Surface Transportation Extension Act - Transfer Request Worksheet

Transfer Request Under the Surface Transportation Extension Act of 1997

		1	2	3	4	5	6
		Fiscal Year	Program	Appropriation Code	Unobligated Balance	Transfer Amount	Funds Subject to Restoration
A.	FROM:
B.	TO:				N/A

I certify that the above information relating to the funds subject to restoration is correct and true.

__________________________________________________
SIGNATURE OF DIVISION ADMINISTRATOR (or designee)

NOTES:

Enter the fiscal year of the applicable apportionment, grant, or allocation. The fiscal year specified in row A must be the same as specified in row B.
Enter the name of the applicable program; i.e., IM, NHS, STP, CMAQ, Bridge, Sect. 402, Sect. 410, Motor Carrier.
Enter the applicable appropriation code from/to which the funds are to be transferred. For fiscal year 1998 funds, use the special appropriation codes established for those funds.
Enter the unobligated balance of the fiscal year apportionment, apportionment segment, grant, or allocation from which funds are to be transferred.
Enter the amount to be transferred.
Enter the amount of funds being transferred to a project that would not be eligible for use of these funds except for the transfer provisions of this legislation; i.e., this project would not qualify for funding under the appropriation code from which the funds are being transferred. Block 6 and certification must be completed, even if the amount is zero.

United States Department of Transportation - Federal Highway Administration