Budget Information and Financial Reporting Form, OSM 49

Detailed Instructions for Completing the OSM 49 Budget Information and Financial Reporting Form

Section A, General

Grantee: Enter the grant recipient's name.

Grant Title: Enter the fiscal year of the grant award, State, and "AML Grant", e.g., FY 1993 Alaska AML Grant.

Grant Number: Enter the grant number assigned by OSM.

Grant Period: Enter the beginning and ending dates of the performance period for which the budget is being submitted.

Section B, "Budget" Information - Complete for Grant Application

Budget/Cost Categories. Enter the Budget/Cost Category title and subaccount number from the list below for all categories applicable to your AML Grant.

Indirect costs are to be added to the associated direct cost to reflect the total costs estimated or charged by Budget/Cost Category.

Subaccount Number and Budget/Cost Category Title:
(State Code = XX. Fiscal Year of Funding = Y.)

XXY01 Non-Emergency Administrative Costs
XXY02 Emergency Administrative Costs
XXY03 Non-Water Supply Project Costs
XXY04 Water Supply Project Costs
XXY05 Emergency Project Costs
XXY06 Future Set-Aside Costs
XXY07 AMD Set-Aside Costs
XXY08 Subsidence Insurance Costs
XXY11 Non-Coal Project Costs
XXY12 Civil Penalty Program Costs
XXY13 ACSI Costs

Budget: For new grant applications, complete the Original/Prior Budget column with all budget/cost categories for which you are requesting approval to expend funds during the grant performance period. For the first change to approved budget, complete the Current Budget column with the revised amount for each budget/cost category. For subsequent revisions, place the current budget amounts in the Original/Prior Budget column, and place the subsequent revisions int he Current Budget column.

Enter the total budgeted amount for the grant on the Total Grant Amount line in the Original/Prior Revision column and the Current Revisions column if appropriate.

Enter the estimated amount of program income expected during the performance period on the total Program Income line. Do not reduce the Total Grant Amount by the amount of anticipated program income!

Section B, "Financial Status Report" Information - Complete for Annual Reports and Closeout.

Cumulative Through: Enter the ending dates of the report period for each annual report and at grant closeout. Ending dates should be increemnts of one, two, and three years from the beginning date of grant performance period.

Cumulative Obligations: For each budgeted budget/cost category, enter the cumulative amount obligated through the end of each annual reporting period.

Cumulative Expenditures: For each budgeted budget/cost category, enter the cumulative amount expended, i.e. paid out through the end of each annual reporting period. For budget/cost categories for which the report is a final report, include all expenditures that pertain to obligations incurred during that annual period. Period expenditures include both direct and indirect costs and must be reported net of program income.

Rpt. Ind. (Report Indicator): For each budget/cost category, enter whether the report is an annual report (A) or a final report (F).

Indirect Costs and Program Income: Enter the amount of total cumulative indirect cost charges and total cumulative program income earned which are included on the Total Net Program Obligations/Expenditures line.

Section C. Indirect Cost Rate Information
Enter the requested information for each approved indirect rate. Update as appropriate for annual reports.

Section D. Signature

For Grant Application - Enter the name, title and signature of the individual authorizing the submission of the budget information. Enter the date the OSM-49 was signed.

For Annual Reports and Closeout - Sign and date the form in the appropriate column indicating whether the submittal is the first annual report, the second annual report, or the third annual report.

Response to this request is required to obtain a benefit. You are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden for this form is estimated to average 5 hours per response including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to the Information Collection Clearance Office, OSM, Room 210 SIB, 1951 Constitution Ave.,NW, Washington, DC 20240, and the Office of Management and Budget, OIRA, Interior Desk Officer, Paperwork Reduction Project 1029-0059, Washington, DC 20503.

Program Narrative Statement, OSM 51

Go To Forms page to download a copy of this form

Instructions for the OSM 51

1. Self-explanatory.

2. Enter the name of the grant applicant.

3. Enter the name of the program and the project being described.

4. Enter the name of the performing organization if it is different from the grant or cooperative agreement recipient.

5. Enter the program narrative statement. Note that project specific information is addressed through the "Authorization to Proceed" process, and is therefore, not required here.
   1. As detailed in OMB Circular A-102 (Revised), the Program Narrative Statement should include the following information:

      Objectives and Need for Assistance. Using the approved AML State Program as the guideline, describe any relevant abandoned mine land problems (physical, economic, social, financial, or institutional) requiring a solution. Indicate the need for the assistance and state the principal and subordinate objectives of the grant. Relevant data based on planning studies should be included or footnoted.

      Results and Benefits Expected. Identify results and benefits to be derived from the reclamation program. For example, describe how the reclamation program will improve the environment and protect the health, safety, and welfare of the public.

      Approach. Outline a plan of action pertaining to the scope of the grant and describe how the proposed work will be accomplished. Cite factors (such as weather, eligibility issues, etc.) which might accelerate or decelerate the work and your reasons for taking this approach as opposed to others. Describe any unusual features of this grant, such as design/technological innovations, and reductions in cost or time. Identify the kinds of data to be collected and maintained. Discuss the criteria and methodology to be used to evaluate the results and success of the reclamation program.

      Geographic Location. No information required.

   2. OSM has minimized as much as possible its requirements for additional information, while still meeting its responsibility to ensure that there is no fraud, waste, or abuse in its Federal programs and complying with other Federal requirements (such as OMB Circular A-87, which requires specific prior Federal approval for the purchase of certain items). Therefore, provide the following general information for the below listed items that comprise (1) Administrative Costs and (2) Project Support Costs, regardless of budget/cost category. Note: This information will generally be sufficient to address the above requirements. However, there may be instances (i.e., significant changes to the grant program) which may require the submission of additional information to the RCC/FO.

      Personnel. Provide an estimate of the number and type of full-time equivalent positions supported by this grant.

      Fringe Benefits. Provide the basis and estimated total amount of fringe benefits.

      Travel. Provide the basis for the computation of travel expenses (e.g., 5 trips, for "y" purpose, at an average cost of $100 per trip; 3 people to attend 3-day meeting for "y" purpose at $200 each - $100 transportation and $100 subsistence).

      Equipment. Provide the estimated dollar amount of total equipment to be purchased, leased or rented. Itemize equipment major, e.g., vehicles, computer-related.

      Supplies. Enter estimated dollar amount of supplies. Include an itemization of computer-related hardware.

      Contractual. Provide a list by purpose and estimated dollar amount of contracts.

      Other. Include other items not reimbursed as an indirect cost (e.g., rent, reproduction, telephone, janitorial and security services). Provide a list by major type with the basis for computation.

   3. Several AML programs require that specific information be included in the program narrative statement. See the following chapters for guidance on the specific program requirements:
      4-10 - Subsidence Insurance Program
      4-20 - Set-Aside Program
      4-40 - Acid Mine Drainage Fund

   4. To ensure consistent classification of costs as either "project", "administrative" or "indirect" for purposes of the Abandoned Mine Land (AML) Grant Program, grantees shall provide the following information as part of the program narrative (OSM 51) for each new AML grant:
      Project Costs: $
      Administrative Costs: $
      Indirect Costs: $

      The total of the three items shall equal the grant request.

      Project Costs include the following construction and construction-related activities:

      1. Project Development - Scope of work preparation, field investigation and sampling, eligibility determinations, NEPA documentation, clearances, and preparation of problem area information for funding and project completion.

      2. Project Design - Aerial photography, mapping, detailed construction plans, specifications, bidding documents, permits.

      3. Realty Work - Ownership determinations, rights of entry, lien evaluations and filing, acquisition.

      4. Construction contract bidding and management.

      5. Construction costs, including exploratory drilling.

      6. Construction inspection - site inspections, job conferences, surveys, aerial inspections.

      7. Post-construction costs - project monitoring, abatement work.

      Administrative Costs include the following non-construction-related activities:

      1. Inventory system management, including reviewing, revising and identifying problem areas in the AML inventory.

      2. Program policy development - State/Tribe Reclamation Plan management, law/regulation analysis, program policy issues, association business.

      3. Program support - Personnel management, fiscal and legal support, grant administration, training, seminars and public information costs.

      4. Nonconstruction project costs - Subsidence insurance, future set-aside program and acid-mine drainage fund.

      Indirect Costs - Total indirect funds included in the grant. Indirect cost is calculated by multiplying the appropriate indirect cost rate by the appropriate direct cost base of the grant, as defined by the grantee's Negotiation Agreement with the Federal cognizant agency.

Certifications Regarding Debarment, Suspension and Other Responsibility Matters, Drug-Free Workplace Requirements and Lobbying, DI 2010

Disclosure Form to Report Lobbying, SF LLL

Assurances--Non-Construction Programs, SF 424B

Assurances--Construction Programs, SF 424D(/b>