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pdfU.S. DEPARTMENT OF THE INTERIOR
OMB Approval No.: 1029-0059
Exp. Date: 7/31/2021
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)
The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This information is
being collected to review, administer and evaluate the States/Tribes grants for program development and administration and enforcement to meet the requirements of the Surface Mining Control Reclamation and Enforcement Act. The obligation to respond is required to obtain a benefit.
Public reporting burden for this form is estimated to average 3 hours per response, including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the
Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, 1849 C Street, NW, Room 4559, Washington, DC 20240.
| File Type | application/pdf |
| File Title | Budget Information and Financial Reporting Form |
| Subject | Budget Information and Financial Reporting Form, osm 49, FAM, Federal Assistance Manual, form |
| Author | yrichardson |
| File Modified | 2021-09-14 |
| File Created | 2010-07-02 |