INSTRUCTIONS: Use this form when a single information collection document involves multiple reporting and recordkeeping requirements. The totals of the figures in cols. should be entered in item 13 of OMB-83-1: cols. (D) &/or (I) = 13a (respondent is only counted once); cols. F & I = 13b; cols. H & K = 13c. (F)Total/(D)Total = (E)Average (H)Total/(F)Total = (G)Average (K)Total/(I)Total = (J)Average
NOTE: The columns will calculate automatically. If Col. E's response is something other than annually, i.e., 1/6 years, list as "1/6" & decimal will display.
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TITLE OF INFORMATION COLLECTION DOCUMENT |
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| Federal and Non-Federal Financial Assistance Instruments |
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| OMB NO. |
0596-0217 |
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| DATE PREPARED |
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| IDENTIFICATION OF REPORTING OR RECORDKEEPING REQUIREMENT |
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ANNUAL BURDEN |
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REPORTS |
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DESCRIPTION |
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Administration Burden and Documents |
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Administration Burden and Documents |
FORMS NO (S) |
NO. OF |
NO OF |
TOTAL ANNUAL |
HOURS |
TOTAL |
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Non-Federal Financial Assistance Templates |
(If "none" |
RESPONDENTS |
RESPONSES |
RESPONSES |
PER |
HOURS |
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so state) |
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PER |
(Col. D x E) |
RESPONSE |
(Col. F x G) |
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RESPONDENT |
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| (A) |
(B) |
(C) |
(D) |
(E) |
(F) |
(G) |
(H) |
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ADMINISTRATION COLLECTION AND FORMS |
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Modification Form |
FS-1500-19 |
7,893 |
1.00 |
7,893 |
0.30 |
2,368 |
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| NEW |
Cooperator Performance Report (Optional Template) |
FS-1500-23 |
4,293 |
2.00 |
8,586 |
2.00 |
17,172 |
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Total |
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12,186 |
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16,479 |
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19,540 |
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FEDERAL FINANCIAL ASSISTANCE TEMPLATES |
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Cooperative Agreement |
Award Letter |
175 |
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- |
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- |
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Domestic Grant |
Award Letter |
761 |
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- |
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- |
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International Cooperative Agreement |
Award Letter |
12 |
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- |
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- |
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International Grant |
Award Letter |
16 |
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- |
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- |
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SUB TOTAL: |
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964 |
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- |
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- |
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NEW FORMS AND COLLECTIONS |
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| NEW |
Certification Regarding Lobbying (Required for all awards over $100K) |
FS-1500-35 |
318 |
1.00 |
318 |
0.15 |
48 |
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| NEW |
Financial Capability Questionnaire |
FS-1500-22 |
200 |
1.00 |
200 |
1.00 |
200 |
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| NEW |
Financial Capability Checklist |
FS-1500-22A |
550 |
1.00 |
550 |
0.50 |
275 |
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| NEW |
Financial Capability Checklist (States ONLY) |
FS-1500-22B |
50 |
1.00 |
50 |
0.50 |
25 |
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| NEW |
Equipment Justification and Certification Statement |
FS-1500-34 |
25 |
1.00 |
25 |
0.42 |
11 |
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STANDARD FORM: Common |
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| 4040-0004 |
Application for Federal Assistance |
SF-424 |
820 |
1.00 |
820.00 |
1.00 |
820.00 |
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| 4040-0005 |
Application for Federal Assistance (Individual) |
SF-424 |
10 |
1.00 |
10.00 |
3.00 |
30.00 |
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| 4040-0001 |
Application for Federal Assistance – Research |
SF-424 RR |
134 |
1.00 |
134.00 |
58.00 |
7,772.00 |
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TOTAL |
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964 |
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964.00 |
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8,622.00 |
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STANDARD FORM: Burden accounted for under another information collection number |
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| 4040-0013 |
Disclosure of Lobbying Activities |
SF-LLL & SF-LLLa |
150 |
1.00 |
150.00 |
0.17 |
25.00 |
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| 4040-0012 |
Request for Advance or Reimbursement |
SF-270 |
939 |
2.50 |
2,347.50 |
1.00 |
2,347.50 |
is 4040-0012. Grants.gov is carrying the burden for using this form. |
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| 4040-0011 |
Outlay Report and Request for Reimbursement for Construction Programs |
SF-271 |
25 |
2.50 |
62.50 |
1.00 |
62.50 |
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| 4040-0006 |
Budget Information – Non-Construction Programs |
SF-424A |
939 |
1.00 |
939.00 |
3.00 |
2,817.00 |
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| 4040-0007 |
Assurances – Non-Construction Programs |
SF-424B |
939 |
1.00 |
939.00 |
0.25 |
234.75 |
SF-424B is approved under 4040-0007 – Grants.gov carries the burden |
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| 4040-0008 |
Budget Information - Construction Programs |
SF-424C |
25 |
1.00 |
25.00 |
3.00 |
75.00 |
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| 4040-0009 |
Assurances – Construction Program |
SF-424D |
25 |
1.00 |
25.00 |
0.25 |
6.25 |
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| 4040-0014 |
Federal Financial Report |
SF-425 |
2,750 |
2.00 |
5,500.00 |
1.50 |
8,250.00 |
SF-425 and 425A – approved under 4040-0014 – Grants. Gov carries the burden. |
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| 3090-0289 |
Tangible Personal Property |
SF-428 |
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Annual Report |
SF-428-A |
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Final Report Form and Instructions |
SF-428-B |
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Disposition Request/Report |
SF-428-C |
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Supplemental Form and Instructions |
SF-428-S |
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| 9000-0045 |
Payment Bond |
SF-25A |
5 |
1.00 |
5.00 |
0.42 |
2.08 |
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TOTAL: |
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9,832 |
21 |
13,064 |
75 |
13,820 |
* |
13,820.08 |
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NONFEDERAL FINANCIAL ASSISTANCE TEMPLATES |
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COOPERATIVE FIRE AGREEMENTS |
FS-1500-7 |
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SUB TOTAL: |
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225 |
1.00 |
225.00 |
3.00 |
675.00 |
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LAW ENFORCEMENT AGREEMENTS |
FS-1500-8 |
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Cooperative Law Enforcement Annual Operating Plan and Financial Plan |
FS-1500-8A |
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SUB TOTAL: |
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174 |
1.00 |
174 |
3.00 |
522 |
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ROADS AGREEMENTS |
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Cooperative Forest Road Agreement |
FS-1500-9 |
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Road Project Agreement |
FS-1500-9A |
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SUB TOTAL: |
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205 |
1.00 |
205 |
4.00 |
820 |
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CHALLENGE COST SHARE AGREEMENTS |
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Challenge Cost-Share Agreement |
FS-1500-10 |
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Master Challenge Cost Share Agreement |
FS-1500-10A |
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Challenge Cost Share Supplemental Project Agreement |
FS-1500-10B |
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Challenge Cost Share Agreement (non-funded) |
FS-1500-10C |
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SUB TOTAL: |
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714 |
1.00 |
714 |
4.00 |
2,856 |
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COLLECTION AGREEMENTS |
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Collection Agreement |
FS-1500-11 |
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Reimbursable Collection Agreement, Rocky Mountain Elk Foundation |
FS-1500-11A |
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Advance Collection Agreement, Rocky Mountain Elk Foundation |
FS-1500-11B |
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Collection Agreement- FERC |
FS-1500-11C |
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SUB TOTAL: |
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975 |
1.00 |
975 |
4.00 |
3,900 |
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RESEARCH AND DEVELOPMENT (R&D) AGREEMENTS |
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Cost-Reimbursable Agreement |
FS-1500-12 |
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Cooperative Research and Development Agreement |
FS-1500-13 |
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Material Transfer Agreement |
FS-1500-13A |
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Nondisclosure Agreement |
FS-1500-13B |
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Joint Venture Agreement |
FS-1500-14 |
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International Joint Venture Agreement |
FS-1500-14A |
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SUB TOTAL: |
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316 |
1.00 |
316 |
4.00 |
1,264 |
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MEMORANDUM OF UNDERSTANDING |
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Memorandum of Understanding |
FS-1500-15 |
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Memorandum of Understanding for Cooperative Frequency Usage |
FS-1500-15A |
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SUB TOTAL: |
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299 |
1.00 |
299 |
3.00 |
897 |
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PARTICIPATING AGREEMENTS |
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Participating Agreement |
FS-1500-16 |
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Master Participating Agreement |
FS-1500-16A |
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Participating Agreement Supplemental Project Agreement |
FS-1500-16B |
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Participating Agreement with an Interpretative Association |
FS-1500-16C |
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Master Participating Agreement with Interpretative Associations |
FS-1500-16D |
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Participating Agreement Supplemental Project Agreement with Interpretative Associations |
FS-1500-16E |
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Participating Agreement for Fuels or Noxious Weed Activities |
FS-1500-16F |
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| NEW |
Participating Agreement (Non-Funded) |
FS-1500-16G |
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SUB TOTAL: |
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962 |
1.00 |
962 |
4.00 |
3,848 |
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STEWARD SHIP AGREEMENTS |
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Master Stewardship Agreement |
FS 1500-21 |
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Stewardship Agreement Supplemental Project Agreement |
FS-1500-21A |
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Stewardship Agreement Financial Plan |
FS-1500-21B |
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Stewardship Agreement |
FS-1500-21C |
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Stewardship Agreement (Short Form) |
FS-1500-21D |
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SUB TOTAL: |
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40 |
1.00 |
40 |
4.45 |
178 |
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TOTAL: |
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3,910 |
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3,910 |
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14,960 |
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FINANCIAL PLANS (OPTIONAL FORMAT) |
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Agreements Financial Plan (Long) |
FS-1500-17A |
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Agreements Financial Plan (Short) |
FS-1500-17B |
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Agreements Financial Plan (Medium Form) |
FS-1500-17C |
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Collection Agreement Financial Plan |
FS-1500-18 |
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SUB TOTAL: |
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3,900 |
1.00 |
3,900 |
0.45 |
1,755 |
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Reports |
Recordkeeping |
Cost |
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% |
No. Resp |
AveResp |
Burden |
AveTime |
Burden |
AveCost* |
Burden |
Cost to Partner |
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| TOTAL: Estimated PRIVATE burden |
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58% |
2,827 |
9.21 |
26,029 |
1.00 |
2,827 |
$33.90 |
28,856 |
$978,202 |
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| TOTAL: Estimated GOVERNMENT Burden |
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41% |
1,998 |
9.21 |
18,400 |
1.00 |
1,998 |
$33.90 |
20,398 |
$691,488 |
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| TOTAL: Estimated INDIVIDUAL Burden |
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1% |
49 |
9.21 |
449 |
1.00 |
49 |
$33.90 |
498 |
$16,866 |
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100% |
4,874 |
9.21 |
44,877 |
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4,874 |
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49,751 |
$1,686,556 |
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| ** Department of Labor, Occupational Employment and Wages, May 2012 (Business Operations Specialist, mean hourly wage- $33.90). Reference Link: http://www.bls.gov/oes/current/oes131199.htm |
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| ** Note that the estimated costs to the recipient are typically allowable cost to the grant or agreement authorized by the applicable cost principle and charged either as an indirect or a direct cost. |
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