Data Entry: Edit –

OMB# 1820-0692

Save Mark as Complete and Submit to RSA Cancel

Grant Reallotment Form

The Rehabilitation Act of 1973, as amended, authorizes the Commissioner of the Rehabilitation Services Administration (RSA) to reallot to other 

grant recipients that portion of a recipient’s annual grant that cannot be used. To maximize the use of appropriated funds under the formula grant 

programs, RSA has developed the Grant Reallotment Form. Each formula grant recipient is required to submit this form to RSA in order to 

determine whether the grantee is relinquishing grant funds, requesting additional grant funds, or seeking no change in the current award amount. 

If ample funds are not relinquished, RSA will exercise its discretion to cancel any scheduled reallotment for each program. RSA will notify 

grantees if a reallotment has been cancelled.

Grantee Name: (Entered Automatically, End-user Data Entry Not Required)

Address: (Entered Automatically, End-user Data Entry Not Required)

Due Date: 08/15/2014

Program PR Award ID Grant Award 

Total

Amount Relinquished Amount 

Requested

Additional 

Amount 

Approved

Revised Grant 

Award Total

BASICVREntered 

Automatically

Entered 

Automatically

Entered by RSA 

Fiscal Staff

Calculated 

Automatically

SE Entered 

Automatically

Entered 

Automatically

Entered by RSA 

Fiscal Staff

Calculated 

Automatically

IL Entered 

Automatically

Entered 

Automatically

Entered by RSA 

Fiscal Staff

Calculated 

Automatically

OIB Entered 

Automatically

Entered 

Automatically

Entered by RSA 

Fiscal Staff

Calculated 

Automatically

CAP Entered 

Automatically

Entered 

Automatically

Entered by RSA 

Fiscal Staff

Calculated 

Automatically

PAIR Entered 

Automatically

Entered 

Automatically

Entered by RSA 

Fiscal Staff

Calculated 

Automatically

Certification Section 110(b)(3) of the Rehabilitation Act makes it clear that funds reallotted to another state are considered to be an increase to 

that state’s allotment for the fiscal year for which funds were appropriated. Therefore, if requesting reallotment funds, I certify that the state is 

capable of providing sufficient match (21.3% for VR and 10% for IL-Part B and OIB) for the additional funds received by September 30th of the 

FFY in which the funds were appropriated.

Section 19(a) of the Rehabilitation Act authorizes formula grantees to carry over any funds appropriated, including original allotments and 

reallotments which are not obligated or expended by recipients by September 30th of the FFY in which the funds were appropriated. Funds 

carried over remain available for obligation and expenditure during the following fiscal year, provided the grantee has fully met, by September 

30th of the FFY in which the funds were appropriated, any matching requirement of the funds to be carried over. I certify that the state can fulfill 

the matching requirement by September 30th of the FFY in which the funds were appropriated. 

Signed? Yes

Signed On

Signed By
Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection 

displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 2 minutes per response, 

including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and 

reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (The Rehabilitation Act 

of 1973, as amended). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions 

for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email 

ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0692. Note: Please do not return the completed Reallotment form to this 

address. If you have any comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. 

Department of Education, State Monitoring and Program Improvement Division, Fiscal Unit, 400 Maryland Avenue, S.W., PCP Room 5034, 

Washington, D.C. 20202-2800.