfers to Other Agencies and Among Title 23 Programs

FHWA Transfer Request - State to Others att1c (FHWA 1576).xls

Fund Transfers to Other Agencies and Among Title 23 Programs

OMB: 2125-0620

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FHWA TRANSFER REQUEST









Type of Transfer Request: Funds to a DOT Agency or Federal Department




































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.



Requesting Agency:







Transfer
Request
Contact:
Name

Tracking Numbers











Title

State FHWA




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



























TOTAL FROM
$0.00






TOTAL TRANSFER
$0.00






























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


For transfer of contract authority and obligation authority







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













Yes









No
















OCFO Comments























#REF!




























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
































Form FHWA-1576 01/2008


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



































































































































































File Typeapplication/vnd.ms-excel
AuthorDonna L. Jones
Last Modified Bybbalana
File Modified2008-03-27
File Created2006-09-09

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