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US Foresl Service OM8 0596-0217
<br />FS-1500-18
<br />,I Service Agreemenl 1LI ___ 1''6'---C"--"O'----'-11.:.:o::6:.:1''7-=o-=o~-1,,O,,O'___ __ 1 Cooperator Agreement "LI _____________ -'
<br />Collection Agreement Financial Plan
<br />Cooperator and FS Contributions
<br />COST eLEMENTS .nd ... Iated d.ta I
<br />Line Item Cost Subt_1s J
<br />PERSONNEL
<br />Resource Specinlists (List <Ill personn e ll
<br /># or Days $/D"y
<br />GS 4 . Senes 100 1 8800 $11600
<br />~1 TT1('It"'n lJ)<:lWl\9ry 'Timc 3090 $5800
<br />Sith ,u._lL""n.ouQS,r 11B.90
<br />TRAVEL
<br />~xplanation of.rips:
<br />From WhereITo Where/For Whom Vehicle l\tlilcag{' P('rOiem and
<br />Cost or Airrare # or Trips Lodging
<br />Cost
<br />Subtotal. Travf'l: $O,OD 0 SO,OO
<br />EQUIPMENT
<br />I'InQ o ~ nod !f:Y IlO ofE:q,il "" . .,,,1 : Unit Cost uantitv
<br />80Ulo_Ul_tUl'tIl.ol wJlltrih SO,OO a
<br />SUPPLIES
<br />Name and TYIJe orSupplies: UnitCos ~ Qu:wtih'
<br />Sublotal, Sup,";,s: SO,OO 0
<br />CONTRACTUAL
<br />l~I""-C;unlr~r~,lh~{ mil nlntf HWIil ".-t'!lIh,r",m .bI. prq).c:f:
<br />SotliflJ(~t """'tlcluH f:
<br />OTHER
<br />'Describe Othcl" Costs of the PI'ojecl:
<br />$un(Olnl l Olh'~n
<br />TOTAL DIRECT CHARGES
<br />OVERHEAD ASSESSMENT Insert Rate Here: (if applicable, see FSH 1909~13) aD%-
<br />Total Party Costs
<br />TOTAL PROJECT COSTS
<br />Burd enSlalemert
<br />~
<br />Cooperator FS Non-Cash
<br />Contribution Contribution
<br />Snbtoe •• I
<br />I Subtotal Comblnetl Subta1 ubl
<br />S10,20800 -$10,2080
<br />$f,792 00 51,792 00
<br />SO 00 SO 00
<br />$12,000,00 $0;00 $12,000,00
<br />$000 so 09
<br />$000 $0 OQ
<br />$0 00 $0 UO
<br />$0,00 $0,00 SO,OO
<br />$0 ()(J SO 00
<br />$000 $000
<br />$0.00 $000
<br />$0,00 $0;09 ~M"
<br />$0.00 $ll.00
<br />$000 SO-oo
<br />$O,DO $0,00 SO,O
<br />sow
<br />->O.QO
<br />$0_00 $0,0 $0,0
<br />SO oq
<br />$000
<br />$0.00 $0.00 $0_00
<br />$12.000 ,00 $0.00 $12.000.00
<br />$0 ,00
<br />$12.000_00 SO ,OO 512,000_00
<br />$12,000.00
<br />According 10 lhe PapNwo rk Redi.."C llon Acl of 1995, an agency may not corducl or sponsor, and a person IS not reqUired 10 ICSPOnd 10 a collecllon of Infarm aiion unle ss ~ displays a va~d OMB contr ol number The valil OMB cornIa I number
<br />[or Ihls informallon co llecllQn Is 0596-0217 The lime requred \0 complele Ihls Informa\lOn co Ue ctl on is eslimaled 10 average 45 mlnutss per responsg including Ihe lime for revieWing ins\ru<;l ions, sCC1rc hmg e)(]slilg dala sources , gathering
<br />lind mainlalnf19 Ih e da ta needed, lind complelifl!il and reVicyn ng lhe col eellon of riormatlln
<br />The US Departm enl o f Agricu/lure (USDA) prohlblls dlSC,"l!na~on inall tl.s programs and actlviljes on lhe bilSIS of race, color, nallonal o r ~in, age , dISilbll ~y, ard v.here appllCilble sex manlal sial US , familial slalus, pilrenlal sialus, re~gon.
<br />sexualonenlahon genehc llIormallon, po"ical beliefs rep nsat or because all or pari o f an ~!vdUilI 's ncome 6 de u .. ed from any pub lIC assisianc e (Nol a ll prohibiled bases ilpply 10 al programs) Person5 I'Itlh dlSilbiliheswho r~QUfe
<br />a ~ernall~ means for commurjcatlon 01 pf09ram Inlormallon (Bra llle , la rge prinl, audoolapfl , etc) shoud contacl USOAs TARGET Center al 202-720-2600 (voICe and TOO)
<br />To r.e a complaint 01 dlscrilnnalcn, 't'1f.e USDA, DI(8clor, OffICe 01 CIVIl Rights, 1<100 Independence A~nue , SW, Washhglon. DC 20250-94 10 or call loll free ISSS) 632-9992(voice) TOO U!>efS can conlacl USDA IhlOugh loca l relay or lhe
<br />Federal relay al (800) 877-8339 (TDO) or (866) 377-86<12 (relay \'OIC!!!) USDA is an equal o ppor lunlly pro~er and employer
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