Form BLS LMI BV BLS LMI BV BLS LMI Budget Variance Request Form

LMI COOPERATIVE AGREEMENT BUDGET VARIANCE REQUEST FORM
1.

Fill in the “FY TOTAL” column of this form from Section B Row i 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.
Form Approved

We estimate that it will take an average of 15 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 [email protected]. 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

OMB No.
1220-0079
Approval Expires
06-30-2027

VARIANCE

CES

$ 0.00

LAUS

$ 0.00

OEWS

$ 0.00

QCEW

$ 0.00

Subtotal

$ 0.00

$ 0.00

$ 0.00

$ 0.00

CES-AAMC

$ 0.00

LAUS-AAMC

$ 0.00

OEWS-AAMC

$ 0.00

QCEW-AAMC

$ 0.00

Subtotal

$ 0.00

$ 0.00

$ 0.00

$ 0.00

TOTAL

$ 0.00

$ 0.00

$ 0.00

$ 0.00

State Agency Name:

LMI CA No.:

Requested by:
Signature:

Date:

Regional Office Review
Variance Requested:

$ 0.00 Percent of Total CA:

Reviewed by:

Date:

Approved by:

Date:

BLS LMI-BV (Revised June 2023)

0.00%