Form BLS OSHS BIF BLS OSHS BIF BLS OSHS Budget Information Form

BUREAU OF LABOR STATISTICS
OCCUPATIONAL SAFETY AND HEALTH STATISTICS
BUDGET INFORMATION FORM

U.S. DEPARTMENT OF LABOR

See complete instructions in OSHS Cooperative Agreement, Part II, Application Instructions.
We estimate that it will take an average of 1.5 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 673. If you have any comments on the estimates or the form, send them to [email protected]. You are not required to respond to the collection of information
unless it displays a currently valid OMB control number.

OMBControl No.1220-0149
$SSURYDO([SLUHV [[[[

SECTION A – GRANTEE INFORMATION
1. Application No.
Grant No.

2. POP for Base Programs

3. State

5. POP for AAMCs

4. Fiscal Year

6. Date Prepared

SECTION B – BUDGET SUMMARY BY ACTIVITY
1. SOII

2. CFOI

3. Total Base Programs

4. SOII AAMC

5. CFOI AAMC

6. Total AAMCs

7. Total Base
+ AAMCs

a. Personnel Salaries

$0

$0

$0

b. Fringe Benefits

$0

$0

$0

c. Travel

$0

$0

$0

d. Equipment

$0

$0

$0

e. Supplies

$0

$0

$0

f. Other

$0

$0

$0

$0

$0

$0

$0

$0

$0

g. Total Direct Charges

$0

$0

$0

$0

h. Indirect Charges

$0

$0

$0

$0

$0

$0

i. Total Charges (Lines g + h )

$0

SECTION C – FORECAST FEDERAL FUNDING NEEDS
1. SOII

2. CFOI

3. Total Base Programs

4. SOII AAMC

5. CFOI AAMC

6. Total AAMCs

7. Total Base
+ AAMCs

a. First Quarter

$0

$0

$0

b. Second Quarter

$0

$0

$0

c. Third Quarter

$0

$0

$0

d. Fourth Quarter

$0

$0

$0

e. Fifth Quarter

$0

$0

$0

f. Sixth Quarter

$0

$0

$0

g. Seventh Quarter

$0

$0

$0

h. Eighth Quarter

$0

$0

$0

$0

$0

i. Total Costs

$0

$0

$0

$0

$0

SECTION D – NON-FEDERAL RESOURCES
1. SOII

2. CFOI

3. Total Base Programs

a. Applicant
b. Total
SECTION E - REMARKS

BLS OSHS BIF, June 2023

4. SOII AAMC

5. CFOI AAMC

6. Total AAMCs

$0
$0

$0

$0

$0

$0

7. Total Base
+ AAMCs

$0

$0

$0

$0