BLS LMI-BV Budget Variance Request Form

LMI COOPERATIVE AGREEMENT BUDGET VARIANCE REQUEST FORM
1.

Fill in the “FY TOTAL” column of this form from Column G of the current BIF in the Cooperative Agreement (CA).

2.

Insert the revised budget figures in the “REVISED FY TOTAL” column. The total amount of the revision cannot exceed 4.0% of the total CA amount. All
amounts should be entered in dollars and cents.

3.

Enter the payments received to date for each program for which a variance is requested (no total is needed). No single program’s “REVISED FY TOTAL” can be
lower than the total payments received to date (“PAYMENTS TO DATE”) for the program.

4.

Forward the form to the regional office for review no later than 60 days after the end of the fiscal year. Regional offices will send Budget Variance Requests to
the national office no later than 15 days after receipt from state agencies. Variance requests must be processed prior to the submission of closeout materials.

We estimate that it will take an average of 5-25 minutes to complete this form including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the information. Your response
is required to obtain or retain benefits under 29 USC 49L-1. If you have any comments regarding these estimates or any other
aspect of this form, including suggestions for reducing this burden, send them to the Bureau of Labor Statistics, Division of
Financial Planning and Management (1220-0079), 2 Massachusetts Avenue, NE, Room 4135, Washington, DC 20212-0001. You
are not required to respond to the collection of information unless it displays a currently valid OMB control number.

PROGRAM

FY TOTAL

REVISED FY TOTAL

PAYMENTS TO DATE

CES
LAUS
OES
QCEW
Subtotal
CES-AAMC
LAUS-AAMC
OES-AAMC
QCEW-AAMC
Subtotal
TOTAL
State Agency Name:

LMI CA No.:

Requested by:
Signature:

Date:

Regional Office Review
Variance Requested:

Percent of Total CA:

Reviewed by:

Date:

Approved by:

Date:

BLS LMI-BV (Revised May 2015)

OMB No.
1220-0079
Approval Expires
05-31-2018

VARIANCE