Form 10-903 Land and Water Conservation Fund Description and Notific

Land and Water Conservation Fund State Assistance Program, 36 CFR 59

10-903

LWCF Applications

OMB: 1024-0031

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LAND AND WATER CONSERVATION FUND
DESCRIPTION AND NOTIFICATION FORM
State

Grant #

Amend #

Date Received

Date Approved

OMB Control No. 1024-0031
Expires: XX/XX/2016

Expiration Date

Start Date

Grant Name:
Element Name:
Sponsor Name:
Address:
A = Acquisition
P = Planning
D = New development
C = Combination
R = Renovation development M = Administration

Type

Acreage

Financial

Acquired

Data

Donated

Sponsor

Acres

L = Local
C = C ounty
S = State

Acquisition Assistance

Estimates:
Total

Number of Park Sites*

Source

Cost

Fund

Amount

Match:

Fed

State

Local

PARK INFORMATION
County Name

City Name

GPS Coordinates
(Deg./Min./Sec./Dir.)

Latitude

Park Name #1:

Prior LWCF Assistance?
Fiscal Year

Yes

New 6(f) Acres at Park
And/Or

Cong Dist.

Zip Code

Longitude

Enhanced 6(f) Acres at Park
(Previously protected acres receiving development assistance by
this action)

Total Number of 6(f)
Acres at Park

SPECIAL INDICES
A. Lease land - private

G. Lands transferred to federal agency

B. Leased land - federal

I. Indian sponsored

O. National Heritage Areas

N. National Historic Landmarks

V. American Heritage Rivers

U. Utility - R-O-W

C. Coastal Grant

J. National Historic Register property

Q. Railroad - R-O-W

W. Wetlands

D. Leased land - expired lease
E. Former federal surplus property
F. Flood plain

K. National Natural Landmarks
L. Less than fee acquisition
M. Mined land

R. National river
S. School park
T. National trail

X. Grant involved conversion
Y. Endangered species
Z. Contingency reserve

A. 00. CAMPGROUNDS
01. Tent sites
02. RV/ camp sites
03. Group camp ground
04. Day camp

D. 00. GOLF COURSE
01. Regular 18 hole
02. Par 3
03. Driving range
04. Regular 9 hole
05. Miniature golf
06. Pitch and putt

H. 00. TRAILS
01. Hiking
02. Horse
03. Bicycle
04. Motorized
05. Natural
06. Exercise

E. 00. SWIMMING FACILITIES
01. Pool
02. Wading pool
03. Spray pool
04. Swimming beach
05. Bathhouse

J. 00. WINTER SPORTS FACILITIES
01. Ski lift
02. Ski slope
03. Ski jump
04. Sled/toboggan run
05. Skating rink
06. Ski trails
07. Snowmobile trails
08. Warming huts

FACILITY CODES

B. 00. PICNIC AREAS
01. Family site
02. Group shelter
C. 00. SPORTS & PLAYFIELDS
01. General purpose playfields
02. Baseball
03. Football
04. Tot lot/playground
05. Tennis courts
06. Basketball
07. Rifle/pistol range
08. Trap/skeet field
09. Archery range
10. Rodeo area
11. Track facility
12. Skate board
13. Soccer
14. Other courts
15. Softball

F. 00. BOATING FACILITIES
01. Launch ramp
02. Berths
03. Boat lift
G. 00. FISHING FACILITIES
01. Pier
03 02. Stream improvement
03. Fishing access

N. 00. NATURAL AREA
P. 00. PASSIVE PARKS
Q. 00. SUPPORT FACILITY
01. Walkways
02. Site improvement/landscaping
03. Utilities
04. Equipment
05. Roads
06. Parking
07. Lighting
08. Signs
09. Comfort station
10. Concession building
11. Maintenance building
R. 00. AMPHITHEATER/ BAND SHELL

K. 00. ENCLOSED SHELTER
01. Pool
02. Courts
03. Picnic

S. 00. LAKE IMPOUNDMENT
T. 00. VISITOR INFORMATION CENTER

L. 00. SHELTERED ICE RINK

U. 00. INTERPRETIVE CENTER

M. 00. HUNTING

V. 00. OTHER

*Attach continuation sheet(s) for grants with 2 or more sites (one per additional site)
NPS 10-903

LAND AND WATER CONSERVATION FUND
DESCRIPTION AND NOTIFICATION FORM
(Continuation Sheet)

Grant #

Amend #

PARK INFORMATION
Park Name #

Prior LWCF Assistance?
Fiscal Year

County Name

City Name

GPS Coordinates
(Deg./Min./Sec./Dir.)

Latitude

Yes

New 6(f) Acres at Park
And/Or

Enhanced 6(f) Acres at Park
(Previously protected acres receiving development assistance by
this action )

Cong Dist.

Zip Code

Longitude
Total Number of 6(f)
Acres at Park

SPECIAL INDICES
A. Lease land - private

G. Lands transferred to federal agency

N. National Historic Landmarks

B. Leased land - federal

I. Indian sponsored

O. National Heritage Areas

U. Utility - R-O-W
V. American Heritage Rivers

C. Coastal Grant

J. National Historic Register property

Q. Railroad - R-O-W

W. Wetlands

D. Leased land - expired lease
E. Former federal surplus property
F. Flood plain

K. National Natural Landmarks
L. Less than fee acquisition
M. Mined land

R. National river
S. School park
T. National trail

X. Grant involved conversion
Y. Endangered species
Z. Contingency reserve

A. 00. CAMPGROUNDS
01. Tent sites
02. RV/ camp sites
03. Group camp ground
04. Day camp

D. 00. GOLF COURSE
01. Regular 18 hole
02. Par 3
03. Driving range
04. Regular 9 hole
05. Miniature golf
06. Pitch and putt

H. 00. TRAILS
01. Hiking
02. Horse
03. Bicycle
04. Motorized
05. Natural
06. Exercise

E. 00. SWIMMING FACILITIES
01. Pool
02. Wading pool
03. Spray pool
04. Swimming beach
05. Bathhouse

J. 00. WINTER SPORTS FACILITIES
01. Ski lift
02. Ski slope
03. Ski jump
04. Sled/toboggan run
05. Skating rink
06. Ski trails
07. Snowmobile trails
08. Warming huts

FACILITY CODES

F. 00. BOATING FACILITIES
01. Launch ramp
02. Berths
03. Boat lift
G. 00. FISHING FACILITIES
01. Pier
03 02. Stream improvement
03. Fishing access

K. 00. ENCLOSED SHELTER
01. Pool
02. Courts
03. Picnic

S. 00. LAKE IMPOUNDMENT
T. 00. VISITOR INFORMATION CENTER

L. 00. SHELTERED ICE RINK

U. 00. INTERPRETIVE CENTER

M. 00. HUNTING

V. 00. OTHER

Paperwork Reduction Act Statement: This information collection is authorized by the Land and Water Conservation Fund Act of 1965 (16
U.S.C. 4601-4 et seq.). Your response is required to obtain or retain a benefit. We use this information to record and track grant projects and to
analyze program trends. We estimate that it will take 1 hour to complete this form, including the time necessary to review instructions gather
data and review the form.
You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park
Service, 1849 C Street, NW. (2601), Washington, DC 20240. We may not collect or sponsor and you are not required to respond to a
collection of information unless it displays a currently valid OMB control number.

NPS 10-903

INSTRUCTIONS
DNF Form (v. Aug. 2010)
The Description and Noti fication Form (DNF) captures information about LWCF
grants and the parks and recreation areas assisted through approval of a new
grant, an amendment, to an existing grant, or a Conversion of Use provisions request.
This information is u sed to aid in reporting the performance of the program to Members
of Congress and the American people. The following directions are provided to assist you.
For amendments only relevant portions are to be completed or as noted below.

GRANT
INFORMATION
State
Grant No.

Amendment No.
Date Received

Approval Date
Expiration Date
Start Date
Grant Name
Element Name
Sponsor Name
Address
Type

Summary information for the entire grant or amendment
regardless of number of specific park areas or parcels involved.

Enter the appropriate two-digit State identifier, e.g. 06.
Enter the five digit number for the Grant, e.g., 00456 (to be
verified by NPS)
Enter the sequential Amendment Number (to be verified by
NPS).
Enter the date on which an actionable project or amendment is
received in the regional office. If the information received is
returned to the State as incomplete and subsequently
resubmitted, the date the resubmitted project was received shall
be entered (to be completed by NPS).
Enter the date the project or amendment was approved as
shown on the project agreement or amendment form (to be
completed by NPS).
Enter the grant expiration date as shown on the project
agreement or amendment form (to be verified by NPS).
The Start Date is the same as the Approval Date unless an
earlier Start Date results from a previously approved Waiver of
Retroactivity; if so, the waiver date is the Start Date.
Enter Project Title from the agreement document in all caps not
to exceed 50 characters.
Leave blank unless a consolidated project is being amended in all
caps not to exceed 50 characters.
Enter name of Grantee or sub-grantee.
Enter address of Grantee or sub-grantee.
Enter the appropriate letter for type of grant. Use the definition
below for guidance.
A= Acquisition: grants for the acquisition of lands and waters
D= New Development: grants where the majority of the
assistance is devoted to development of new recreation or
eligible support facilities.
R= Redevelopment: grants primarily involving renovations,
rehabilitation, replacement or retrofitting of existing recreation
and support facilities.
P= Planning: grants related to the development of a SCORP
document.
C= Combination: grants involving both acquisition and
development.
M= Other: if authorized.

Sponsor

Acreage Acquired
Donated Acres
Acquisition
Assistance

No. of Park Sites

Total Cost
Fund Amount
Source of Match

Enter appropriate letter for sponsor type.
L= Local: a local unit of government (including tribes) other
than a county or parish.
C= County or Parish.
S= State
When the project type is either A or C, enter the total numbers
of acres to be acquired to the nearest tenth regardless of number
of parcels or their location (purchased acres + donated acreage)
Indicate to the nearest tenth of an acre that portion of the total
acreage being donated if any.
Enter the Fund assistance provided to cover actual cash outlay
for real property purchased, including project administration and
relocation costs. For C projects, administration costs will be
prorated between development and acquisition.
If all the acres acquired are donated, i.e., total acres acquired =
donated acres acquired, there is no acquisition cost and this field
should remain empty. If the total acres acquired are larger than
the donated acres acquired, acquisition assistance is to be
entered.
Identify the number of separate park sites (distinct park units)
being assisted under this project. Park information for each site
is to be completed below.
For conversions, the total number of park sites associated with
the grant as a result of a conversion should be entered (e.g.,
enter 1 for a total conversion and replacement; enter 2 for a
partial conversion with one replacement site).
Enter the estimated total cost of project as shown on the grant
agreement For amendments enter the total cost of the
amendment.
Enter the LWCF dollar share of the total cost, not to exceed 50
percent. For amendments enter the LWCF dollar share of the
amendment.
Identify the source of the non-LWCF share of the project cost by
selecting the appropriate box. Other federal programs
authorized by law to match LWCF grants will be considered
“Federal” (i.e., CDBG).
Note: the application of a negotiated indirect cost rate requires a
State contribution and must be so identified.

PARK
INFORMATION
Park Name

Information related to each park or recreation area impacted by
the grant (or added through a conversion). For projects
involving more then one park/area, attach a Continuation sheet
for each. This information does not apply to planning and
program administration grants.

Enter the official name of the park or recreation area (XYZ Park,
Recreation Area, State Natural Area, Playground, Field, Preserve,
etc.). If unknown, enter a generic name as a place holder for
subsequent correction. Do not repeat descriptors often found in
the Grant Name which are not designated park names such as
“development”, “improvement”, “Phase II,” etc. If the funded

County Name
City Name

Congressional
District
Zip Code
Prior LWCF
Assistance
GPS Coordinates

Fiscal Year
New 6(f) Acres at
Park

Enhanced 6(f)
Acres at Park

Total Number of
6(f) acres at Park

development is a named facility within a park (e.g., ABC Tennis
Courts within XYZ Park), XYZ Park is to be entered.
Enter the county in which the funded park or recreation area is
located. If in more than one county, show all.
Enter name of city (township, etc.) in which funded park or
recreation area is located. For projects not located within a subcounty jurisdiction, enter name of jurisdiction located nearest to
actual park site.
Enter the 2-digit number for the Congressional District in which
the funded park or recreation area is located. If physically
located in more than one district, enter number of each district in
which located.
Enter 9-digit zip code in which the funded park or recreation area
is located (00000-0000).
Check appropriate box to indicate whether this park or recreation
area has ever received LWCF assistance before. If XYZ Park has
neither been acquired in total or in part nor previously developed
through a prior LWCF grant, enter “No”.
Enter the geo-reference coordinates in degree, minutes, seconds,
and direction for the park or recreation area. This point should
refer to the approximate center point of the 6(f) area as is
feasible. In all cases, the coordinates should correspond to area
within the 6(f) boundary. For projects involving linear parks,
such as trails, the reference point should relate to the middle
section of the trail.
This is the federal Fiscal Year in which new grants and
amendments are “approved” by NPS and the contract document
is executed. Fiscal Year is not the date submitted to NPS.
Enter the total acreage of the 6(f) area that is newly protected
under this grant through either acquisition, new development,
redevelopment or a combination of either. The area should be
clearly shown on the 6(f) boundary map and in most cases will
include the acreage of the entire park.
For amendments, new acres will only be shown if there is an
increase in the Federal share for the purpose of adding additional
acres to the project scope.
Enter the previously protected 6(f) acreage at the park or
recreation area that is now receiving “development” assistance
(enhancement) through a new development, renovation
development or combination project. In other words, the park
area is receiving further improvement in addition to what has
been received through prior LWCF assistance. The acreage
enhanced is not limited to the footprint of the development being
funded but includes the total acreage previously protected
through prior grants and identified on the pre-existing 6(f)
boundary map.
For amendments, enhanced acres will only be shown for
amendments which increase the Federal share for the specific
purpose of adding new scope items within the 6(f) area.
Enter the total number of 6(f) acres now protected as a result of
the current and all previous grants or amendments at the site. It
is intended to capture the size of the LWCF- protected recreation

Special Indices

Facility Codes

Creation of a New
Park or Recreation
Area
(Reserved)

estate at the facility as a result of both current and past LWCF
involvement. This number should reflect changes resulting from
conversions.
These indices reflect special/unusual features of a proposal.
Select all that are relevant.
For amendments which add or delete special indices previously
entered, overwrite the special indices originally entered with all
those applicable as of the latest amendment.
Select as many facility codes (Primary plus subcodes) as
necessary to describe the specific facilities being developed. For
acquisition projects, select only primary codes (A00, B00, etc.)
which represent the planned use of the site. For combination
projects, select the primary codes plus the appropriate subcodes.
For amendments which add or delete facility codes previously
entered, overwrite the facility codes originally entered with all
those applicable as of the latest amendment.
Indicate whether this LWCF grant will result in the acquisition or
development of a facility providing outdoor recreation
opportunity that previously did not previously exist. New acres
added or new development at a previously existing facility are
not included under this definition (this information is currently
being collected by NPS and will be added to the next revision of
the DNF).

File Type	application/pdf
File Title	DNF 8-26.p65
Author	leungm
File Modified	2013-09-16
File Created	2008-06-25