**Data Entry: Edit**

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**OMB# 1820 -**  **0692**


### S av e Ma rk

as C om plete and S ubm itto R SA Ca nc el

**Grant Reallotment Form** The Rehabilitation Act of 1973, as amended, authorizes the Commissioner of the Rehabilitation Services Administration (RSA) t o 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 i n orde r 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 : 08/1 5 /201 4 Program PR Award ID Grant Award Total Amount Relinquished Amount Requested Additional

Amount Approved Revised Grant

Award Total
BASI C
VR Entered

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 fund s 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 collecti on 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 co mpleting 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 t

his 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.