THE NAVAJO NATION Office of Management and Budget BUDGET REVISION REQUEST
TO: FROM: NAME / TITLE (Please Print/Type) E-MAIL PHONE NO.
AMOUNT LOD
PART 1 OF 2
• Post Office Box 646 Window Rock, Arizona 86515 • Telephone (928)871-6570 • www.omb.navajo.org •
OFFICE OF MANAGEMENT AND BUDGET, EXECUTIVE DIRECTOR
DATE BUSINESS UNIT NO.
AMOUNT
PROGRAM / DEPARTMENT TITLE
FUNDS AVAILABLE (OMB USE ONLY) LOD FROM OBJECT CODE & DESCRIPTION
TO OBJECT CODE & DESCRIPTION
TOTAL: JUSTIFICATION: (Must be detailed and complete):
$0.00
TOTAL:
$0.00
IMPACT ON PROGRAM PERFORMANCE CRITERIA: (Must be detailed and complete):
PRINT DEPT./PRG. DIRECTOR NAME & TITLE
PRINT BRANCH/DIV. DIRECTOR NAME & TITLE
APPROVAL SIGNATURE
CONCURRENCE SIGNATURE
DO NOT ATTACH ORIGINAL FINANCIAL DOCUMENTS. DO NOT ALTER THIS FORM.
PART 2 OF 2
BUDGET REVISION REQUEST
TO: FROM: NAME / TITLE (Please Print/Type) E-MAIL PHONE NO. DATE BUSINESS UNIT NO. OFFICE OF MANAGEMENT AND BUDGET, EXECUTIVE DIRECTOR
PROGRAM / DEPARTMENT TITLE AMOUNT: OMB COMMENTS:
TRACKING NO.
OMB ACTION
DISAPPROVED APPROVED
Batch Number / Date
Post By / Date
OMB EXECUTIVE DIRECTOR DATE