- Form DS-21 - Interlock Device Installation Confirmation - New York
- Form MV-1W - Withdrawal of Consent - New York
- Form DPR-152 - Drinking Driver Program Annual Enrollment Report - New York
- Form DPR-102 - Drinking Driver Program Instructor Application - New York
- Form DPR-151 - DDP Fiscal Report - New York
- Form DPR-104 - Drinking Driver Program Service Agreement - New York
Fillable Printable Form DPR-151 - DDP Fiscal Report - New York
Fillable Printable Form DPR-151 - DDP Fiscal Report - New York
Form DPR-151 - DDP Fiscal Report - New York
LOCATION CODE: ________________________________________
S
PONSORING AGENCY NAME: ______________________________________________________________
R
EPORTING PERIOD: JANUARY 1 THROUGH DECEMBER 31, ________________________________________
D
RINKING DRIVER PROGRAM NAME:___________________________________________________________
DRINKING DRIVER PROGRAM
(DDP) FISCAL REPORT
Driver Program Regulation
www.dmv.ny.gov
DPR-151 (3/15)
PAGE 1 of 4
1. Enrollment Fees
2. Transfer/Reentry Fees
3. Total Revenue †
Dollar Amount
4. Salaries (Schedule A)
5. Fringe Amount (Schedule A)
6. Materials and Equipment
7. Travel and Training
10. Total Instruction Expenses †
Instruction
8. Classroom Rent
9. Classroom Utilities
11. Salaries (Schedule B)
12. Fringe Benefits (Schedule B)
13. Travel/Conventions/Workshops
14. Office Equipment
Administration
15. Office Supplies
16. Office Rent
17. Custodial Services
18. Utilities/Telephone
19. Insurance (Schedule C)
20. Other (Schedule D)
21. Overhead Cost (Rate:________%)
22. Total Administrative Expenses †
23. TOTAL EXPENSES †
24. NET SURPLUS OR DEFICIT †
REVENUE
EXPENSES
*DPR-151*
Business ID Number
OFFICE USE ONLY
$
$
$
$
$
PAGE 2 of 4www.dmv.ny.gov
Items Provided by Sponsor At No Cost to DDP
Monetary
Value
1. Salaries (Schedule A)
2. Fringe Benefits (Schedule A)
3. Materials and Equipment
4. Travel and Training
7. Total Instruction Expenses Provided by Sponsor †
Instruction
5. Classroom Rent
6. Classroom Utilities
8. Salaries (Schedule B)
9. Fringe Benefits (Schedule B)
10. Travel/Conventions/Workshops
11. Office Equipment
Administration
Non-Revenue-Generating Enrollees
12. Office Supplies
13. Office Rent
14. Custodial Services
15. Utilities/Telephone
16. Insurance (Schedule C)
Number of Indigent Enrollees
17. Total Administrative Expenses Provided by Sponsor †
18. TOTAL EXPENSES PROVIDED BY SPONSOR †
EXPENSES
$
$
$
DPR-151 (3/15)
SCHEDULE B
Lines 11 & 12 - Administration Salaries & Fringe Benefits
Number of
Positions
Job Title
TOTALS
Annual
Hours
Worked
(4) Total
Salaries
Paid
Fringe
Rate
(5) Fringe Amount
(Fringe Rate x
Total Salaries Paid)
Total Salaries
Paid +
Fringe Amount
PAGE 3 of 4
SCHEDULE A
Lines 4 & 5 - Instructor Salaries & Fringe Benefits
Line 4: Instructor Salaries - Itemize the number of positions, the title(s), the total hours worked, and total salaries
paid to instructors.
Line 5: Instructor Fringe Amount - Itemize the fringe rate paid for each instructor listed for Line 4, and the total
fringe amount paid.
Number of
Positions
Job Title
Annual
Hours
Worked
(11) Total
Salaries
Paid
Fringe
Rate
(12) Fringe Amount
(Fringe Rate x
Total Salaries Paid)
Total Salaries
Paid +
Fringe Amount
Line 11: Administrator Salaries - Itemize the number of positions, the title(s), the total hours worked, and total
salaries paid to administrative staff.
Line 12: Administrative Fringe Amount - Itemize the fringe rate paid for each administrator listed for Line 11, and
the total fringe benefits paid.
DPR-151 (3/15)
www.dmv.ny.gov
$$$
TOTALS
$$$
SCHEDULE D
Line 20 - Other
PAGE 4 of 4
DPR-151 (3/15)
Items/Service
Cost
SCHEDULE C
Line 19 - Insurance
Line 19: Insurance - List each type of insurance, by insurance carrier, and the actual amounts paid during the year.
Items/Service
Cost
Line 20: Other - Itemize all other administrative costs not included in lines 11 - 18.
Complete and return to:
New York State Department of Motor Vehicles
Driver Program Regulation-Room 412
6 Empire State Plaza
Albany, New York 12228
CERTIFICATION - To the best of my knowledge, this fiscal report form is correct, and conforms with
generally accepted accounting principles.
Print Name
Signature (Sign Name in Full)
Date
Drinking Driver Program Director:
DDP E-Mail Address
ç
Print Name
Signature (Sign Name in Full)
Date
Agency Fiscal Officer or Fiscal Representative:
ç
www.dmv.ny.gov
TOTAL
$
TOTAL
$
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