LAC 4:V.1903. Form BA-7

FORM BA-7 Revised 7/91 | State of Louisiana Division of Administration Office of Planning and Budget Request for Changes in Appropriation department name:______________________ agency name:__________________________ schedule number:______________________ head of budget unit:____________________ title:_________________________________ | date:____________________ agency ba-7 no:___________ opb log no. category of means of financing or expenditure | budgeted 19_____19_____ | adjustment (+) / (-) | revised 19_____19_____ means of financing general fund by: direct interagency transfers fees and self-generated statutory dedications interim emergency board federal total means of financing expenditures by program | dollars | positions | dollars | positions | dollars | positions program name: program name: program name: program name: program name: program name: program name: program name: TOTAL for opb use only agenda no. Policy and Procedure Memorandum No. 52, Revised, requires that all Request for Changes in Appropriations be fully documented. At a minimum, the following questions and statements must be answered. Use Continuation Sheets as needed. Failure to answer all questions completely will be cause to return this document without action. What is the source of funding [If other than General Fund (Direct)]? Specifically identify any grant or public law and the purposes of the funds, if applicable. A copy of any grant application and the notice of approved grant or appropriation must accompany the BA-7. What are the expenditure restrictions of the fund? What is the financial impact in the current year and the next four fiscal years? Means of Financing General Fund By: | Current Year | Year 1 | Year 2 | Year 3 | Year 4 Direct Interagency Transfers Fees and Self-Generated Statutory Dedications Interim EmergencyBoard Federal Total Means of Financing What programmatic impact (positive or negative) will occur as a result of the approval of this request? What strategy will be used in accomplishing your agency's mission and goals? Will this action require additional personnel? Explain in detail.