SSA-4513-SUP Supplement State Agency Report of Obligations for SSA Di

Social Security Administration				Form Approved OMB No. 0960-0421
SUPPLEMENT
STATE AGENCY REPORT OF OBLIGATIONS FOR SSA DISABILITY PROGRAMS
(See instructions for completing form on reverse)
NAME OF AGENCY				STATE
				FISCAL YEAR
				DATE PREPARED
Indirect Cost Calculations (include pertinent information below: rate, base, exclusions). If the numbered items do not reflect your State agreement, change it as appropriate and explain changes in the remarks section. We have repeated lines 1-4 below to allow for reporting changes in indirect cost agreements within the Federal fiscal year.
FOR PERIOD			From:
			To:
	1.	Indirect Cost (Base multiplied by the Rate plus item 4 below)		$	0
	2.	Indirect Cost Rate
	3.	Base		$
		a. If base excludes equipment, etc., show amount of obligations excluded		$
		b. If base excludes fringe benefits, show amount of obligations excluded		$
		c. If other obligated funds are exluded from base, specify amount
	4.	Other Indirect Charges--not included above (provide explanation in Remarks)		$
FOR PERIOD			From:
			To:
	1.	Indirect Cost (Base multiplied by the Rate plus item 4 below)		$	0
	2.	Indirect Cost Rate
	3.	Base		$
		a. If base excludes equipment, etc., show amount of obligations excluded		$
		b. If base excludes fringe benefits, show amount of obligations excluded		$
		c. If other obligated funds are exluded from base, specify amount
	4.	Other Indirect Charges--not included above (provide explanation in Remarks)		$
Total Indirect Cost for the Federal Fiscal Year				$	0
Attach the latest indirect cost agreement if approved since submission of prior SSA-4513.
REMARKS: (Provide pertinent remarks here and/or include additional attachments.)
Form SSA-4513 SUP (6-2002)