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Tbase instructions constitute pan of the documentation that supports your re- <br />-.i1d roc,: Lie r '3ta:;,ec' for public viewing and scrutiny. (See instruction D) <br />A. GENERAL <br />1. This report may be based on either- <br />. Budgetary action on the pan of your government OR <br />• Executive proposals made as the basis for future legislative or <br />budgetary action. <br />2. This report is your government's plan for the use of general revenue <br />sharing funds. It does not bind your final action and may be amended <br />without notifying the Office of Revenue Sharing. <br />3. Please print or type this report and use black ink. <br />4. Show all amounts m whole dollars. rounding to the nearest dollar. <br />5. The Categories (column A) for Planned Expenditures are not listed in <br />the order of importance. Your general revenue sharing funds may be <br />spent in one, several, or all of these categories. <br />5. The sum of Planned Expenditures (line 15. column 8 plus line 15. <br />column C) must equal the preprinted Anticipated Payment (on the <br />upper right of the form) <br />7. This form is addressed to the official authorized to receive revenue <br />sharing funds but must be signed by the Chief Executive Offices <br />(these may or may not be the same person). <br />8. You may send photo copies of the original form to ORS <br />9. Do not allow your completed form to be mailed by a newspaper of <br />any individual or group outside of your administration. Many forms <br />handled this way are misplaced, delaying your government's compliance. <br />10. When your form has been received and accepted by the Office of <br />Revenue Sharing. you will receive an Acceptance Card directly from <br />ORS. This card will be stamped with the date your report was accepted <br />and the document control number for your report Please keep the <br />Acceptance Card as part of your general revenue sharing documen- <br />tation If you do not receive an Acceptance Card. or it your report has <br />not been returned to you by the Office of Revenue Sharing within three <br />weeks from the date your report was mailed. please contact the Office <br />of Revenue Sharing. Your report may not have been received by ORS. <br />E. CAPITAL EXPENDITURES (column 8) <br />The expenditure categories listed on Lines 1 through 13 are typical <br />Capita! Expenditures and are not intended to restrict your use of funds. <br />You may add a category in the space provided On line 14. column A. <br />Enter on the appropriate lines) (I through 14) the amount that is the <br />portion of the preprinted Anticipated Payment you plan to spend in each <br />ceprtel expenditure category <br />On rine i 5, column B, enter the total of amounts entered in column B. <br />C. OPERATING /MAINTENANCE EXPENDITURES (column CI <br />You are restricted by taw to the priority expenditure categories (listed <br />on lines 1 through 8 in column A) for Operating/Maintenance Expen- <br />ditures. Please do not add other categories. <br />Enter on the appropriate lines) in column C the amount that is the por- <br />tion of the preprinted Anticipated Payment you plan to spend for operat- <br />ing /maintenance purposes within each priority category. <br />On line 15, column C, enter the total of amounts entered in column C. <br />0. LOCATION OF DOCUMENTATION (block D) <br />In order to give your interested citizens a better opportunity to partici- <br />pate m choosing ways to use general revenue sharing funds, you <br />are requested to fill in the blank lines, The first blank should contain the <br />deadline for submission of proposed uses of these funds: the second <br />blank should be completed with the name of the person authorized to <br />receive such proposals. Enter on the next line the location of a copy of <br />this report and supporting documents. <br />E. ASSURANCES <br />The law requires each recipient government. through its Chief Executive <br />Officer. to assure the Secretary of the Treasury that it will comply with <br />the statutory provisions listed below. This assurance is required to <br />receive revenue sharing funds for any entitlement period beginning on <br />or after January 1. 1973. By signing Section E of this report. your Chief <br />Executive assures compliance with these provisions. It is not required <br />that these assurance provisions be published in a local newspaper. <br />The references in parenthesis are to the State and Local Fiscal Assis- <br />tance Act of 1972. Your government must assure that it will: <br />1. Establish a trust fund and deposit all revenue sharing funds received <br />in that trust fund. according to regulations prescribed by the Treasury <br />Department (Section 123(a) (11) <br />2. Use revenue sharing funds within a reasonable time (two years from <br />the end of each entitlement period). according to regulations prescribed <br />by the Treasury Department (Section 123(a)121). <br />3. In the case of the local government. use revenue sharing funds only <br />for priority expenditures. as defined in Section 103(a) of the Act (Sec- <br />tion 123{a)(3)) <br />4. Provide for the expenditure of revenue sharing funds in accordance with <br />the laws and procedures applicable to the expenditure of its own rev- <br />enues (Section 123(a) 14)). <br />5. Use fiscal accounting and audit procedures as specified by the Secre- <br />tary of the Treasury: provide access to and the right to examine books, <br />documents. papers. or records required for purposes of reviewing com- <br />piiartce with the Act: make such reports as the Secretary may reason- <br />ably require (Section 123(a) (5)), <br />6. Comply with the prevailing wage provisions of the Davis -Bacon Act <br />on any construction project costing in excess of 52000 when 25 percent . <br />or more of the costs of such project are paid out of revenue sharing <br />funds (Section 123(a) (6)) <br />7. Pay individuals employed in lobs financed in whole or in part out of <br />revenue sharing funds wages not lower than the prevailing rates of pay <br />for persons employed by rt in similar pubiic occupations This provision <br />does not apply to an employee or employees in any program category <br />who are being paid in whole or in part with general revenue sharing <br />funds unless 25 percent or more of the aggregate wages paid to all <br />employees in that category are paid from revenue sharing funds (Sec- <br />tion 123(a) (711 <br />S. In case of the governing body of an Indian tribe or Alaskan native village. <br />spend revenue sharing funds for the benefit of members of the tribe or <br />village residing in the county area from which its revenue sharing funds <br />were allocated (Section 123(a) 18)). <br />9. Not exclude from participation in. deny the benefits of. or subject to <br />discrimination. under any program or activity funded in whole or in <br />part with revenue sharing funds. any person in the United States on the <br />ground of race. color. national origin. or sex (Section 122) <br />AUDIT (block F) <br />• Question Fl must be answered <br />• If the "Yes" block (question F1) is checked. answer question F2. <br />G. PUBLIC PARTICIPATION (block G) <br />F. <br />H. <br />PAGE- 5 <br />Please check as many answers as apply. <br />CIVIL RIGHTS (block H) <br />The Equal Employment Opportunity Act of 1972 (PL. 92 -261) as <br />amended requires that if your government employs 15 or more full time. <br />paid employees. records must be maintained showing the race (or <br />minority group) and sex of each of your employees. The Equal Em- <br />ployment Opportunity Commission may periodically request this in- <br />formation to be submitted on the "State and Local Government In- <br />formation Form (EEO -4) Further information on this requirement <br />may be obtained from. <br />Equal Employment Opportunity Commission <br />2401 E Street. N.W. <br />Washington. D.C. 20506 <br />1. Check the correct answer for your government <br />if the "Yes " block (question H) is checked. answer question H2. <br />If the "No" block is checked. answer question H3. <br />2. Enter date )month. year) of the latest EEO -4 form your government <br />submitted to EEOC. <br />3. Enter total number of full time, paid employees of your government on <br />March 31. 1975 (or your pay period closest to that date). <br />J. <br />PUBLICATION (block l( <br />The upper portion of the report (above the heavy Me) must be published <br />in a newspaper of general circulation in your geographical area The <br />news media, including minority and bilingual media. must also be ad- <br />vised that a copy of this report has been published in a local paper. If <br />your government has received certification waiving this publication re- <br />quirement. "Publication not required" will be preprinted by ORS in the <br />red block on the lower right of the form The published portion may be <br />photographically reduced to any size that will remain legible to the <br />reader. This form need not be published as a legal advertisement Enter <br />the actual or estimated cost of publication on the line provided. The <br />name of the newspaper and date of publication must be entered in the <br />space provided <br />To insure speedy processing of your report. please print the name of the <br />person completing the report, her or his title. and a telephone number <br />(including the area code) where she or he may be reached during the <br />day. <br />After completing the report. please send only the original report (or a photo <br />copy of the original) to the Office of Revenue Sharing in the envelope provided <br />Before mailing. please check your report for the following: <br />v <br />Y <br />The Preprinted Account Number is correct for your government. <br />All of the preprinted Anticipated Payment is either entered in one cate- <br />gory or divided among several categories (column AI. <br />All amounts are shown in whole dollars. rounded to the nearest dollar <br />Sum of Planned Expenditures (Me 15. column 8 plus line 15, column <br />C) equals preprinted Anticipated Payment <br />Signature of Chief Executive Officer (block EI <br />Name of the Publishing Newspaper (Block 1) <br />The name and telephone number of the person completing the report <br />have been entered in block J <br />