LINE ITEM SHIFT REQUEST Form 2.1.4. (Rev. 10.2019) State of California California Department of Food and AgricultureOffice of Grants Administration

Date Grant Agreement # Grant Award Amount Line Item Shift #

Grant Recipient Information

Organization Name:

Contact Name: Email:

Justification

Line Item Shift Budget Adjustment Table

Project Budget Categories Current Project

Budget

(A)

Line Item Shift

Revision

(B)

Revised Project

Budget

(A + B)

1. PERSONNEL

a) Salaries and Wages

b) Fringe Benefits

2. OPERATING EXPENSES

a) Travel

b) Equipment

c) Supplies

3. CONTRACTORS/CONSULTANTS

4. OTHER DIRECT COSTS

5. INDIRECT COSTS (can't increase)

Totals:

(Must net zero) (Must equal award

amount)

Authorized Official

Printed Name Telephone Number

Signature Date

FOR STATE USE ONLY

Approved LISR #1 _____% LISR #2 _____% LISR #3 _____% LISR #4 _____%

Not Approved

CDFA Authorized Signature: Date:

Grant Agreement #: Line Item Shift Request Number: Organization Name: Contact Name: Email Address: Justification: Current Budget - Fringe Benefits: 0Current Budget - Salaries & Wages: 0Current Budget - Travel: 0Current Budget - Equipement: 0Current Budget - Supplies: 0Current Budget - Contractor/Consultant: 0Current Budget - Other Direct Costs: 0Current Budget - Indirect Costs: 0Current Project Budget Total (A): 0Line Item Shift Revision - Salaries & Wages: 0Line Item Shift Revision - Fringe Benefits: 0Line Item Shift Revision - Travel: 0Line Item Shift Revision - Equipment: 0Line Item Shift Revision - Supplies: 0Line Item Shift Revision - Contractors/Consultants: 0Line Item Shift Revision - Other Direct Costs: 0Line Item Shift Revision - Indirect Costs: 0Revised Project Budget - Salaries and Wages: 0Revised Project Budget - Fringe Benefits: 0Revised Project Budget - Travel: 0Revised Project Budget - Equipment: 0Revised Project Budget - Supplies: 0Revised Project Budget - Contractors/Consultants: 0Revised Project Budget - Other Direct Costs: 0Line Item Shift Revision Total (B): 0Revised Project Budget - Indirect Costs: 0Revised Project Budget Total (A + B): 0Authorized Official Name: Authorized Official - Telephone Number: Grant Award Amount: Authorized Official Signature: Date: Authorized Official - Date Signed: For State Use Only: