Form OSM-49 Budget Information and Financial Reporting Form

U.S. DEPARTMENT OF THE INTERIOR

OMB Approval No.: 1029-0059
Exp. Date: 7/31/2015

OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT
Budget Information and Financial Reporting Form
SECTION A. GENERAL

Grantee:

Grant Title:

Grant Number:

Grant Period:  to 

SECTION B. BUDGET AND FINANCIAL REPORT INFORMATION
Budget/Cost Categories

Budget

Financial Status Report

Financial Status Report

Cumulative Through 
Title

Number

Cumulative Through

Cumulative Through

Original/

Current

Cumulative

Cumulative

Rpt

Cumulative

Cumulative

Rpt

Cumulative

Cumulative

Rpt

Prior Budget

Budget

Obligations

Expenditures

Ind

Obligations

Expenditures

Ind

Obligations

Expenditures

Ind

0.00

Total Net Program Obligations/Expenditures

0.00

Total Grant Amount

Financial Status Report

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Total Unobligated Balance

0.00

T otal Indirect Costs
Total Program Income
SECTION C. INDIRECT COST RATE INFORMATION

Type rate #1: Predetermined[ ] Final[ ] Provisional[ ] Fixed[ ] Type rate #2: Predetermined[ ]
Indirect Rate Calc: Base $_________ Indirect Amount $_______
Rate ______%

Final[ ]

Provisional[ ]

Fixed[ ]Type rate #3: Predetermined[ ] Final[ ] Provisional[ ] Fixed[ ]

Indirect Rate Calc: Base $_________ Indirect Amount $_______

Period Covered by Rate:  Rate ______%

Period Covered by Rate: 

Indirect Rate Calc: Base $_________ Indirect Amount $_______
Rate ______%

Period Covered by Rate:

SECTION D. SIGNATURES

Name/Title and Signature of Authorized Official (Grant Application) Date of Signature

Excel

Signature of Authorized Official and

Signature of Authorized Official and

Signature of Authorized Official and

Date First Annual Report Signed

Date Second Annual Report Signed

Date Third Annual Report Signed
OSM-49 (August 1995)