BLS LMI-1B Budget Information Form

BUREAU OF LABOR STATISTICS
BUDGET INFORMATION FORM

See complete instructions in LMI Cooperative Agreement, Part II, Application Instructions.

U.S. DEPARTMENT OF LABOR

We estimate that it will take an average of 3.5 hours 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 on the estimates
or the form, send them to BLS, 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.

OMB No. 1220-0079
Approval Expires xx-xx-xxxx

State Abbreviation:

Name of Submitting Official:

Page _______ of ________

CA No.:

Title of Submitting Official:

Phone:

Fiscal Year:
CA Duration:
Col. A
Col. B
Col. C
Line
FIRST QUARTER
Number Program and Cost Category Staff years
Dollars
Program:
1
2
3
4

Activity Title:

FLC:

Activity Title:

FLC:

Activity Title:

FLC:

Activity Title:

Program Staff
AS & T Staff
Nonpersonal Services
Total Resources

Program:
9
10
11
12

FLC:
Program Staff
AS & T Staff
Nonpersonal Services
Total Resources

Program:
5
6
7
8

Col. D
SECOND QUARTER
Staff years
Dollars

Program Staff
AS & T Staff
Nonpersonal Services
Total Resources

Program:
13
14
15
16

Program Staff
AS & T Staff
Nonpersonal Services
Total Resources

17

Total LMI AAMCs

BLS LMI-1B (Revised May 2018)

Date Completed:
Col. E
Col. F
Col. G
THIRD QUARTER
FOURTH QUARTER TOTAL: FY
AAMC
Staff years Dollars Staff years Dollars
Staff years
Dollars