State Agency Report of obligations for SSA Disability Programs--SSA-4513 & SSA-4513-SUP

Instructions for Completion of Form SSA-4513 Supplement

Heading
Enter official name of the agency, state, date
prepared, fiscal year for which you are reporting,
and the period beginning October 1 of that fiscal
year through the end of the calendar quarter for
which you are reporting.

Line Entries
Indirect Cost Calculations - This section reflects
the total costs authorized by indirect cost
agreements, State-wide cost allocation
agreements, etc. If the numbered items do not
reflect your State agreement, change it as
appropriate and explain changes in the remarks
section. We have repeated lines 1-4 below to
allow for reporting changes in indirect cost
agreements within the Federal fiscal year (e.g.,
split years).
Line 1. Indirect Cost - Automatically
calculated (Base multiplied by the
Indirect Cost Rate plus item number 4
below).
Line 2, Indirect Cost Rate - Enter the
rate as approved by the indirect cost
agreements, State-wide cost allocation
agreements, etc.

Line 3. Base - Enter total amount of
obligations included in the base per
approved cost agreements, State-wide
cost allocations agreements, etc.
Line 3 (a-c). Base Exclusions - Enter
the amount of obligations excluded
from the base (for equipment, fringe
benefits and other costs) as appropriate.
Line 4. Other Indirect Charges-not
included in 1-3 above - Enter the
amount of indirect charges and include
explanation of charges in Remarks
section.
Total Indirect Cost for Federal Fiscal Year This is automatically calculated to represent the
total indirect costs for the federal fiscal year
(sum of line 1 for both of above breakout
periods).
Remarks - Enter any pertinent remarks (e.g.,
status of unliquidated obligations, explanation of
any adjustments, etc.) andlor include additional
attachments (e.g., copy of indirect cost
agreement, etc.).

Paperwork Reduction Act Statements

Form SSA-4513 SUP (6-2002)

Thefollowing revised PRA Statement will be inserted into the form at its
next scheduled reprinting:
Paperwork Reduction Act Statement - This information collection meets the
requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction
Act of 1995. You do not need to answer these questions unless we display a valid Office
of Management and Budget control number. We estimate that it will take about 30
minutes to read the instructions, gather the facts, and answer the questions. You may send
comments on our time estimate above to: SSA, 6401 Security Blvd, Baltimore, MD
21235-6401. Send only comments relating to our time estimate to this address, not the
completed form.