Form HS-FORM-217 Highway Safety Program Cost Summary

OMB Control No. 2127-0003

U.S. Department of Transportation Expiration Date xx/xx/xxxx

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			Federal Share to Local
			Previous Balance	Increase/(Decrease)	Current Balance
Total NHTSA
Total FHWA
Total NHTSA & FHWA

State Official Authorized Signature: Federal Official Authorized Signature:

NAME:_______________________________ NHTSA - NAME:________________________________________________

TITLE:______________________________ TITLE:________________________________________________

DATE:___________________ 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. 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 2127-0003. Public reporting for this collection of information is estimated to be approximately 30 minutes per response, including the time for reviewing instructions and completing the form. All responses to this collection of information are required to obtain or retain benefits. 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

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.

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 Program Areas

PA...Planning & Administration

AL...Alcohol

EM...Emergency Med. Serv.

MC...Motorcycle Safety

OP...Occupant Protection

PS...Pedestrian/Bicycle Safety

PT...Police Traffic Services

TR...Traffic Records

AI...Accident Investigation

CP...Commun. Traf. Safety Proj.

CL...Codes and Laws

DC...Debris Hazard Control

DE...Driver Education

DL...Driver Licensing

IS...Identification & Surveil.

PM...Paid Advertising

RH...Rail-Highway Crossing

RS...Roadway Safety

SA...Safe Communities

SB...School Bus

SE...Speed Enforcement

TC...Traffic Courts

VI...Periodic Motor Veh. Inspect.

VR...Motor Vehicle Registration

SC...Speed Control

RH...Rail/Highway Crossings

157 FUNDS USED AS NHTSA 402

157PA...Planning & Admin.

157AL...Alcohol

157EM...Emerg. Med. Services

157MC...Motorcycle Safety

157OP...Occupant Protection

157PS...Pedestrian/Bicycle Safety 157PT...Police Traffic Services

157TR...Traffic Records

157AI...Accident Investigation

157CP...Comm. Traff. Safety Proj.

157CL...Codes and Laws

157DC...Debris Hazard Control

157DE...Driver Education

157DL...Driver Licensing

157IS...Ident. & Surveillance

157RH...Rail‑Highway Crossing

157SA...Safe Communities

157SB...School Bus

157SC...Speed Control

157SE...Speed Enforcement 157TC...Traffic Courts

157VI...Per. Motor Veh. Insp. 157VR...Motor Vehicle Regis.

157PM‑Paid Advertising

Incentive Funds

HB...153 Helmets & Belts

J3...2003b Child Passenger Protec.

J2...405 Occ.. Protection

J6...408 Alcohol

J7...410 Alcohol (ISTEA)

J8...410 Alcohol (TEA21)

J9...411 Data Program

Special Funding Areas

CR...Child Restraint

LE...Safety Belt

SO...Special Occup. Protect.

SS...School Bus Set Aside

TS...Traffic Records

YA...Youth Alcohol

NOTE: Priority Areas are bolded and underlined for NHTSA and FHWA program areas.

NHTSA 157 INCENTIVE FUNDS

157J2...157 as 405 Occ. Prot. Prog.

157J8...157 as 410 Alcohol

157J9‑157 as 411 Data Program

TRANSFER FUNDS (Pre-TEA21 & TEA21)

Pre-TEA-21:

For Section 153 Transfer funds add a AT@ in front of the Program Area.

TEA-21:

154 AL ...Alcohol

154HE ....Hazard Elimination

154PA ....Planning & Administration

154PM....Paid Advertising

164AL ....Alcohol

164HE ....Hazard Elimination

164PA ....Planning & Administration

164PM....Paid Advertising

FHWA Progam Areas

FPA...Planning & Administration

FPS...Pedestrian Safety

FTE...Traffic Engineering Serv.

FHD...Highway Design

FIS...Identifica. & Surveil

FSC...Speed Control

FRH...Rail/Highway Crossing

Special Funding Areas

FSM...Safety Management

FSB...School Bus