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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
File Type | application/pdf |
File Title | FS-100 G&A Cover Sheet |
Author | Oracle Reports |
File Modified | 2021-07-22 |
File Created | 2020-05-05 |