State Sources of Non-federal Matching Share Report

OMB Control Number: 1024-0038

Expiration Date: XX/XX/2017

EXHIBIT 25-A SOURCES OF NONFEDERAL MATCHING SHARE REPORT

(TO BE SUBMITTED ONLY WITH THE END-OF-YEAR REPORT)

STATE: FISCAL YEAR: ___ DATE: ___ AMENDMENT:

Each State shall supply the following data on nonfederal matching share. Documentation on file with the State should support the total amount claimed as contributed during the fiscal year for the matching share.

TOTAL MATCHING FUNDS CONTRIBUTED

DURING THE LAST FISCAL YEAR

DONATED

SOURCE OF MATCH CASH ($) SERVICES & PROPERTY ($)

FEDERAL............................................

STATE..................................................

REGIONAL.............................................

TRIBAL..................................................

COUNTY...............................................

MUNICIPAL............................................

CERTIFIED LOCAL GOVERNMENT.............

*EDUCATIONAL INSTITUTION...................

*NONPROFIT...........................................

*COMMERCIAL ORGANIZATION................

*PRIVATE...............................................

TOTAL

* Indentify sources and amount of match on a separate sheet of paper.

Paperwork Reduction Act Statement. We (National Park Service) collect this information as part of the process for reviewing the procedures and programs of State, tribal, and local governments participating in the national historic preservation program and the Historic Preservation Fund grant program. The information is required to obtain or retain a benefit. We use the information to evaluate those programs and procedures for consistency with the National Historic Preservation Act, as amended, (16 U.S.C. 470 et seq.) and compliance with Governmentwide grant requirements. We provide no assurance of confidentiality with the exception of some location information concerning some properties included in government historic preservation property inventories. Pursuant to Section 304 of the National Historic Preservation Act of 1966, as amended, release of information is tightly controlled when such release could have the potential of damaging those qualities that make a property historic.

A Federal agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The Office of Management and Budget has reviewed and approved these information collection requirements and assigned OMB Control Number 1024-0038. We estimate that it will take you 2.25 hours to complete the Non-Federal Sources Report, including time for reviewing instructions, searching existing data sources, gathering the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Service Information Collection Clearance Officer, National Park Service, 1849 C Street, NW. (2600), Washington, DC 20240

Guidelines for Completing the Sources of Nonfederal Matching Share Report

1. Each blank must be filled in, even if the entry is "zero" or "not applicable."

2. The word "contributed" refers to matching funds disbursed for activities performed during the fiscal year. This includes matching share for activities assisted with funds carried over from the previous fiscal year. It does not include matching share contributed in the following fiscal year. Contributed funds that are NPS-­approved pre-agreement costs for the following year's grant should not be included in this year's Report. List only allowable nonfederal share of cash, goods, services, or property.

3. The "Federal" source line means Community Development Block Grant or other Federal funds that, by the law governing those funds, may be used as nonfederal share to match other Federal grants (such as Historic Preservation Fund grants). See Chapter 14, Section M. Do not enter the HPF grant award in this Report (Sources of Nonfederal Matching Share Report).

4. "Regional" refers to nonfederal, governmental organizations or agencies (e.g., Councils of Government) that have a jurisdiction that is greater than local or municipal but less than Statewide.

5. "Nonprofit" refers only to organizations officially recognized as nonprofit by the Internal Revenue Service.

6. "Tribal" refers only to Federally recognized Indian tribes or Native Alaskan groups.

7. The "Commercial Organization" source line means any "for profit" business organization.

8. The "Private" source line means an individual or family unit not contributing as a "nonprofit" or "commercial organization."

9. The grand total must at least equal the total nonfederal matching share as shown on the SF 424 (plus funds carried over from the previous fiscal year) minus any matching share that is to be used to match the HPF funds carried over into the following year. To qualify as "overmatch," additional funds must be listed on the SF 424 and SF 424A Budget Forms, not just on this Report.

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