Form HS 217 HS 217 Highway Safety Program Cost Summary

O.M.B. No. 2127-0003
(Expires XX/XX/XXXX)

U.S. Department of Transportation
National Highway Traffic Safety
Administration
Federal Highway Administration

HIGHWAY SAFETY PROGRAM COST
SUMMARY

State________ Number__________ Date__________________

Program Area

Approved
Program
Costs

State/Local
Funds

Federally Funded Programs
Previous
Balance

Increase/(Decrease)

Federal
Share
to Local

Current
Balance

Total NHTSA
Total FHWA
Total
NHTSA &
FHWA

State Official Authorized
Signature:
NAME:__________________________
_____
TITLE:__________________________
____
DATE:___________________

Federal Official Authorized Signature:
NHTSA NAME:________________________________________
TITLE:___________________________________
________
DATE:__________________
Effective Date:_________________

HS Form 217

INSTRUCTIONS FOR PROGRAM COST SUMMARY

This form is to be used to provide funding documentation for grant programs under Title 23, United States
Code.
State - The State submitting the HS Form-217
Number - Each HS-217 will be in sequential order by fiscal year (e.g., 99-01, 99-02, etc.)
Date - The date of occurrence of the accounting action(s) described.
Program Area - The code designating a program area (e.g., PT-99, where PT represents the Police Traffic
Services and 99 represents the Federal fiscal year). Funds should be entered only at the program area level, not at
the task level or lower.
Approved Program Costs - The current balance of Federal funds approved (but not obligated) under the HSP or
under any portion of or amendment to the HSP.
State/local Funds - Those funds which the State and its political subdivisions are contributing to the program,
including both hard and soft match.

Paperwork Reduction Act Burden Statement
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for
failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-0650. Public
reporting for this collection of information is estimated to be approximately 30 hours per response, including the time for reviewing
instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, 1200 New Jersey Ave SE Washington,
DC, 20590, Washington, D.C.

FEDERALLY FUNDED PROGRAMS
Previous Balance - The balance of Federal funds obligated and available for expenditure by the State in the
current fiscal year, as of the last Federally-approved transaction. The total of this column may not exceed the sum
of the State's current year obligation limitation and prior year funds carried forward. (The column is left blank on the
updated Cost Summary required to be submitted under 23 CFR §1200.12(d). For subsequent submissions, the
amounts in this column are obtained from the "Current Balance" column of the immediately preceding Cost
Summary.)
Increase/(Decrease) - The amount of change in Federal funding, by program area, from the funding reflected
under the "Previous Balance".
Current Balance - The net total of the "Previous Balance" and the "Increase/(Decrease)" amounts. The total of
this column may not exceed the sum of the State's current year obligation limitation and prior year funds carried
forward.
Federal Share to Local - Total Federal funds dedicated to programs implemented for the benefit of local
governmental entities.

NHTSA/FHWA Program Area Codes
NHTSA 402
PA

Planning and Administration

AL

Alcohol

EM

Emergency Medical Services

MC

Motorcycle Safety

OP

Occupant Protection

PS

Pedestrian/Bicycle Safety

PT

Police Traffic Services

TR

Traffic Records

AI

Accident Investigation

CP

Community Traffic Safety Project

CL

Codes and Laws

DC

Debris Hazard Control

DE

Driver Education

DL

Driver Licensing

IS

Identification and Surveillance

RH

Railroad/Highway Crossings

RS

Roadway Safety

SA

Safe Communities

SB

School Bus

SC

Speed Control

SE

Speed Enforcement

TC

Traffic Courts

VI

Periodic Motor Vehicle Inspection

VR

Motor Vehicle Registration

CR

Child Restraint

PM

Paid Advertising

SO

Special Occupant Protection

TS

Traffic Records

YA

Youth Alcohol
405 Occupant Protection

J2

405 Occupant Protection

J2PM

J2 Paid Media

K2

405 Occupant Protection

K2PM

405 Paid Media

405 OP SAFETEA-LU

NHTSA 406
K4PA

406 Planning and Administration

K4

406 Safety Belts Incentive

K4PM

406 Safety Belts Paid Media

K4AL

406 Alcohol

K4EM

406 Emergency Medical Services

K4MC

406 Motorcycle Safety

K4OP

406 Occupant Protection

K4PS

406 Pedestrian/Bicycle Safety

K4PT

406 Police Traffic Services

K4TR

406 Traffic Records

K4AI

406 Accident Investigation

K4CL

406 Codes and Laws

K4DC

406 Debris Hazard Control

K4DE

406 Driver Education

K4DL

406 Driver Licensing

K4IS

406 Identification and Surveillance

K4RS

406 Roadway Safety

K4SA

406 Safe Communities

K4SB

406 School Bus

K4SC

406 Speed Control

K4SE

406 Speed Enforcement

K4TC

406 Traffic Courts

K4VI

406 Periodic Motor Vehicle Inspection

K4VR

406 Motor Vehicle Registration

K4CR

406 Child Restraint

K4LE

406 Safety Belts

K4SO

406 Special Occupant Protection

K4SS

406 School Bus Set Aside

K4TS

406 Traffic Records

K4YA

406 Youth Alcohol

K4BH

406 55/65 Enforcement

K4RH

406 Railroad/Highway Crossings

K9

408 Data Program Incentive

J8

New 410 Alcohol

J8PM

J8 Paid Media

408 Data Program SAFETEA-LU
New 410 Alcohol

410 Alcohol SAFETEA-LU
K8

410 Alcohol SAFETEA-LU

K8PA

410 Alcohol Planning and Administration

K8PM

410 Alcohol SAFETEA-LU Paid Media
410 High Fatality Rate

K8FR

410 High Fatality Rate
410 High Visibility

K8HV

410 High Visibility
411 Data Program

J9

411 Data Program
2003B Child Pass. Protect

J3

2003B Child Pass. Protect
2010 Motorcycle Safety

K6

2010 Motorcycle Safety Incentive
2011 Child Seats

K3

2011 Child Seat Incentive

K3PM

2011 Paid Media

157AL

157 Alcohol

157PA

157 Planning and Administration

157EM

157 Emergency Medical Services

157 Incentive Funds

157MC

157 Motorcycle Safety

157OP

157 Occupant Protection

157PS

157 Pedestrian Safety

157PT

157 Police Traffic Services

157TR

157 Traffic Records

157AI

157 Accident Investigation

157CP

157 Community Traffic Safety Projec

157CL

157 Codes and Laws

157DC

157 Debris Hazard Control

157DE

157 Driver Education

157DL

157 Driver Licensing

157IS

157 Identification and Surveillance

157RH

157 Railroad/Highway Crossings

157RS

157 Roadway Safety

157SA

157 Safe Communities

157SB

157 School Bus

157SC

157 Speed Control

157SE

157 Speed Enforcement

157TC

157 Traffic Courts

157VI

157 Periodic Motor Vehicle Inspecti

157VR

157 Motor Vehicle Registration

157CR

157 Child Restraint

157PM

157 Paid Advertising

157YA

157 Youth Alcohol

157LE

157 Safety Belts

157J2

157 405 Occupant Protection

157J8

157 410 Alcohol

157J9

157 411 Data Program

157TS

157 Traffic Records
157 Innovative Funds 2002

IN2

157 Innovative FY 2002

IPM2

157 Innovative Paid Media FY 2002

IN3

157 Innovative FY 2003

IPM3

157 Innovative Paid Media FY 2003

157 Innovative Funds 2003

157 Innovative Funds 2004
IN4

157 Innovative FY 2004

IPM4

157 Innovative Paid Media FY 2004

IN5

157 Innovative FY 2005

IPM5

157 Innovative Paid Media FY 2005

157 Innovative Funds 2005

1906 Prohibit Racial Profiling
K10

1906 Prohibit Racial Profiling

154PA

154 Planning and Administration

154AL

154 Alcohol

154 Transfer Funds

154PM

154 Paid Media

154HE

154 Hazard Elimination
164 Transfer Funds

164PA

164 Planning and Administration

164AL

164 Alcohol

164PM

164 Paid Media

164HE

164 Hazard Elimination

163ID

Impaired Driving Mobilization 2004

163DM

Impaired Driving Mobilization 2005

FRS

Roadway Safety

163 Impaired Driving

FHWA 402