U.S. Department of Transportation National Highway Traffic Safety Administration Federal Highway Administration O.M.B. No. 2127-0003

(Expires 3/31/08)
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 Federal Share
to Local
Previous Balance Increase/(Decrease) 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.


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
    PAPlanning and Administration
    ALAlcohol
    EMEmergency Medical Services
    MCMotorcycle Safety
    OPOccupant Protection
    PSPedestrian/Bicycle Safety
    PTPolice Traffic Services
    TRTraffic Records
    AIAccident Investigation
    CPCommunity Traffic Safety Project
    CLCodes and Laws
    DCDebris Hazard Control
    DEDriver Education
    DLDriver Licensing
    ISIdentification and Surveillance
    RHRailroad/Highway Crossings
    RSRoadway Safety
    SASafe Communities
    SBSchool Bus
    SCSpeed Control
    SESpeed Enforcement
    TCTraffic Courts
    VIPeriodic Motor Vehicle Inspection
    VRMotor Vehicle Registration
    CRChild Restraint
    PMPaid Advertising
    LESafety Belts
    SOSpecial Occupant Protection
    SSSchool Bus Set Aside
    TSTraffic Records
    YAYouth Alcohol

    405 Occupant Protection
    J2405 Occupant Protection
    J2PMJ2 Paid Media

    408 Alcohol
    J6408 Alcohol

    410 Alcohol
    J7410 Alcohol

    New 410 Alcohol
    J8New 410 Alcohol
    J8PMJ8 Paid Media

    411 Data Program
    J9411 Data Program

    2003B Child Pass. Protect
    J32003B Child Pass. Protect

    157 Incentive Funds
    157AL157 Alcohol
    157PA157 Planning and Administration
    157EM157 Emergency Medical Services
    157MC157 Motorcycle Safety
    157OP157 Occupant Protection
    157PS157 Pedestrian Safety
    157PT157 Police Traffic Services
    157TR157 Traffic Records
    157AI157 Accident Investigation
    157CP157 Community Traffic Sfty Project
    157CL157 Codes and Laws
    157DC157 Debris Hazard Control
    157DE157 Driver Education
    157DL157 Driver Licensing
    157IS157 Identification and Surveillance
    157RH157 Railroad/Highway Crossings
    157RS157 Roadway Safety
    157SA157 Safe Communities
    157SB157 School Bus
    157SC157 Speed Control
    157SE157 Speed Enforcement
    157TC157 Traffic Courts
    157VI157 Periodic Mtr Vehicle Inspection
    157VR157 Motor Vehicle Registration
    157CR157 Child Restraint
    157PM157 Paid Advertising
    157SO157 Special Occupant Protection
    157SS157 School Bus Set Aside
    157YA157 Youth Alcohol
    157LE157 Safety Belts
    157J2157 405 Occupant Protection
    157J8157 410 Alcohol
    157J9157 411 Data Program

    157 Innovative Funds
    IN2157 Innovative FY 2002
    IPM2157 Innovative Paid Media FY 2002
    IN3157 Innovative FY 2003
    IPM3157 Innovative Paid Media FY 2003
    IN4157 Innovative FY 2004
    IPM4157 Innovative Paid Media FY 2004
    IN5157 Innovative FY 2005
    IPM5157 Innovative Paid Media FY 2005

    FHWA 402
    FPAPlanning and Administration
    FPSPedestrian Safety
    FRSRoadway Safety
    FRHRailroad/Highway Crossings
    FSBSchool Bus
    FSCSpeed Control
    FSMSafety Management

    154 Transfer Funds
    154PA154 Planning and Administration
    154AL154 Alcohol
    154PM154 Paid Media
    154HE154 Hazard Elimination

    164 Transfer Funds
    164PA164 Planning and Administration
    164AL164 Alcohol
    164PM164 Paid Media
    164HE164 Hazard Elimination

    163 Impaired Driving
    163IDImpaired Driving Mobilization 2004
    163DMImpaired Driving Mobilization 2005