Form HS-3463 "Tennessee Ssbg Contract Budget Revision" - Tennessee

What Is Form HS-3463?

This is a legal form that was released by the Tennessee Department of Human Services - a government authority operating within Tennessee. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2020;
  • The latest edition provided by the Tennessee Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form HS-3463 by clicking the link below or browse more documents and templates provided by the Tennessee Department of Human Services.

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Download Form HS-3463 "Tennessee Ssbg Contract Budget Revision" - Tennessee

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Tennessee Department of Human Services
TENNESSEE SSBG CONTRACT BUDGET REVISION
AGENCY:
CONTRACT NUMBER:
CONTRACT TYPE:
SSBG
FISCAL YEAR:
Adult Day Care
Homemaker
INCREASE
Revision Requested by:
EXPENSE OBJECT LINE ITEM CATEGORY
CURRENT BUDGET
REVISED BUDGET
(DECREASE)
Salaries
-
Benefits & Taxes
-
Date:
Professional Fee/ Grant & Award
-
Supplies
-
Telephone
-
Postage & Shipping
-
Occupancy
-
Equipment Rental & Maintenance
-
Printing & Publications
-
Travel / Conferences & Meetings
-
Interest
Insurance
-
Specific Assistance To Individuals
-
Depreciation
Revision Approved by:
-
Other Non-Personnel
-
Capital Purchase
-
Indirect Cost / Adm. Exp. / M&G
Date:
-
TOTAL
$0.00
$0.00
-
TDHS staff should check the “Forms” section of the intranet to ensure the use of current versions. Forms may not be altered without prior approval.
Distribution: Pending
RDA: 11155
HS-3463 (3-20)
Page 1 of 1
Tennessee Department of Human Services
TENNESSEE SSBG CONTRACT BUDGET REVISION
AGENCY:
CONTRACT NUMBER:
CONTRACT TYPE:
SSBG
FISCAL YEAR:
Adult Day Care
Homemaker
INCREASE
Revision Requested by:
EXPENSE OBJECT LINE ITEM CATEGORY
CURRENT BUDGET
REVISED BUDGET
(DECREASE)
Salaries
-
Benefits & Taxes
-
Date:
Professional Fee/ Grant & Award
-
Supplies
-
Telephone
-
Postage & Shipping
-
Occupancy
-
Equipment Rental & Maintenance
-
Printing & Publications
-
Travel / Conferences & Meetings
-
Interest
Insurance
-
Specific Assistance To Individuals
-
Depreciation
Revision Approved by:
-
Other Non-Personnel
-
Capital Purchase
-
Indirect Cost / Adm. Exp. / M&G
Date:
-
TOTAL
$0.00
$0.00
-
TDHS staff should check the “Forms” section of the intranet to ensure the use of current versions. Forms may not be altered without prior approval.
Distribution: Pending
RDA: 11155
HS-3463 (3-20)
Page 1 of 1