LWCF Record of Electronic Payment

									OMB Control Number 1024-0031
									Expires: XX/XX/2016
	LWCF RECORD OF ELECTRONIC PAYMENT
NPS supplement to the ASAP system
	State						Payment No.			Date*
	LWCF Grant No.	ASAP Account ID (if grant has multiple lines, report draws by line)	Request No.	Select Type:			Amount		Period of Performance**
				Partial, Final or Adjustment					From xx/xx/xxxx	To xx/xx/xxxx
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	TOTAL (must be same as total requested this date under ASAP)						$0.00
	Submitted By (Name/Title/Office/Agency):
	To (as an e-mail attachment):
	elisabeth_fondriest@nps.gov, Insert NPS LWCF contact(s)
	* Date of ASAP request - email submission to NPS Regional Office and NPS WASO should be same date of but NO LATER THAN one business day
	after ASAP request.
	** Period of Performance - Enter the month, day, and year for the beginning and ending of the period covered by this payment, i.e., the time period for
	specific work performed and/or costs incurred that are being reimbursed through the ASAP payment identified herein.