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Description
Government Agency Budget Request Forms document sample
Document Sample
FY-2011 Budget Request - Agency / Organizational Related Information
BRR0010 Last changed:
1. Please enter the Agency Number and
the Agency Name on this line - > 123 - Agency Name Here
ag.# - agency name
2. MAILING ADDRESS
3. AGENCY HEAD Name
Title
Phone#
Fax#
E-mail
4. ALTERNATE Name
CONTACT PERSON Title
Phone#
Fax#
E-mail
5. Type of agency governing body: (Authority, Board, Commission, Council, Court, None)
6. Description of Governing Body:
7. List the names, titles, appointing authority, and expiration dates of current appointments for your Governing Board (or
Commission). Provide the addresses and phone numbers of each in the Budget Request system or on a diskette. Do not
provide the phone and addresss information on any hard copies.
8. Agency management / division / program directors (name and phone numbers):
Division / Program: Director / Manager: Title: Phone number:
.
9. Agency Mission Statement:
10. Agency Duties/Responsibilities:
FY-2010 Budget Request
FY-2011 Budget Request - Agency Budget Summary Information
BRR0260 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1 Indicate how much the agency budget would be reduced (state, federal and other
funding) and describe the actions and program changes the agency would recommend to
achieve the funding levels for each of the following scenarios. Include a description of
the impact on various programs and services. If the information will not fit in the fields
provided in the system, enter "submitted separately" in the fields provided and then submit
separately typed pages along with the physical copies of the request.
1) If the FY-2011 appropriation was equal to the FY-2010 appropriation excluding any
carryover available for FY-2010 and any other non-recurring funding sources;
2) If the FY-2011 appropriation was reduced by 5% of the FY-2010 appropriation
excluding any carryover available for FY-2010 and any other non-recurring funding sources.
FY-2010 Budget Request
FY-2011 Budget Request - Summary by Program / Activity and Fund
BRR0221
Agcy. No.& Name 123 - Agency Name Here
$000's
Act. FY-2008 FY-2009 FY-2010 FY-2011
No. Program / Activity Name Actual Actual BWP Request
Total expends. by program 0 0 0 0
Fd.No. Fund Name
Total funding 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Summary by Subactivity and Fund
BRR0220
Agcy. No.& Name 123 - Agency Name Here
Program / Activity
Name & No.
$000's
Subact. FY-2008 FY-2009 FY-2010 FY-2011
No. Subactivity Name Actual Actual BWP Request
Total expends. by subactivity 0 0 0 0
Fd. No. Fund Name
Total funding 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Expenditure Summary
BRR0215
Agcy. No.& Name: 123 - Agency Name Here
Summarize your FY-2011 Budget Request in the following format.
Totals should match OSF Form BRR0221 Totals
For purposes of answering this question, use the following definitions:
Salaries & Benefits = all expenditure codes between 510000 - 513999
Professional services = 515000 - 515999;
Travel = 521000 - 529999;
Lease-Purchase expenditures = 543000 - 543999;
Equipment = 541000 - 549999 (excluding 543000-543999);
Payments to Local Gov't. Sub-divisions = 555000 - 555999;
Other Operating Expenses = all other expenditure codes
Total Expenditures for Operations (all activities and sub-activities combined/total budget):
$000's
FY-2008 FY-2009 FY-2010 FY-2011 %Chg.
Expenditure Category Actual Actual BWP Request fr. '08
Salaries & Benefits n/a
Professional services n/a
Travel n/a
Lease-Purchase
Expenditures n/a
Equipment n/a
Payments to Local
Gov't Sub-divisions n/a
Other Optg. Expenses n/a
Total 0 0 0 0 n/a
FY-2010 Budget Request
FY-2011 Budget Request - Revenue Summary
BRR0045 Last changed:
Agcy. No.& Name 123 - Agency Name Here
Please summarize your FY-2011 Budget Request in the following format. Revenue totals for '08 and '09 should tie to the
receipt totals on the Receipts and Disbursements reports.
For purposes of answering this question, use the following definitions:
Sales/Exchanges = receipt of revenue from sale of goods and/or services, (700 - 799)
Grants = receipt of federal or private sector moneys for the purpose of administering a specified program,
(550 - 561)
Other revenue = all other revenue sources (excluding 995 - 999)
Total Revenues (all activities and subactivities combined/total budget):
$000's
FY-2008 FY-2009 FY-2010 FY-2011 %Chg.
Actual Actual BWP Request fr. '08
Sales/Exchanges n/a
Grants n/a
Other Revenue n/a
Total 0 0 0 0 n/a
FY-2010 Budget Request
FY-2011 Budget Request - FTE Summary by Program / Activity
BRR0050 Last changed:
Agcy. No.& Name 123 - Agency Name Here
Act. FY-2008 FY-2009 FY-2010 FY-2011 %Chg.
No. Program / Activity Name Actual Actual BWP Request fr. '08
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
1. TOTALS 0.0 0.0 0.0 0.0 n/a
2. FTE exempt from limit n/a
3. Limited FTE (line 1 minus 2) 0.0 0.0 0.0 0.0 n/a
4. Legislated FTE Limit
5. No. of Passenger Vehicles (see
instructions)
Additional Comments:
1. If your agency will need a change in the amount of your legislated FTE limit for the upcoming fiscal year, please explain why
the change is needed.
2. Explain any substantial change in the number of FTE's for FY-2008 to FY-2009 and FY-2009 to Budgeted FY-2010.
FY-2010 Budget Request
FY-2011 Budget Request - Program Information / Performance Measures
BRR0030 Last changed:
Agcy. No.& Name 123 - Agency Name Here
Program Name
1. Provide the statutory references for this program:
2. Describe the purpose of this program, including a description of what you intend to accomplish.
3. Explain the benefits of this program:
a. Directly to society:
b. To other agencies:
4. Please describe budget actions taken by agency management or legislative actions that increased or reduced funding
for both FY-2009 and FY-2010 and discuss the programmatic impact of these budget changes:
5. Client Information:
a. Description of
clients
b. Number of potential
clients
c. Number of clients
served
d. Describe how the
clients are served
FY-2010 Budget Request
Program Information / Performance Measures (cont.)
6. Program Goals / Performance Measures (PM):
List your program goals and measures. Include Performance Measures as well as the inputs, outputs,
outcome measures and efficiency measures that describe how you accomplish your goals.
Identify/list in the following table, the appropriate yearly benchmarks you have reached in the past two
years; hope to reach in the current year; and plan to reach in order to achieve the program goals in
the next 2 years:
(enter the agency goal being addressed, then the name and description of the performance
measure, enter data next to the fiscal year noted)
Goal # Agency goal
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2008 FY-2009 FY-2010 FY-2011
Orig Est 08 Orig Est 09
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2008 FY-2009 FY-2010 FY-2011
Orig Est 08 Orig Est 09
Goal # Agency goal
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2008 FY-2009 FY-2010 FY-2011
Orig Est 08 Orig Est 09
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2008 FY-2009 FY-2010 FY-2011
Orig Est 08 Orig Est 09
FY-2010 Budget Request
FY-2011 Budget Request - Expenditures by Program
BRF0280 Last changed:
Agcy. No.& Name 123 - Agency Name Here
FY-2009 Information
$000's
Priority Program Name: State $ Rev. Fund $ Fed. Fds $ Total FTE
1
Program Description:
2
Program Description:
3
Program Description:
4
Program Description:
FY-2010 Budget Request
FY-2011 Budget Request - State Pay Percentage Calculation
BRR0130 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1. For the following table, please respond based upon your agency's current Budget Work Program
amounts for personal services.
$000's
a. Total expenditures for personal services (salaries/benefits):
b. Amount used from unsubsidized enterprise operations funds:
c. Amount used from federal funds:
State Pay Percentage: ((a-b-c)/a) n/a
2. In calculating the amount of appropriations needed to fund a statewide employee pay increase, we will use the
percentage above for your agency. If this percentage is not accurate, please enter the percentage you calculate as
appropriate and then explain how you calculated it.
a. State Pay Percentage:
b. Explanation of calculation:
c. Explanation of why state pay percentage as originally calculated won't work:
FY-2010 Budget Request
FY-2011 Budget Request - Summary of FY-2009 Supplemental Funding Requests
BRR0101 Last changed:
Agcy. No.& Name 123 - Agency Name Here
(each separate supplemental request requires the submission of an OSF FORM BRR0100)
$000's
State State Total Personnel
Appropriated Revolving Federal Funding (FTE)
Priority Description of Funding Change Funding Funds Funds Changes Changes
List funding changes in priority order. Total each column. (nearest 10th)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TOTAL CHANGES 0 0 0 0 0.0
FY-2010 Budget Request
FY-2011 Budget Request - FY-2010 Supplemental Requests - Detail
BRR0100 Last changed:
Agcy. No.& Name 123 - Agency Name Here Agency Priority:
Brief Description of this Funding Change:
(this is the "name" that will be used on the Summary to list this particular funding request)
Justification for the Funding Change:
1. Describe the purpose of this funding change, including a description of the problem that
has resulted in a supplemental funding need. Describe what you intend to accomplish with
this funding. Include a description of actions you've taken to date to avoid the funding
need.
2. If the purpose of this funding change is to address a mandate, please specify whether it
is a court ordered, state, or federal mandate, and include the appropriate legal reference
and description.
a. Type of mandate:
b. Legal reference:
c. Description of
mandate:
3. Describe the other alternatives you reviewed as you were developing this proposal, including private sector solutions.
4. Discuss changes in the workload that has precipitated this funding need. Show the
anticipated workload levels compared to what has happened so far this year.
FY-2010 Budget Request
SUPPLEMENTAL FUNDING CHANGES - Detail (continued)
5. For this funding request, list the positions needed, by job family descriptor. Include
current and budgeted FTE for any existing positions assigned to this effort.
Job Job Family Activity FY-2010 FY-2010 Additional
Family Descriptor number Budgeted Projected FY-11 need
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Total FTE's 0.0 0.0 0.0
6. For this funding request, provide the salary by position. Total benefits needed should be
calculated and provided on one line. The total of this section will be the amounts you post
to the table in question 7. Include actual and budgeted amounts for similar positions
already funded for this program / initiative.
Personnel Expenditures (New Positions)
Job Job Family FY-2010 FY-2010 Additional
Family Descriptor Budgeted Projected FY-11 need
0
0
0
0
0
0
0
0
0
0
0
Total Salaries 0 0 0
Benefits for all positions 0
Total 0 0 0
FY-2010 Budget Request
SUPPLEMENTAL FUNDING CHANGES - Detail (continued)
7. Provide the following expenditure and funding information. If this funding needs to be
annualized and continued in subsequent years, include the expanded request in the FY-
2011 funding changes section.
Expenditures by object category FY-2010 FY-2010 Additional
Expenditure Category: Budgeted Projected FY-11 need
Salaries/Benefits 0 0 0
Professional Services 0
Travel 0
Lease Purchase 0
Equipment 0
Pymts to Local Gov't 0
Other 0
Total Costs 0 0 0
FY-2010 FY-2010 Additional
Expenditures by Source Budgeted Projected FY-11 need
Appropriated 0
Revolving 0
Federal 0
Total Costs 0 0 0
check figure ok ok ok
Exp.by Fd, Act., & Subact. FY-2010 FY-2010 Additional
Fund # Activ.# Subact. # Budgeted Projected FY-11 need
0
0
0
0
0
0
0
0
0
0
Total 0 0 0
check figure ok ok ok
Explain the following items identified in question 7. Explain assumptions made and calculations of costs.
8. Salaries/Benefits
9. Professional Services
10. Other Recurring Costs
11. Explain funding sources, including details of any amounts that will be covered by
federal or revolving funds (what federal program is providing the funding; fee increases
involved; etc.)
FY-2010 Budget Request
FY-2010 Budget Request
FY-2011 Budget Request - Carryover Funds Used in the FY-2010 Budget &
FY-2011 Cash Needs
BRR0080 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1. Describe the agency's FY-2011 needs for cash appropriations.
2. In the following table, show how much carryover you have budgeted or plan on budgeting in FY-2010:
$000's
Recurring One-time Total Budgeted
Expenditures Expenditures Carryover
Annually Appropriated Funds 0
Revolving Funds 0
Federal Funds 0
Total Carryover 0 0 0
Comments:
3. If you used or plan on using carryover for recurring operations in FY-2010, the current budget year, explain the
purpose.
4. If carryover was used or will be used in FY-2010 for recurring operations, please indicate the impact of not having
these funds again in FY-2011. If you indicate a negative impact, explain what actions you will take to manage the
situation. (list all actions in priority order.)
FY-2010 Budget Request
FY-2011 Budget Request - Summary of FY-2011 Operations Funding Changes
BRR0141 Last changed:
Agcy. No.& Name 123 - Agency Name Here
(each program / adjustment / priority requires the submission of an OSF FORM BRR0140)
$000's
Summary of FY-2011 Funding Changes State State Total Personnel
Appropriated Revolving Federal Funding (FTE)
Priority Description of Funding Change Funding Funds Funds Changes Changes
List funding changes in priority order. Total each column. (nearest 10th)
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
16 0
17 0
18 0
19 0
20 0
21 0
22 0
23 0
24 0
25 0
26 0
27 0
TOTAL CHANGES 0 0 0 0 0.0
FY-2010 Budget Request
FY-2011 Budget Request - Operations Funding Changes - Detail by Program/Subactivity
BRR0140 Last changed:
Agcy. No.& Name 123 - Agency Name Here Agency priority:
Brief Description of this Funding Change:
(this is the "name" that will be used on the Summary to list this particular funding request)
Justification for the Funding Change:
1. Describe the purpose of this funding change. Include the following factors in your answer: what you intend to accomplish; benefits
to the citizens of Oklahoma; short-term or long-term savings or cost effectiveness; and efficiencies that will result if funded.
2. If the purpose of this funding change is to address a mandate, please specify whether it is a court ordered, state,
or federal mandate, and include the appropriate legal reference and description.
a. Type of mandate:
b. Legal reference:
c. Description of
mandate:
3. Describe the other alternatives you reviewed as you were developing this proposal.
4. Discuss how much of this funding request can be provided by user fees and describe the fee levels that should
be charged.
5. Discuss whether or not these services could be provided through vouchers, thus allowing the users maximum
flexibility on choice of provider.
FY-2010 Budget Request
6. Client Information:
a. Description of
clients
b. Number of potential
clients
c. Number of clients
served
d. How are the clients
served
7. Program Performance Measures:
Describe how you do / will measure that program goals are met. List program goals and measures. Include
Performance Measures as well as the inputs, outputs, outcome measures and efficiency measures that
describe how you accomplish your goals. Identify/list in the following table, the appropriate yearly
benchmarks you have reached in the past year; hope to reach in the current year; and plan to reach in order
to achieve the program PM's in the next 2 years:
Goal # Agency goal
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2009 FY-2010 FY-2011
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2009 FY-2010 FY-2011
Goal # Agency goal
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2009 FY-2010 FY-2011
Goal # Agency goal
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2009 FY-2010 FY-2011
PM # Agency Performance Measure Title (limit to 28 characters)
Performance measure - description
Actual Budgeted Estimated
FY-2009 FY-2010 FY-2011
FY-2010 Budget Request
OPERATIONS FUNDING CHANGES - Detail by Program / Sub-activity (continued)
8. For this funding request, list the positions needed, by job family descriptor. Include current and budgeted FTE for
any existing positions assigned to this effort.
New FTE /
Changes to
Budgeted
Baseline FTE Only
Job Job Family Activity FY-2009 FY-2010 FY-2011
Family Descriptor no. Actual Budgeted Requested
Total FTE's 0.0 0.0 0.0
9. For this funding request, provide the salary by position, for all positions needed. Total benefits needed should be
calculated and provided on one line. The total of this section will be the amounts you post to the table in question 8.
Include actual and budgeted amounts for similar positions already funded for this program / initiative.
Personnel Expenditures / Positions $000's: New
Funding /
Changes to
FY-2010
$000's - Baseline Budgeted
Job Job Family FY-2009 FY-2010 FY-2011
Family Descriptor Actual Budgeted Requested
Total Salaries 0 0 0
Benefits for all positions
Total 0 0 0
FY-2010 Budget Request
OPERATIONS FUNDING CHANGES - Detail by Program / Sub-activity (continued)
10. For this funding request, provide the following expenditure and funding information. Include the actual and
budgeted information for existing programs you are wishing to expand through this request.
$000's: New
Funding /
Changes to
FY-2010
$000's - Baseline Budgeted
FY-2009 FY-2010 FY-2011
Expenditure Category: Actual Budgeted Requested
Start-up Costs:
Equipment
Other
Total Start-up Costs 0 0 0
Recurring Costs:
Salaries/Benefits 0 0 0
Professional Services
Travel
Lease Purchase
Equipment
Pymts to Local Gov't
Other
Total Recurring Costs 0 0 0
Total Costs 0 0 0
$000's: New
Funding /
Changes to
FY-2010
$000's - Baseline Budgeted
FY-2009 FY-2010 FY-2011
Expends. by Revenue Source: Actual Budgeted Requested
Appropriated
Revolving
Federal
Total Costs 0 0 0
check figure ok ok ok
FY-2010 Budget Request
Funding by Fund, Activity, & Sub-activity
$000's: New
Funding /
Changes to
FY-2010
$000's - Baseline Budgeted
FY-2009 FY-2010 FY-2011
Fd # Activity # Subact. # Actual Budgeted Requested
Total 0 0 0
check figure ok ok ok
FY-2010 Budget Request
OPERATIONS FUNDING CHANGES - Detail by Program / Sub-activity (continued)
Explain the following items identified in question 10. Explain assumptions made and calculations of costs.
11. Start-up costs
12. Salaries/Benefits
13. Professional Services
14. Other Recurring Costs
15. Explain funding sources, including details of any amounts that will be covered by federal or revolving funds
(what federal program is providing the funding; fee increases involved; etc.)
FY-2010 Budget Request
FY-2011 Budget Request - Agency Income and Cashflow Summary
BRR0041 Last changed:
Agcy. No.& Name 123 - Agency Name Here
$000's
FY-2008 FY-2009 FY-2010 FY-2011
Cashflow: Actual Actual BWP Request
A. Beginning Cash Balance 0 0 0
B. Prior year obligations:
Payroll transfers
Other operations
C. Cash Available (A - B) 0 0 0 0
D. Income to the fund 0 0 0 0
E. Appropriation transfers
F. Total fds available (C+D+E) 0 0 0 0
G. Current FY operations expenditures: (1)
Payroll transfers
Other operations
H. Capital outlay expenditures
I. Ending Balance (F - G - H) 0 0 0 0
J. Funds invested w/Treasurer
at year-end
note: (1) Expenditures represent the payment of claims processed during the fiscal year against this fund, for the particular fiscal
year only. Payment of prior year obligations goes on line B. Only operations expenditures go on this line (All Capital Outlay
expenditures go on line H). Column 3 amount should equal total for this fund shown in Column 5, Form BR-1. Column 4
amount should equal total for this fund shown in Column 6/7 on Form BR-1.
Income to the Fund: $000's
Receipt FY-2008 FY-2009 FY-2010 FY-2011
Code Source Actual Actual BWP Request
Total Income to the Fund 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Agency Income and Cashflow Summary - by Fund
BRR0040 Last changed:
Agcy. No.& Name 123 - Agency Name Here
Fund No. & Name
$000's
FY-2008 FY-2009 FY-2010 FY-2011
Cashflow: Actual Actual BWP Request
A. Beginning Cash Balance 0 0 0
B. Prior year obligations:
Payroll transfers
Other operations
C. Cash Available (A - B) 0 0 0 0
D. Income to the fund 0 0 0 0
E. Appropriation transfers
F. Total fds available (C+D+E) 0 0 0 0
G. Current FY operations expenditures: (1)
Payroll transfers
Other operations
H. Capital outlay expenditures
I. Ending Balance (F - G - H) 0 0 0 0
J. Funds invested w/Treasurer at
year-end
note: (1) Expenditures represent the payment of claims processed during the fiscal year against this fund, for the particular
fiscal year only. Payment of prior year obligations goes on line B. Only operations expenditures go on this line (All Capital
Outlay expenditures go on line H). Column 3 amount should equal total for this fund shown in Column 5, Form BR-1.
Column 4 amount should equal total for this fund shown in Column 6/7 on Form BR-1.
Income to the Fund: $000's
Receipt FY-2008 FY-2009 FY-2010 FY-2011
Code Source Actual Actual BWP Request
Total Income to the Fund 0 0 0 0
Explain by source of revenue any substantial change in income for each of the years indicated above:
FY-2010 Budget Request
FY-2011 Budget Request - Individual Fees Summary
BRR0061 Last changed:
Agcy. No.& Name 123 - Agency Name Here
Fee 1 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Fee 2 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Fee 3 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Actual / estimated collections - $000's
Fund FY-2008 FY-2009 FY-2010 FY-2011
Fee Name: no. Actual Actual Estimated Estimated
Fee 1 19x
210
Fee 2 19x
210
Fee 3 19x
210
Total collected 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Agency Individual Fees
BRR0060 Last changed:
Please see instructions to determine which fee form you should complete; "agency individual fees" or "agency group fees".
Agcy. No.& Name 123 - Agency Name Here
1. Fee Information:
a. Name of fee
b. Statutory reference
c. Name and number
of program/activity
funded
2. Describe the fee (what is the name of the fee; who pays it; what does the fee pay for; and so-forth):
3. If you are anticipating or requesting any fee increases either through legislation or through rulemaking, please explain your plans.
4. Complete the following tables:
Actual Budgeted Estimated
Fee amount charged: FY-2008 FY-2009 FY-2010 FY-2011
Agcy. Fund FY-2008 FY-2009 FY-2010 FY-2011
No. No. Actual Actual Estimated Estimated
$000's
Amount Collected by
Fund:
Total Collected 0 0 0 0
Additional comments:
5. List the OSF revenue / receipt code used to deposit these funds: _________________
FY-2010 Budget Request
FY-2011 Budget Request - Group Fees Summary
BRR0071 Last changed:
Agcy. No.& Name 123 - Agency Name Here
Group Fee 1 name:
Fee 1 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Fee 2 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Group Fee 2 name:
Fee 1 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Fee 2 name:
Statutory reference:
FY-2008 FY-2009 FY-2010 FY-2011
Fee amounts:
Actual / estimated collections - $000's
Fund FY-2008 FY-2009 FY-2010 FY-2011
no. Actual Actual Estimated Estimated
Group Fee 1 19x
210
Group Fee 2 19x
210
Total collected 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Agency Group Fees
BRR0070 Last changed:
Please see instructions to determine which fee form you should complete.
Agcy. No.& Name 123 - Agency Name Here
1. Reference name for group
2. If you are anticipating or requesting any fee increases either through legislation or through rulemaking, please explain
your plans.
3. Please provide the following information for each fee in the group:
Prog./ Prog./Act. Statutory
Fee Name Activ. # Name Reference Description
4. Please provide the amount charged for each fee for the following years. Please put the exact fee amount (not a
rounded number).
Fee: ______________________________
Actual Estimated
FY-2008 FY-2009 FY-2010 FY-2011
5. Please complete the following table for the entire group of fees:
$000's
Agcy. Fund FY-2008 FY-2009 FY-2010 FY-2011
No. No. Actual Actual Estimated Estimated
Amount Collected
by Fund:
Total Collected 0 0 0 0
Additional comments:
6. List the OSF revenue/receipt code used to deposit these funds: _________________
FY-2010 Budget Request
FY-2011 Budget Request - Federal Funds Summary
BRR0151 Last changed:
Agency No.
& Name 123 - Agency Name Here
Summary of Federal Revenues
$000's
CFDA Fund FY-2008 FY-2009 FY-2010 FY-2011
no. Program Name No. Actual Actual Estimated Estimated
Totals 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Federal Programs Data Sheet
BRR0150 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1. CFDA or OSF Tracking Number and Official Name of Federal Program:
CFDA #: Program Name:
2. If your agency refers to this program by a different name, please provide the alternate name:
3. Describe the program / explain its purpose and how it is accomplished:
4. Explain the state matching requirements for this program:
5. Describe any limits on the use of funding available from this federal program:
6. Indicate how many years this federal funding will be available:
7. Explain any substantial change in the funding provided by this program for each of the years indicated in the table:
8. Discuss what actions you will take if this federal funding ends. If this program needs to be funded from some other
source, describe why this program should continue to be funded and discuss available sources of funding.
FY-2010 Budget Request
FEDERAL PROGRAMS DATA SHEET - continued
9. Please complete the following table: $000's
FY-2008 FY-2009 FY-2010 FY-2011
Actual Actual Estimated Estimated
a) Expenditures
State Dollars
Federal Dollars
Total 0 0 0 0
b) Passed through to Local Units of Government:
State Dollars
Federal Dollars
Total 0 0 0 0 0
c) Federal Revenues
d) FTE's Funded by this Program (rounded to the nearest tenth of an FTE):
by State funds
by Federal funds
Total FTE 0.0 0.0 0.0 0.0 0.0
10. List the fund number and name to which these funds are deposited:
fd.no. fund name
fd.no. fund name
fd.no. fund name
FY-2010 Budget Request
FY-2011 Budget Request - Grants and Pass-throughs Summary
BRR0111 Last changed:
Agency No.
& Name 123 - Agency Name Here
Summary of Grants / Pass-through Expenditures
$000's
FY-2008 FY-2009 FY-2010 FY-2011
Name of grant program Actual Actual Estimated Estimated
Totals 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Grants and Pass-throughs to Local Gov't
and Nonprofit Organizations
BRR0110 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1. Name of grant program:
2. Describe the program / explain its purpose and how it is accomplished:
3. Indicate whether or not your agency was directed by legislation to provide funding to a specific entity.
Please explain the issue and provide the applicable legal reference.
4. Explain how the program is administered and the rules for receiving funds.
5. Explain how the rules for the program are established.
6. Please complete the following table.
$000's - - FTE's to nearest tenth
FY-2008 FY-2009 FY-2010 FY-2011
Expenditures: Actual Actual Budgeted Estimated
Appropriated
Revolving
Federal
Total Expenditures 0 0 0 0
FTE's
FY-2010 Budget Request
FY-2011 Budget Request - Property Maintenance
BRR0090 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1. Describe the agency's maintenance program for equipment, buildings, vehicles, land, and other property.
2. Additional comments:
3. Please complete the following table:
$000's - - FTE's to nearest tenth
FY-2009 FY-2010 FY-2010
Estimated Estimated Estimated
Total Value of Assets:
Equipment
Buildings
Vehicles
Land
Other property
Total Value 0 0 0
Total Maintenance Expenditures:
Equipment
Buildings
Vehicles
Land
Other property
Total Maintenance Expenditures 0 0 0
FTE's
FY-2010 Budget Request
FY-2011 Budget Request - Agency Capital Outlay Summary
BRR0161 Last changed:
Agcy. No.& Name 123 - Agency Name Here
(details for each project are included in the Capital Outlay Budget material provided to the Long-Range Capital Planning Commission)
$000's
Total Request Project Federal Other State Total
Priority Description of Capital Outlay Request Number Funds Funds Appropriations Project
List funding changes in priority order. Total each column.
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
16 0
17 0
18 0
19 0
20 0
21 0
22 0
23 0
24 0
25 0
26 0
27 0
Totals 0 0 0 0
FY-2010 Budget Request
FY-2011 Budget Request - Legislation Needs
BRR0250 Last changed:
Agcy. No.& Name 123 - Agency Name Here
1. Indicate the Title that is being affected.
2. Provide a description of the legislative change you are seeking.
3. Explain why the change is needed including what you intend to accomplish through the change in law.
FY-2010 Budget Request
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