FRA F 31 Grant Adjustment Request Form

OMB Control No. 2130-XXXX

Expires XX/XX/XXXX
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Federal Railroad Administration Grant Adjustment Request Form
Sections I, II, and III of this form should be completed by the grantee. The grant manager may make
adjustments to the grantee’s submission for further accuracy.

I.

Basic Information

Date of Request:

State:

Agreement Number:

Project Title:

Grantee:

Grant Program Name:

Point of Contact (POC) name and title:

POC Telephone:

ext.

POC Email:

II.

Adjustment Type and Justification

A. Select the category of grant adjustment request and applicable example within each adjustment type (select all
that apply):
Level Adjustment Category
1

1

Definition

Administrative

Minor changes to basic grant
information

No-cost
Extension

An extension to the grant period of
performance that does not
substantively change scope,
deliverables, project outcomes and is
12 months or less on aggregate

1

Minor SOW
Modification

2

Significant
NGA
Modification

Changes to the agreed-upon
Statement of Work that do not
substantively change project
delivery goals or affect grant
scope

Modifications that may affect project
scope, project delivery, expected
project benefits, terms and conditions,
etc.

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Adjustment Type
Change in point of contact, or authorized
representative
Change in grant name or federal identifier
Change in address
Other
No-cost extension of 12 months or less (on
aggregate)

Modification to deliverable(s) or deliverable
schedule
Budget revisions
Changes to discrete elements of a project
plan
Change of payment method
Other
Additional federal funds
De-obligation of funds
Substantial scope changes (with or without
new funds)
No-cost extension of 12+ months (aggregate)
Tapered match
Removal or addition of special conditions
Significant budget revisions
Other

B. Please provide a detailed description and justification of the grant adjustment request:

III.

Certification of Authorized Representative

I have reviewed this request and certify that the proposed changes will improve my organization’s ability to
successfully execute project activities according to the grant or cooperative agreement. Furthermore, I certify that,
to the best of my knowledge, the request is allowable within the terms and conditions of the award.

____________________________
Signature of the Authorized Official

Date:

Name:
Title:

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The sections below are for FRA use only:

IV. Risk Assessment (to be completed by the regional manager)
A. Is the proposed adjustment level one or level two? (If level one, Section IV is not required.)
Level One

Level Two

B. Evaluate the proposed adjustment against the risk factors below:

C.

1.

Could the proposed adjustment negatively impact effective project delivery, such as safety, effective internal
controls, and/or quality control and assurance?
Yes
No

2.

Could the adjustment negatively affect the public benefits expected from the project?
Yes
No

3.

Does the grantee have a history of performance concerns or non-compliance issues that may indicate an
inability to effectively mitigate or manage risk, such as substantive monitoring findings?
Yes
No

4.

Does the proposed adjustment conflict with existing requirements of the NGA, including its terms and
conditions?
Yes
No

5.

Does this adjustment constitute a change of scope or significantly affect the schedule or budget?
Yes
No

If you answered “Yes” to any risk element in Section B above, describe why the risk is necessary or tolerable to
achieve program/project success or important public benefits. If you answered “No” to all questions
above, proceed to Section D below.

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D. Describe the risk mitigation strategy(s), if any, that will be applied to this grant as a result of the adjustment.
Risk mitigation is required for adjustments described in Section C above.
Move to reimbursable payments (if previously on advanced payment)
Require additional or more detailed reporting requirements
Require increased/changed project deliverables or grantee assurances
Require enhanced monitoring by FRA or grantee
Establish additional approval thresholds
Require grantee to obtain or offer technical assistance to sub grantee(s)
Other (if so, explain):
If none are selected, explain why a risk mitigation strategy is not necessary:

E.

Describe the programmatic decision-making process for approving this adjustment. Include a high-level
summary of important meetings, attach key documentation submitted by the grantee, and include any other
decision memoranda that may be deemed important. Describe how any strategies FRA, the grantee, or subgrantees/recipients proposes to implement will mitigate project delivery or grant compliance risk (should a risk
be identified).

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F.

If this is a TIGER grant, has OST approved the adjustment?
Yes

No (If no, do not proceed until you have obtained OST approval.)

Date Approved: _______________
G. Have you worked with the grantee to make SOW or budget changes (if applicable)?
Yes

No

N/A

If yes, explain what changes were applied and why:

H. Required Signature

Regional Manager:

______________________________
Signature

___________________________
Date

V. Final Review & Approvals (to be completed by the grant manager)
A. Does the adjustment require additional federal funds be added to the grant?
Yes

No

If yes, denote the amount of needed Federal funds:
B. Grant Manager Decision:
Is the proposed adjustment approved or disapproved to advance to the next step in the approval process?
Approved

Disapproved

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VI. Signatures

Grant Manager:
(final signature)

Other (if applicable
highest signing
Authority):

Other (if applicable):

______________________________
Signature

___________________________
Date

______________________________
Signature

___________________________
Date

______________________________
Signature

___________________________
Date

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