Form FHWA 1575 FHWA 1575 FHWA Transfer Request within State FHWA 1575

BEFORE USING THIS WORKSHEET, SAVE A COPY FOR USE AS YOUR MASTER. DO NOT USE "COPY SHEET".

FHWA TRANSFER REQUEST

Type of Transfer Request:

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/or obligation authority be transferred as shown.

Requesting Agency:

Transfer Request Contact:

Name

Tracking Numbers

Transfer to State:

Title

State

FHWA/OCFO

Telephone

Email

Item #

Description of Fund - From

Fiscal Year

Program Code

Demo ID or Urban Area Code

Amount

From Item #

Description of Fund - To

Program Code

Demo ID or Urban Area Code

Amount

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

TOTAL FROM

$0.00

TOTAL TRANSFER

$0.00

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

For State-to-State transfer of funds and limitation

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

STATE TRANSPORTATION DEPARTMENT

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-1575 01/2008

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

Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Canada

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virgin Islands

Virginia

Washington

West Virginia

Wisconsin

Wyoming