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Agreement Financial Plan (Medium Form)
ICR 200906-0596-003 · OMB 0596-0217 · Object 16698501.
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| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
|---|---|
| File Title | Agreement Financial Plan (Medium Form) |
| Author | FSDefaultUser |
| Last Modified By | Calc |
| File Modified | 2010-09-13 |
| File Created | 2026-10-24 |
| Conversion State | complete |
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U.S. Forest Service OMB 0596-0217 FS-1500-17C Instructions: Use this form in conjunction with Forest Service Handbook (FSH) 1509.11, Ch. 70, Financial Planning Requirements, for participating, challenge cost-share, joint venture, and cost-reimbursable agreements. This form may be used for other types of Forest Service Manual 1580 agreements, when useful. Choose one of the two (2) financial plan versions and complete. Use Version 1 (Financial Plan - Cash to Coop) when you will have Cash to the Cooperator. Use Version 2 (Financial Plan - Cash to FS) when you have cash to the Forest Service. Users do not have to use or print versions/sheets that are not applicable to their agreement. The purpose of this form is to capture the total estimated value of the proposed agreement. Once the agreement is approved, in writing, by the parties, then this financial plan becomes the financial estimates for the agreement. This financial plan must display the parties' expected contributions to the agreement. These contributions should be broken down by party contribution type (e.g., non-cash, in-kind, cash to cooperator), see below for definitions, and cost elements (e.g., salaries, supplies, travel). Cost element values should be the result of documented cost analysis on this form. Each financial plan version provides samples of cost analysis calculations, see associated Excel comment balloons. Additional instructions are located on version 1 and 2 cost analysis tabs. Definitions for the Matrix Column Headings: (a) Forest Service Noncash Contribution: Forest Service noncash contributions may consist of employee salaries, overhead (indirect), 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. (b) Forest Service Volunteer Labor (In-Kind) Contribution: This is the value of volunteer labor donated for completion of the project by the Forest Service for which the Forest Service has incurred no expense. Forest Service volunteer agreements (either sponsored or individual) should be used to document the donated services. The value of volunteer labor should be commensurate with local labor rates for similar work. (c) Forest Service Cash to the Cooperator: This is the maximum amount of funding that will be reimbursed or advanced to the Cooperator. This is an expense to the Forest Service. (d) Cooperator Noncash Contribution: These are expenses the Cooperator incurs that are contributed to the project in lieu of cash, but for which costs are incurred, such as employee salaries, overhead (indirect costs), travel, equipment, supplies, and so forth. These do not include in-kind contributions from third parties, such as donations from other entities or volunteer labor. (e) Cooperator, In-Kind Contribution: In-kind contribution provided to the Cooperator from a third party organization(s) for use in the project for which the Cooperator has incurred no expense. Value assessed for volunteer labor and donated materials, equipment and supplies should be valued based on FSH 1509.11, Ch. 70. These values are not reimbursable and can only be used to satisfy the Cooperator's matching requirement. Display these contributions by Cost Element Expenditures. (f) Cooperator Cash to the Forest Service: These are Cooperator cash contributions actually transferred to the Forest Service for use in completing the project. This is an expense to the Cooperator and does not include in-kind contributions made to the Cooperator from other organizations. 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. Include cash the Cooperator is transferring to the Forest Service for the project, that has been received as a grant(s) from a non-Federal entity(ies). OMB 0596-0217 FS-1500-17C U.S. Forest Service (g) Cooperator, Other Federal Contribution: Contribution provided to the Cooperator from Federal agencie(s) for use in the project. Display these contributions by Cost Element Expenditures. (h) Total Project Value: The sum of all the values provided toward the project. This figure reflects the true estimated cost of the project. Definitions for Cost Allowability (a) Allowable Cost: A cost, as recorded on the Agreements Financial Plan (Long, Medium, and Short) forms, associated with an agreement, which meets the criteria for authorized expenditures specific in a cost principle methodology. Generally, it meets the cost principle methodology, and is a cost the parties to an agreement intend to charge, and must be: Reasonable for the performance of the award; Necessary and reasonable for proper and efficient performance and administration of the agreement; Consistently treated as either a direct or indirect cost; Generally, determined in accordance with generally accepted accounting principles (GAAP); Net of all applicable credits (that is, less any future rebates from the purchase of goods or services); Separate from a cost or from a cost-sharing/matching requirement of another Federal award or agreement, unless otherwise permitted by Federal law or regulation; Adequately documented; Authorized or not prohibited by Federal, State, or local laws and regulations; Compliant with limits or exclusions on types or amounts of costs, as set forth in relevant Federal laws, agreement terms and conditions, or other governing regulations (examples of such costs include: entertainment, alcohol, and taxes); and,Consistent with the agency’s and cooperator’s internal policies, regulations, and procedures that apply to both Federal awards or agreements and other cooperator activities. (b) Allocable Cost: A cost, as recorded on the Agreements Financial Plan (Long, Medium, and Short) forms, associated with an agreement, which in accordance with the relative benefit received by either party for the award, is treated consistently with other costs incurred for the same purpose and in like circumstances, and if it: Is incurred specifically for the award; Benefits both the award and other ancillary work, and the cost may be distributed in reasonable proportion to the benefits received (an example of this type of cost is a piece of equipment that is used for multiple projects); or Necessary to the overall operation of the organization, although a direct relationship to any particular cost objective may not be shown. (c) Reasonable Cost: A cost, as recorded on the Agreements Financial Plan (Long, Medium, and Short) forms, associated with an agreement, that, in its nature and amount, does not exceed an amount that a prudent person, under the circumstances prevailing at the time the decision was made, would incur. Other factors to consider are: Whether the cost is of a type generally recognized as ordinary and necessary for the entity’s operation or agreement performance; The restraints or requirements imposed by factors such as generally accepted, sound, business practices; arms-length bargaining; Federal and State laws and regulations; and the terms and conditions of the agreement; Market prices or industry standard costs for similar goods and services (that is, is the cooperator offering goods or services for an amount that exceeds what is readily available in the marketplace); Whether individuals concerned acted with prudence under the circumstances, considering their responsibilities to the entity; its members, employees, and clients; the public; and the government; and Significant deviations from established practices of the governmental entity that might unjustifiably increase costs charged to the agreement. Burden Statement U.S. Forest Service OMB 0596-0217 FS-1500-17C According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0217. The time required to complete this information collection is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD). To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 202509410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer. OMB 0596-0217 FS-1500-17C U.S. Forest Service Attachment USFS Agreement No.: Mod No. Cooperator Agreement No.: This Financial Plan may not be used to collect funds AND disburse funds on the same agreement. Separate agreements must be used in this situation. Agreements Financial Plan (Medium Form) 1. Financial Plan Matrix: COST ELEMENTS (Direct Costs) Salaries/Labor Travel Equipment Supplies/Materials Printing Other Other Subtotal Cooperator Indirect Costs FS Overhead Assessment Gross Total Note: All columns may not be used. Use depends on source and type of contribution(s). FOREST SERVICE CONTRIBUTIONS COOPERATOR CONTRIBUTIONS (a) (b) (c) (d) (e) (f) Volunteer Cash Noncash Labor to Noncash In-Kind Other Federal (g) (In-Kind) Cooperator 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 $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 $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 $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 $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 $0.00 $0.00 $0.00 Matching Costs Determination Total Forest Service Share = (a+b+c)/(g) = (h) Other Federal Contribution = (f)/(g) = (i) Total Federal Share = (h+i) = (j) Total Cooperator Share (d+e)/(g) = (k) Total (j+k) = (l) (h) #DIV/0! (i) #DIV/0! (j) #DIV/0! (k) #DIV/0! (l) #DIV/0! Page 4 OMB 0596-0217 FS-1500-17C U.S. Forest Service ncial Plan (Medium Form) Page 5 WORKSHEET FOR FS Non-Cash Contribution Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense $0.00 Employees Cost/Trip # of Trips Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment $0.00 # of Units Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials # of Items Cost/Item Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material # of Units Cost/Unit Total $0.00 Non-Standard Calculation Total Printing $0.00 Other Expenses Standard Calculation Item # of Units Cost/Unit Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Other $0.00 Subtotal Direct Costs $0.00 Forest Service Overhead Costs Current Overhead Rate Subtotal Direct Costs Total $0.00 $0.00 $0.00 Total FS Overhead Costs TOTAL COST $0.00 TOTAL COST $0.00 WORKSHEET FOR Volunteer Labor (In-Kind) Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense $0.00 Employees Cost/Trip # of Trips Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment # of Units $0.00 Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment Supplies/Materials Standard Calculation Supplies/Materials $0.00 # of Items Cost/Item Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials Printing Standard Calculation Paper Material $0.00 # of Units Cost/Unit Total $0.00 Non-Standard Calculation Total Printing Other Expenses Standard Calculation Item $0.00 # of Units Cost/Unit Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Other Subtotal Direct Costs TOTAL COST $0.00 $0.00 $0.00 WORKSHEET FOR FS Cash to the Cooperator Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense $0.00 Employees Cost/Trip # of Trips Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment # of Units $0.00 Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials # of Items Cost/Item Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material # of Units Cost/Unit Total $0.00 Non-Standard Calculation $0.00 $0.00 Total Printing Other Expenses Standard Calculation Item # of Units Cost/Unit Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Other $0.00 Subtotal Direct Costs $0.00 Cooperator Indirect Costs Current Overhead Rate Total Coop. Indirect Costs Subtotal Direct Costs $0.00 Total $0.00 $0.00 TOTAL COST $0.00 WORKSHEET FOR Cooperator Non-Cash Contribution Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Cost/Trip # of Trips Cost/Day # of Days Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense Employees Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment # of Units Non-Standard Calculation Total Equipment Supplies/Materials Standard Calculation Supplies/Materials # of Items Cost/Item # of Units Cost/Unit # of Units Cost/Unit Non-Standard Calculation Total Supplies/Materials Printing Standard Calculation Paper Material Non-Standard Calculation Total Printing Other Expenses Standard Calculation Item Non-Standard Calculation Total Other Subtotal Direct Costs $0.00 Cooperator Indirect Costs Current Overhead Rate Subtotal Direct Costs $0.00 Total Coop. Indirect Costs TOTAL COST $0.00 t Analysis Column m figures provided in the matrix. ells. able. Line items may be added or zed formula for determing a line omatically. The Non-Standard culation formula that is other than the y x # of days, costs may be calculated s 1 employee x $1,200/contract= rd Calculation, and provide a brief line below the figures. Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Total $0.00 $0.00 $0.00 $0.00 $0.00 Total $0.00 $0.00 $0.00 Total $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0.00 Total $0.00 $0.00 WORKSHEET FOR Cooperator In-Kind Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor $0.00 Travel Standard Calculation Travel Expense Employees Cost/Trip # of Trips Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment $0.00 # of Units Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials # of Items Cost/Item Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material # of Units Cost/Unit Total $0.00 Non-Standard Calculation Total Printing $0.00 Other Expenses Standard Calculation Item # of Units Cost/Unit Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Other $0.00 Subtotal Direct Costs TOTAL COST $0.00 $0.00 WORKSHEET FOR Cash to FS Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense $0.00 EmployeesCost/Trip # of Trips Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment $0.00 # of Units Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials # of Items Cost/Item Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material # of Units Cost/Unit Total $0.00 Non-Standard Calculation Total Printing $0.00 Other Expenses Standard Calculation Item # of Units Cost/Unit Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Other $0.00 Subtotal Direct Costs $0.00 Forest Service Overhead Costs Current Overhead Rate Subtotal Direct Costs $0.00 Total $0.00 $0.00 Total FS Overhead Costs TOTAL COST $0.00 WORKSHEET FOR Other Federal Cost Analysis Column Use this worksheet to perform the cost analysis that supports the lump sum figures provided in the matrix. NOTE: This worksheet auto populates the relevant and applicable matrix cells. Cost element sections may be deleted or lines may be hidden, if not applicable. Line items may be added or deleted as needed. The Standard Calculation sections provide a standardized formula for determing a line item's cost, e.g. cost/day x # of days=total, where the total is calculated automatically. The Non-Standard Calculation sections provide a write-in area for line items that require a calculation formula that is other than the standardized formules, e.g. instead of salaries being calculated by cost/day x # of days, costs may be calculated simply by a contracted value that is not dependent on days worked, such as 1 employee x $1,200/contract= $1,200. Be sure to review your calculations when entering in a Non-Standard Calculation, and provide a brief explanation of units used to make calculation, e.g. '1 month contract,' on a line below the figures. Salaries/Labor Standard Calculation Job Description Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Salaries/Labor Travel Standard Calculation Travel Expense $0.00 Employees Cost/Trip # of Trips Total $0.00 $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Travel Equipment Standard Calculation Piece of Equipment $0.00 # of Units Cost/Day # of Days Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Equipment $0.00 Supplies/Materials Standard Calculation Supplies/Materials # of Items Cost/Item Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Supplies/Materials $0.00 Printing Standard Calculation Paper Material # of Units Cost/Unit Total $0.00 Non-Standard Calculation Total Printing $0.00 Other Expenses Standard Calculation Item # of Units Cost/Unit Total $0.00 $0.00 $0.00 $0.00 Non-Standard Calculation Total Other $0.00 Subtotal Direct Costs $0.00 Forest Service Overhead Costs Current Overhead Rate Subtotal Direct Costs Total $0.00 $0.00 $0.00 Total FS Overhead Costs TOTAL COST $0.00 TOTAL COST $0.00 OMB 0596-0217 FS-1500-17C U.S. Forest Service Attachment: USFS Agreement No.: Mod. No. Cooperator Agreement No.: This Financial Plan may not be used to collect funds AND disburse funds on the same agreement. Separate agreements must be used in this situation. Agreements Financial Plan (Medium Form) with Program Income 1. Financial Plan Matrix: COST ELEMENTS (Direct Costs) Salaries/Labor Travel Equipment Supplies/Materials Printing Other Other Subtotal Cooperator Indirect Costs FS Overhead Assessment Gross Total Note: All columns may not be used. Use depends on source and type of contribution(s). FOREST SERVICE COOPERATOR CONTRIBUTIONS CONTRIBUTIONS (g) GROSS (a) (b) (c) (d) (e) (f) TOTAL BY Volunteer Other LINE Noncash Labor Noncash In-Kind Cash to FS Federal (In-Kind) $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 $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 $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 $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 $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 $0.00 $0.00 $0.00 Matching Costs Determination Total Forest Service Share = (a+b)/(g) = (h) Other Federal Contribution = (f)/(g) = (i) Total Federal Share = (h+i) = (j) Total Cooperator Share [(c+d+e) = (k) Total (j+k) = (l) (h) #DIV/0! (i) #DIV/0! (j) #DIV/0! (k) #DIV/0! (l) #DIV/0! Page 25