FS-1500-NEW11A Financial Plan A

Federal and Non-Federal Financial Assistance Instruments

FS_1500_NEW11A.xls

State, Local, and Tribal Govt. - Federal and Non-Federal Financial Assistance Instruments

OMB: 0596-0217

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USFS Agreement No.:
Mod. No.







Cooperator Agreement No.:


















Agreements Financial Plan (Long Form)
1. Financial Plan Matrix:
Note: All columns may not be used. Use depends on source and type of contribution(s).











FOREST SERVICE CONTRIBUTIONS COOPERATOR CONTRIBUTIONS

FSDefaultUser: (a) Forest Service Non-Cash Contribution: Forest Service employee salaries, travel, equipment, supplies, etc., provided toward completion of the project. Total Forest Service indirect cost (overhead) is also included in this column. All the costs listed here are an expense to the Forest Service. (a) FSDefaultUser: (b) Value of Forest Service In-Kind Contribution: Forest Service contributions toward completion of the project for which the Forest Service has incurred no expense. These contributions include such items as volunteer labor, donated materials, equipment, supplies, etc., contributed by third parties directly to the Forest Service. Forest Service volunteer and/or equipment rental agreements should be used to document the donated services. (b) FSDefaultUser: (c) Reimbursable Cooperator Expenses: The figure(s) listed are both the maximum Forest Service funds to be obligated for reimbursement and Cooperator expenses that are not included anywhere else on this form. This is an expense to the Forest Service. (c) FSDefaultUser: Forest Service Noncash Contribution. Forest Service noncash contributions may consist of employee salaries, overhead, travel provided, and/or equipment and supplies purchased and provided to the cooperator for use in the project. These costs are an expense to the Forest Service, but do not include funding for reimbursement of cooperator expenses. (d) FSDefaultUser: (e) Value of Cooperator In-Kind Contribution: Cooperator non-cash contributions provided toward completion of the project for which the Cooperator has incurred no expense. These contributions can be made from the Cooperator or through the Cooperator by other entities and include such items as volunteer labor, donated materials, equipment, supplies, etc. These values are not reimbursable and can only be used to satisfy the Cooperator's matching requirement. (e) FSDefaultUser: (f) Cash Contribution to the Forest Service: Cooperator cash contribution provided to the Forest Service for use in completing the project. This is an expense to the Cooperator. Display by Cost Element where these funds will be expended. Be sure to cite a collection authority in the Agreement if this column is used. (f) (g) (h) (i) (j) (k) (l)



Reimb.


THIRD PARTY
COST ELEMENTS Non-Cash In-Kind Coop. Non-Cash In-Kind Cash Cash Non-Cash In-Kind (m)
Total
Direct Costs

Expenses


FSDefaultUser: (g) Third Party Cash Contribution Non-Federal: Cash contribution provided to the Cooperator from Non-Federal organization(s) for use in the project. Display these contributions by Cost Element expenditures. Non-Fed FSDefaultUser: (h) Third Party Cash Contribution Federal: Cash contributions provided to the Cooperator from Federal agency(ies) for use in the project. Display these contributions by Cost Element expenditures. Federal FSDefaultUser: (i) Third Party Non-Cash Contribution Non-Federal: Non-cash contribution provided to the Cooperator from Non-Federal organization(s) for use in the project. Display these contributions by Cost Element Expenditures. Non-Fed FSDefaultUser: (j) Third Party Non-Cash Contribution Federal: Non-cash contribution provided to the Cooperator from Federal agencie(s) for use in the project. Display these contributions by Cost Element Expenditures. Federal FSDefaultUser: (k) Third Party In-Kind Contribution Non-Federal: In-kind contribution provided to the Cooperator from Non-Federal organization(s) for use in the project. Display these contribtuions by Cost Element Expenditures. Non-Fed FSDefaultUser: (l) Third Party In-Kind Contribution Federal: In-kind contribution provided to the Cooperator from Federal agencie(s) for use in the project. Display these contributions by Cost Element Expenditures. Federal
Salaries/Labor











$0.00
Travel











$0.00
Equipment Use











$0.00
Supplies











$0.00
Materials











$0.00
Printing











$0.00
FSDefaultUser: This cost element can be replaced with a cost element unique to your agreement. Other











$0.00
FSDefaultUser: This cost element can be replaced with a cost element unique to your agreement. Other











$0.00
Subtotal $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Indirect Costs











$0.00
Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00






















(n) Estimated Program Income (subtract from total of column (m):




Matching Costs Determination



(o) Net Total Project Value:



$0.00
Total Forest Service Share =

(p)









(a+b+c)/(o) = (p)

#DIV/0!























Third Party Contribution-- Federal =

(q)









(h+j+l)/(o) = (q)

#DIV/0!
Reimbursement Calculation





Forest Service reimbursement percent (as % of expenses directly incurred by the Cooperator-- i.e., Cooperator's non-cash and cash contributions only-- that are subject to Forest Service reimbursement)
Total Federal Share =

(r)
(u)
(p+q) = (r)

#DIV/0!
(c)/[(c+d+f) - (n)] = (u)




#DIV/0!














Total Cooperator Share

(s)
Reimbursable Amount = Total actual cost incurred to date (sum of cost elements from the Cooperator's invoice as







[(d+e+f+g+i+k) - (n)] / (o) = (s)

#DIV/0!
prescribed in agreement provisions


and
multiplied by #DIV/0!





(u) minus any previous Forest Service payments, not to exceed the subtotal amount listed in column (c) minus any










(t)
estimated program income.)







Total (r+s) = (t)

#DIV/0!















































































2. Cost Analysis:












Use the following section to show additional information that supports the lump sum figures provided above. The following Cost Analysis boxes, (a)-(l), should provide a cost analysis of the corresponding matrix columns, (a)-(l), above, e.g. matrix column (a) FS Non-Cash Contribution should be analyzed under block (a), below, and matrix column (b) In-Kind Contribution should be analyzed under block (b), below, etc. Furthermore, each cost analysis box, below, should have clear labels indicating which cost element, above, that is being analyzed, e.g. Salary/Labor = hrs or days x rate; Travel = miles x rate or months x FOR rate, days x per diem rate; Equipment Use = hrs or days x rate; Supplies & Materials--list of items and estimated cost; Printing = estimated cost per item; Indirect Cost = Direct cost x current indirect rate.















If necessary, add additional sheets for cost analysis. To compress any unwanted portion(s) of this section, highlight the section to be hidden, then select "Format", "Row", and "Hide" from the toolbar.


EXAMPLE Column (a): Salary GS 11 Biologist @ 40 hrs x $25.02/hr = $1,000.80, GS 5 Crew Leader @ 80 hrs x $12.79/hr = $1,023.20, GS 3 Crew 3 x 80hrs x $10.19/hr = $2445.60; Travel 12 round trips x 50 miles x $.375/mi. = $225; Indirect Cost: $4,694.60 x 19.2% = $901.36 (a)




















(b)




















(c)




















(d)



















(e)


















(f)


















(g)

















(h)

















(i)
















(j)
















(k)















(l)































































































































3. Instructions: Use this form in conjunction with ID 1509.11-2007-1.


























Use Cost Elements that apply to the particular project. The Cost Elements listed are examples of those commonly used. Delete those that don't apply. Value assessed for volunteer labor should be commensurate with local labor rates for similar work. Donated materials, equipment and supplies should be valued at rates and prices available in the current local market.














(a) Forest Service Non-Cash Contribution: Forest Service employee salaries, travel, equipment, supplies, etc., provided toward completion of the project. Total Forest Service indirect cost (overhead) is also included in this column. All the costs listed here are an expense to the Forest Service.














(b) Value of Forest Service In-Kind Contribution: Forest Service contributions toward completion of the project for which the Forest Service has incurred no expense. These contributions include such items as volunteer labor, donated materials, equipment, supplies, etc., contributed by third parties directly to the Forest Service. Forest Service volunteer and/or equipment rental agreements should be used to document the donated services.














(c) Reimbursable Cooperator Expenses: The figure(s) listed are both the maximum Forest Service funds to be obligated for reimbursement and Cooperator expenses that are not included anywhere else on this form. This is an expense to the Forest Service.














(d) Cooperator Non-Cash Contribution: Cooperator employee salaries, travel, equipment, supplies, etc., provided toward completion of the project. Total Cooperator indirect cost (overhead) is also included in this column. All the costs listed here are an expense to the Cooperator.














(e) Value of Cooperator In-Kind Contribution: Cooperator non-cash contributions provided toward completion of the project for which the Cooperator has incurred no expense. These contributions can be made from the Cooperator or through the Cooperator by other entities and include such items as volunteer labor, donated materials, equipment, supplies, etc. These values are not reimbursable and can only be used to satisfy the Cooperator's matching requirement.














(f) Cash Contribution to the Forest Service: Cooperator cash contribution provided to the Forest Service for use in completing the project. This is an expense to the Cooperator. Display by Cost Element where these funds will be expended. Be sure to cite a collection authority in the Agreement if this column is used.














(g) Third Party Cash Contribution Non-Federal: Cash contribution provided to the Cooperator from Non-Federal organization(s) for use in the project. Display these contributions by Cost Element expenditures.














(h) Third Party Cash Contribution Federal: Cash contributions provided to the Cooperator from Federal agency(ies) for use in the project. Display these contributions by Cost Element expenditures.














(i) Third Party Non-Cash Contribution Non-Federal: Non-cash contribution provided to the Cooperator from Non-Federal organization(s) for use in the project. Display these contributions by Cost Element Expenditures.














(j) Third Party Non-Cash Contribution Federal: Non-cash contribution provided to the Cooperator from Federal agencie(s) for use in the project. Display these contributions by Cost Element Expenditures.














(k) Third Party In-Kind Contribution Non-Federal: In-kind contribution provided to the Cooperator from Non-Federal organization(s) for use in the project. Display these contribtuions by Cost Element Expenditures.














(l) Third Party In-Kind Contribution Federal: In-kind contribution provided to the Cooperator from Federal agencie(s) for use in the project. Display these contributions by Cost Element Expenditures.














(m) Gross Total Project Value: The sum of all the values provided toward the project. This figure reflects the true estimated cost of the project.














(n) Estimated Program Income: The gross income estimated to be generated under the project between the effective date of award and completion of the project, such as conference or workshop fees received, rental fees earned from renting real property or equipment acquired with agreement funds, or the sale of commodities or items developed under the project.
















(o) Net Total Project Value: The sum of all the values provided toward the project with Estimated Project Income taken into consideration. This figure reflects the true estimated cost of the project.
















































Burden Statement



















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File Typeapplication/vnd.ms-excel
AuthorFSDefaultUser
Last Modified ByFSDefaultUser
File Modified2008-09-15
File Created2007-01-22

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