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FS-1500-0100 (REV. 01/2026)
<br />Additional Contacts (if applicable):
<br />28. Cooperator Program Manager:
<br />29. U.S. Forest Service Program Manager:
<br />Name: Nancy Shaff
<br />Name: Darra Cannedy
<br />Phone: (509) 962-7685 Email: nancy.shaff@co.kittias.wa.us
<br />Phone: (509) 664-9390 Email: darra.cannedy@usda.gov
<br />30. Cooperator Program Manager:
<br />31. U.S. Forest Service Program Manager:
<br />Name:
<br />Name:
<br />Phone: Email:
<br />Phone: Email:
<br />Any additional contacts shall be included in an attachment to this instrument.
<br />Additional Signatories (if applicable):
<br />By signing this instrument, the signer certifies that they are vested with the authority to enter into this instrument.
<br />32.
<br />Cooperator Signature:
<br />Name and Title:
<br />Date:
<br />33.
<br />Cooperator Signature:
<br />Name and Title:
<br />Date:
<br />This instrument, subject to the provisions above, is executed by The U.S. Forest Service Authorized Signatory:
<br />U.S. Forest Service Signatory Official (SO) Name and Title:
<br />34.
<br />Signature:
<br />TARA UMPHRIES, Forest Supervisor, Okanogan-
<br />Date:
<br />Wenatchee National Forest
<br />U.S. Forest Service Grants Management Specialist Name:
<br />35.
<br />Signature:
<br />Date:
<br />Any additional signatories shall be included in an attachment to this instrument.
<br />PAPERWORK REDUCTION ACT STATEMENT
<br />According to the Paperwork Reduction Act of 1995, a Federal agency may not conduct or sponsor, and a person is not required to respond to,
<br />an information collection request unless it displays a valid Office of Management and Budget (OMB) control number. The valid OMB control
<br />number for this information collection request is 0596-0217. Response to this information collection request is mandatory to obtain or retain
<br />benefits. The authority for this information collection request is Paperwork Reduction Act (Pub. L. No. 96-511, 94 Stat. 2812, as amended by
<br />Pub. L. 104-13) 44 U.S.C. §§ 3501-3521. The time required to complete this information collection request is estimated to average 3 hours per
<br />response, including the time for reviewing instructions, searching existing data sources, collecting and maintaining the data needed, and
<br />completing and reviewing the information collection request. Send comments regarding this burden estimate or any other aspect of this
<br />information collection request, including suggestions for reducing the burden, to Forest Service Information Collections Officer,
<br />SM.FS.InfoCollect@usda.gov, with OMB control number 0596-0217 in the subject line.
<br />NONDISCRIMINATION STATEMENT
<br />In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its
<br />Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on
<br />race, color, national origin, religion, sex, disability, age, marital status, family/parental status, income derived from a public assistance program,
<br />political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply
<br />to all programs). Remedies and complaint filing deadlines vary by program or incident.
<br />Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American
<br />Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA
<br />through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
<br />To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a
<br />Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information
<br />requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail:
<br />U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C.
<br />20250-9410; (2) fax: (202) 690-7442; or (3) email: program. intakeeusda.gov.
<br />USDA is an equal opportunity provider, employer, and lender.
<br />File Code:1500 For technical questions and Section 508 accommodation, please contact SM.FS.fseformsCcDusda.gov Page of
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