COLORADO DIVISION OF CRIMINAL JUSTICE DCJ4Av1.doc (Rev. 11-05) DCJ FORM 4-A - BUDGET REVISION SUBGRANTEE: GRANT NUMBER: PROJECT TITLE: PROJECT DURATION FROM: TO: PREPARED BY: PHONE: ( ) DATE: A GRANT MODIFICATION IS NOT AUTHORIZED UNTIL IT IS APPROVED IN WRITING BY THE DIVISION OF CRIMINAL JUSTICE. To request a change, submit two signed forms (one with original signatures) including narratives, to DCJ. Once approved by DCJ, a copy will be returned for your records. See reverse side for instructions. THE PURPOSE OF THIS REQUEST IS TO REVISE THE BUDGET CATEGORIES. THE TOTAL AMOUNT OF THE FEDERAL/STATE AWARD CANNOT INCREASE. TOTAL MATCH AMOUNT CHANGES MUST BE APPROVED. A. BUDGET CHANGE BUDGET CURRENT APPROVED BUDGET REQUESTED BUDGET CHANGE AMOUNT of TOTAL CHANGE by line item CATEGORY Federal/State Award Cash Match * In Kind Match * Total Federal/State Award Cash Match * In Kind Match* Total + or (-) Personnel Supplies & Operating Travel Equipment Professional Services Confidential Funds TOTAL * Cash and/or In Kind match may not apply. Refer to your Statement of Grant Award. ***Division of Criminal Justice Use Only*** THIS REQUEST IS Approved Denied, see attached B. NARRATIVE: A NARRATIVE explaining and justifying the need for a budget revision is attached. By: All other terms and conditions of the original grant with any approved modifications PROGRAM SPECIALIST, DCJ DATE remain in full force and effect. I hereby certify that the content of this form, other than the data entry required, has not been altered. PROJECT DIRECTOR SIGNATURE DATE FINANCIAL OFFICER SIGNATURE DATE DETAILED INSTRUCTIONS FOR COMPLETING DCJ FORM 4-A - BUDGET REVISION HEADING Subgrantee: This is the agency to which the grant award was made. Grant Number: This is the grant number assigned to the project by DCJ. It can be found on the Statement of Grant Award. Project Title: This is the name of the project which is identified on the Statement of Grant Award. Duration: This is the period of the grant award. It can be found on the Statement of Grant Award, and is changed only if the project requests and receives a grant extension. (DCJ Form 4-C) Prepared by: Name of person completing this form. Include this person's phone number. Date: This is the date the Budget Revision form is completed. A. Budget Change: Current Approved Budget: If this is your first budget revision request, indicate the approved budget which can be found on the Statement of Grant Award. If you have previously requested and received approval for a budget revision, please indicate your most recently approved budget. Show the federal/state award, matching dollars, if any, and total by budget category. These amounts should be the same as shown on the most recent Statement of Grant Award or most recent approved budget revision. Requested Budget Change: Please indicate your requested change in budget amounts for each category. You would generally be moving dollar amounts between categories. The total amount of the Federal/State award cannot increase from the current approved budget. Amount of Total Change: In this column, show which budget categories have changed by indicating the dollar amount of the increase or decrease. Show decrease amounts in parentheses "( )". Since the purpose of this form is to move dollars between categories, the total change should be 0. B. Narrative: Attach a narrative to this form explaining and justifying the need for a budget revision. Signatures: Both the designated Financial Officer AND Project Director must sign this form. Two signed forms (one with original signatures) must be submitted to DCJ. Once approved by DCJ, a copy will be returned for your records.
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