Grant or Agreement Award Face Sheet

Clear Form
UNITED STATES DEPARTMENT OF AGRICULTURE – FOREST SERVICE
Grant or Agreement Award Face Sheet
Title:

FAIN:
Cooperator Instrument #:

Instrument Type:

Assistance Listing (CFDA) Number and Title:

Authority:

Cooperator Unique Entity Identifier (UEI/DUNS):
Cooperator (Legal Name and Address – must match SAM)
Name:
Address:
City:
State:
Zip:
Cooperator Program Manager
Name:
Phone:
Email:
Cooperator Administrative Contact
Name:
Phone:
Email:

Period of Performance
Start date:
Forest Service Unit Address
Name:
Address:
City:
State:
Forest Service Program Manager
Name:
Phone:
Email:
Forest Service G&A Specialist
Name:
Phone:
Email:

Financial Information
Cooperator Matching Funds:

Federal Funding to Cooperator:

Cooperator Indirect Cost Rate (approved rate and rate charged to award):
De minimis
Rate:
NICRA
Program Income/Revenue: N
Y

Master Agreement Number:

Reporting Requirements
Performance Report Frequency:

Financial Report Frequency:

Semi-Annual

Zip:

Payment Method:
Advance & Reimbursement

Cooperator Match %:

Quarterly

Expiration date:

Annual

Other (Specific Conditions)

N/A

Quarterly

Semi-Annual

Reimbursement Only

Annual

Other (Specific Cond.)

ATTACHMENTS
The attachments listed below are hereby incorporated and made a part of this award.
REQUIRED FOR ALL INSTRUMENTS:
Scope of Work / Narrative
Budget/Financial Plan
Provisions
REQUIRED DEPENDENT ON INSTRUMENT TYPE:
Statement of Mutual Interest/Benefit
Federal Financial Assistance Forms
Assurances
Good Neighbor/Stewardship Attachments
Conditional/optional provisions
This instrument, subject to the provisions above, is executed by (Forest Service Unit):
Signature
Forest Service Signatory Official (SO) Name and Title

Federal Award Date

The authority and format of this instrument has been reviewed and approved for signature.
Signature
G&A Specialist Name (if different than SO)

Date

By signing this instrument, the signer certifies that they are vested with the authority to enter into this arrangement.
Cooperator Signature
Name and Title

Date

Cooperator Signature
(Optional)
FS 1500-100

Date

Name and Title
USDA-FS

Page:

1