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U.S. DEPARTMENT OF THE INTERIOR OFFICE OF SURFACE (Office of Surface Mining)

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U.S.A. forms for Office of Surface Mining

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U.S. DEPARTMENT OF THE INTERIOR
OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT
OMB Approval No.: 1029-0059
Exp. Date: 7/31/2021
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 Financial Status Report
Cumulative Through  Cumulative Through Cumulative Through
Original/ Current Cumulative Cumulative Rpt Cumulative Cumulative Rpt Cumulative Cumulative Rpt
Title Number Prior Budget Budget Obligations Expenditures Ind Obligations Expenditures Ind Obligations Expenditures Ind
Total Net Program Obligations/Expenditures
Total Grant Amount
Total Unobligated Balance
Total Indirect Costs
Total Program Income
SECTION C. INDIRECT COST RATE INFORMATION
Type rate #1: Predetermined[ ] Final[ ] Provisional[ ] Fixed[ ] Type rate #2: Predetermined[ ] Final[ ] Provisional[ ] Fixed[ ]Type rate #3: Predetermined[ ] Final[ ] Provisional[ ] Fixed[ ]
Indirect Rate Calc: Base $_________ Indirect Amount $_______ Indirect Rate Calc: Base $_________ Indirect Amount $_______ Indirect Rate Calc: Base $_________ Indirect Amount $_______
Rate ______% Period Covered by Rate:  Rate ______% Period Covered by Rate:  Rate ______% Period Covered by Rate:
SECTION D. SIGNATURES
Name/Title and Signature of Authorized Official (Grant Application)
Date of Signature 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
Excel OSM-49 (August 1995)
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U.S. DEPARTMENT OF THE INTERIOR OFFICE OF SURFACE (Office of Surface Mining)

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Completed 10 August 2020

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