diff --git a/apps/st/src/components/statistics/verification/ApprovalInputDialog.tsx b/apps/st/src/components/statistics/verification/ApprovalInputDialog.tsx
new file mode 100644
index 000000000..49170e7ae
--- /dev/null
+++ b/apps/st/src/components/statistics/verification/ApprovalInputDialog.tsx
@@ -0,0 +1,177 @@
+"use client";
+
+import { useEffect, useState } from "react";
+
+import {
+    Button,
+    Dialog,
+    DialogClose,
+    DialogContent,
+    DialogFooter,
+    DialogHeader,
+    DialogTitle,
+    Input,
+    Label,
+    Textarea,
+} from "@common/components";
+
+export interface ApprovalFormData {
+    rjctOpnnCn: string;
+    lastCfmtnPicNm: string;
+    lastCfmtnPicTelNo: string;
+    lastCfmtnPicDeptNm: string;
+    lastCfmtnPicJbgdNm: string;
+}
+
+export interface ApprovalInputDialogProps {
+    open: boolean;
+    onOpenChange: (open: boolean) => void;
+    onConfirm?: (data: ApprovalFormData) => void | Promise<void>;
+}
+
+export function ApprovalInputDialog({
+    open,
+    onOpenChange,
+    onConfirm,
+}: ApprovalInputDialogProps) {
+    const [rjctOpnnCn, setRjctOpnnCn] = useState("");
+    const [lastCfmtnPicNm, setLastCfmtnPicNm] = useState("");
+    const [lastCfmtnPicTelNo, setLastCfmtnPicTelNo] = useState("");
+    const [lastCfmtnPicDeptNm, setLastCfmtnPicDeptNm] = useState("");
+    const [lastCfmtnPicJbgdNm, setLastCfmtnPicJbgdNm] = useState("");
+
+    const [isSubmitting, setIsSubmitting] = useState(false);
+
+    const resetForm = () => {
+        setRjctOpnnCn("");
+        setLastCfmtnPicNm("");
+        setLastCfmtnPicTelNo("");
+        setLastCfmtnPicDeptNm("");
+        setLastCfmtnPicJbgdNm("");
+    };
+
+    const handleDialogOpenChange = (nextOpen: boolean) => {
+        if (!nextOpen) resetForm();
+        onOpenChange(nextOpen);
+    };
+
+    useEffect(() => {
+        if (!open) {
+            resetForm();
+        }
+    }, [open]);
+
+    const handleConfirm = async () => {
+        try {
+            setIsSubmitting(true);
+            const formData: ApprovalFormData = {
+                rjctOpnnCn: rjctOpnnCn.trim(),
+                lastCfmtnPicNm: lastCfmtnPicNm.trim(),
+                lastCfmtnPicTelNo: lastCfmtnPicTelNo.trim(),
+                lastCfmtnPicDeptNm: lastCfmtnPicDeptNm.trim(),
+                lastCfmtnPicJbgdNm: lastCfmtnPicJbgdNm.trim(),
+            };
+            await onConfirm?.(formData);
+        } finally {
+            setIsSubmitting(false);
+        }
+    };
+
+    return (
+        <Dialog open={open} onOpenChange={handleDialogOpenChange}>
+            <DialogContent
+                className="max-w-[56rem]"
+                aria-describedby={undefined}
+            >
+                <DialogHeader>
+                    <DialogTitle>승인 정보 입력</DialogTitle>
+                </DialogHeader>
+                <div className="flex flex-col gap-4 py-2">
+                    <div className="flex flex-col gap-2">
+                        <Label className="text-label">최종 확인 담당자명</Label>
+                        <Input
+                            value={lastCfmtnPicNm}
+                            onChange={(e) => {
+                                setLastCfmtnPicNm(e.target.value);
+                            }}
+                            className="!text-[1.3rem]"
+                            placeholder="담당자명을 입력하세요."
+                            disabled={isSubmitting}
+                        />
+                    </div>
+                    <div className="flex flex-col gap-2">
+                        <Label className="text-label">
+                            최종 확인 담당자 전화번호
+                        </Label>
+                        <Input
+                            value={lastCfmtnPicTelNo}
+                            onChange={(e) => {
+                                setLastCfmtnPicTelNo(e.target.value);
+                            }}
+                            className="!text-[1.3rem]"
+                            placeholder="전화번호를 입력하세요."
+                            disabled={isSubmitting}
+                        />
+                    </div>
+                    <div className="flex flex-col gap-2">
+                        <Label className="text-label">
+                            최종 확인 담당자 부서명
+                        </Label>
+                        <Input
+                            value={lastCfmtnPicDeptNm}
+                            onChange={(e) => {
+                                setLastCfmtnPicDeptNm(e.target.value);
+                            }}
+                            className="!text-[1.3rem]"
+                            placeholder="부서명을 입력하세요."
+                            disabled={isSubmitting}
+                        />
+                    </div>
+                    <div className="flex flex-col gap-2">
+                        <Label className="text-label">
+                            최종 확인 담당자 직급명
+                        </Label>
+                        <Input
+                            value={lastCfmtnPicJbgdNm}
+                            onChange={(e) => {
+                                setLastCfmtnPicJbgdNm(e.target.value);
+                            }}
+                            className="!text-[1.3rem]"
+                            placeholder="직급명을 입력하세요."
+                            disabled={isSubmitting}
+                        />
+                    </div>
+                    <div className="flex flex-col gap-2">
+                        <Label className="text-label">반려 의견 내용</Label>
+                        <Textarea
+                            value={rjctOpnnCn}
+                            onChange={(e) => setRjctOpnnCn(e.target.value)}
+                            className="min-h-[10rem] resize-y !text-[1.3rem] !leading-6"
+                            placeholder="반려 의견 내용을 입력하세요. (선택사항)"
+                            disabled={isSubmitting}
+                        />
+                    </div>
+                </div>
+                <DialogFooter>
+                    <DialogClose asChild>
+                        <Button
+                            type="button"
+                            color="gray"
+                            disabled={isSubmitting}
+                        >
+                            취소
+                        </Button>
+                    </DialogClose>
+                    <Button
+                        type="button"
+                        color="primary"
+                        disabled={isSubmitting}
+                        onClick={() => void handleConfirm()}
+                    >
+                        확인
+                    </Button>
+                </DialogFooter>
+            </DialogContent>
+        </Dialog>
+    );
+}
diff --git a/apps/st/src/components/statistics/verification/StatisticsVerificationReport.tsx b/apps/st/src/components/statistics/verification/StatisticsVerificationReport.tsx
index 837433b8d..896ee061c 100644
--- a/apps/st/src/components/statistics/verification/StatisticsVerificationReport.tsx
+++ b/apps/st/src/components/statistics/verification/StatisticsVerificationReport.tsx
@@ -46,6 +46,10 @@ import {
 } from "@common/components";
 
 import DataGrid from "@/components/module/DataGrid";
+import {
+    type ApprovalFormData,
+    ApprovalInputDialog,
+} from "@/components/statistics/verification/ApprovalInputDialog";
 import type { CellEditedCallbackParams } from "@/components/type/DataGrid.type";
 import { toGridRows } from "@/components/util/grid/gridFunction";
 
@@ -167,6 +171,7 @@ function StatisticsVerificationReport() {
     const [selectedResultRows, setSelectedResultRows] = useState<
         VerifyResultItem[]
     >([]);
+    const [approvalDialogOpen, setApprovalDialogOpen] = useState(false);
     const editedResultRowMapRef = useRef<Map<number, VerifyResultItem>>(
         new Map(),
     );
@@ -405,24 +410,27 @@ function StatisticsVerificationReport() {
         handleSearch(DEFAULT_FILTERS, DEFAULT_SUB_FILTERS);
     }
 
-    async function handleApprove() {
+    function handleApprove() {
+        if (selectedReportRows.length === 0) return;
+        setApprovalDialogOpen(true);
+    }
+
+    async function handleApprovalConfirm(formData: ApprovalFormData) {
         const commonParam = {
             statsYr: filters.statsYr,
-            sewerBzmnCd: filters.sewerBzmnCd ?? "",
-            statsCd: filters.statsCd ?? "",
             mdfrId: userInfo?.userUnqId ?? "",
         };
         const approvalRequests = selectedReportRows.map((row) => ({
             ...commonParam,
-            rjctOpnnCn: row.rjctOpnnCn ?? "",
-            lastCfmtnPicNm: row.laePicNm ?? "",
-            lastCfmtnPicTelNo: row.laePicTelNo ?? "",
-            lastCfmtnPicDeptNm: row.laeKbrdrDeptNm ?? "",
-            lastCfmtnPicJbgdNm: row.laeKbrdrJbgdNm ?? "",
+            ...formData,
+            statsCd: row.statsCd ?? "",
+            sewerBzmnCd: row.sewerBzmnCd ?? "",
         }));
+
         try {
             if (await confirm("승인하시겠습니까?")) {
                 await onApproveStats(approvalRequests);
+                setApprovalDialogOpen(false);
             }
         } catch {
             alert("승인 중 오류가 발생했습니다.");
@@ -474,6 +482,11 @@ function StatisticsVerificationReport() {
 
     return (
         <div className="relative">
+            <ApprovalInputDialog
+                open={approvalDialogOpen}
+                onOpenChange={setApprovalDialogOpen}
+                onConfirm={handleApprovalConfirm}
+            />
             <div className="flex justify-between p-2">
                 <div className="flex items-center gap-6">
                     <FilterSelect
diff --git a/apps/st/src/entities/statistics/model/input/statistics-input-status-interface.ts b/apps/st/src/entities/statistics/model/input/statistics-input-status-interface.ts
index 4e77492fe..5816165f4 100644
--- a/apps/st/src/entities/statistics/model/input/statistics-input-status-interface.ts
+++ b/apps/st/src/entities/statistics/model/input/statistics-input-status-interface.ts
@@ -12,6 +12,7 @@ export interface StatsInputStatusList {
     ctpvNm?: string;
     sggNm?: string;
     statsCd?: string;
+    sewerBzmnCd?: string;
     menuTabName?: string;
     locgStatusNm?: string;
     inputRate?: number;