Form 10-903 LWCF Description and Notification Form

NPS Form 10-903 (09/2016) OMB Control No. 1024-0031

National Park Service Expiration Date ##/##/####

DESCRIPTION AND NOTIFICATION FORM

Land and Water Conservation Fund

State

Grant #

Amend #

Date Received

Date Approved

Start Date

End Date

     

     

     

     

     

     

     

Grant Name

     

Sub-Grantee Agency

     

Sub-grantee Address

     

Email Address:      

Co-Sponsor Agency

     

Co-Sponsor Address

     

Type

A = Acquisition D = New Development R – Renovation Development

P = Planning C = Combination M = Administration S = Stewardship

Sponsor

L = Local C = County S = State

Number of Parks *      

Acreage Acquired

Donated Acres

Federal Acquisition $ Share

Federal Acquisition % Share

Source of Match

     

     

     

     

Fed State Local

PARK INFORMATION

Park Name

County Name

City Name

Zip Code

+4 Zip Code

     

     

     

     

     

Park Address

Congressional District

Prior LWCF Assistance?

     

     

Yes No

New 6(f) Acres at Park

Existing 6(f) Acres at Park

Total 6(f) Acres at Park

Latitude

Longitude

     

     

     

     

SPECIAL INDICES

A. Leased land – non-federal

G. Transferred to federal agency

N. National Historic Landmarks

U. Utility R.O.W.

B. Leased land - federal

I. Sponsored by Tribe

O. National Heritage Areas

V. American Heritage Rivers

C. Coastal

J. National Historic Register

Q. Railroad R.O.W.

W. Wetlands

D. Leased land - expired

K. National Natural Landmark

R. National river

X. Involved conversion

E. Former federal surplus property

L. Less than fee acquisition

S. School park

Y. Endangered Species

F. Flood plain

M. Mined land

T. National trail

Z. Contingency Reserve

FACILITY CODES

A. 00. CAMPGROUNDS

D. 00. GOLF COURSE

H. 00. TRAILS

N. 00. NATURAL AREA

01. Tent Sites

01. 18 hole

01. Hiking

P. 00. PASSIVE PARKS

02. RV sites

02. Par 3

02. Horse

Q. 00. SUPPORT FACILITY

03. Group campground

03. Driving range

03. Bicycle

01. Walkways

04. Day camp

04. 9 hole

04. Motorized

02. Landscaping

B. 00. PICNIC AREAS

05. Miniature golf

05. Nature

03. Utilities

01. Individual table sites

06. Pitch and putt

06. Fitness

04. Equipment

02. Group shelter/pavilion

E. 00. SWIMMING FACILITIES

J. 00. WINTER SPORTS FACILITIES

05. Roads

C. 00. SPORTS PLAYFIELDS

01. Pool

01. Ski lift

06. Parking

01. General purpose playfields

02. Wading pool

02. Ski slope

07. Lighting

02. Baseball/softball

03. Spray playground/ splash pad

03. Ski jump

08. Signs

03. Football/soccer

04. Swimming beach

04. Sled/toboggan run

09. Restrooms/showers bldg.

04. Tot lot/playground

05. Bathhouse

05. Skating rink

10. Concession building

05. Tennis courts

F. 00. BOATING FACILITIES

06. Ski trails

11. Maintenance building

06. Basketball/other courts

01. Launch ramp

07. Snowmobile trails

R. 00. AMPHITHEATER

07. Rifle/pistol range

02. Berths

08. Warming huts

08. Trap/skeet field

03. Boat lift

K. 00. ENCLOSED SHELTER

S. 00. LAKE IMPOUNDMENT

09. Archery range

G. 00. FISHING FACILITIES

01. Pool

10. Rodeo arena

01. Pier

02. Courts

T. 00. VISITOR CENTER

11. Track facility

02. Stream improvement

03. Picnic

12. Skateboard park

03. Fishing access

04. Ice rink

U. 00. INTERPRETIVE CENTER

M. 00. HUNTING

V. 00. OTHER:      

Site #

Grant #

     

     

PARK INFORMATION

Park Name

County Name

City Name

Zip Code

4-Digit Zip

     

     

     

     

     

Park Address

Congressional District

Prior LWCF Assistance?

     

     

Yes No

New 6(f) Acres at Park

Existing 6(f) Acres at Park

Total 6(f) Acres at Park

Latitude

Longitude

     

     

     

     

SPECIAL INDICES

A. 00. CAMPGROUNDS

D. 00. GOLF COURSE

H. 00. TRAILS

N. 00. NATURAL AREA

01. Tent Sites

01. 18 hole

01. Hiking

P. 00. PASSIVE PARKS

02. RV sites

02. Par 3

02. Horse

Q. 00. SUPPORT FACILITY

03. Group campground

03. Driving range

03. Bicycle

01. Walkways

04. Day camp

04. 9 hole

04. Motorized

02. Landscaping

B. 00. PICNIC AREAS

05. Miniature golf

05. Nature

03. Utilities

01. Individual table sites

06. Pitch and putt

06. Fitness

04. Equipment

02. Group shelter/pavilion

E. 00. SWIMMING FACILITIES

J. 00. WINTER SPORTS FACILITIES

05. Roads

C. 00. SPORTS PLAYFIELDS

01. Pool

01. Ski lift

06. Parking

01. General purpose playfields

02. Wading pool

02. Ski slope

07. Lighting

02. Baseball/softball

03. Spray playground/Splash pad

03. Ski jump

08. Signs

03. Football/soccer

04. Swimming beach

04. Sled/toboggan run

09. Restrooms/Showers bldg.

04. Tot lot/playground

05. Bathhouse

05. Skating rink

10. Concession building

05. Tennis courts

F. 00. BOATING FACILITIES

06. Ski trails

11. Maintenance building

06. Basketball/other courts

01. Launch ramp

07. Snowmobile trails

R. 00. AMPHITHEATER

07. Rifle/pistol range

02. Berths

08. Warming huts

08. Trap/skeet field

03. Boat lift

K. 00. ENCLOSED SHELTER

S. 00. LAKE IMPOUNDMENT

09. Archery range

G. 00. FISHING FACILITIES

01. Pool

10. Rodeo arena

01. Pier

02. Courts

T. 00. VISITOR CENTER

11. Track facility

02. Stream improvement

03. Picnic

12. Skateboard park

03. Fishing access

04. Ice rink

U. 00. INTERPRETIVE CENTER

M. 00. HUNTING

V. 00. OTHER:      

The Description and Notification 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 used 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.

For amendments only relevant portions are to be completed or as noted below.

GRANT INFORMATION	Summary information for the entire grant or amendment regardless of number of specific park areas or parcels involved.
State	Enter the appropriate two-digit FIPS State Code (e.g., California = 06)
Grant No.	Enter the five digit number for the Grant, e.g., 00456 (to be verified by NPS)
Amendment No.	Enter the sequential Amendment Number (to be verified by NPS).
Date Received	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).
Approval Date	Enter the date the project or amendment was approved as shown on the project agreement or amendment form (to be completed by NPS).
Expiration Date	Enter the grant expiration date as shown on the project agreement or amendment form (to be verified by NPS).
Start Date	Enter the Start Date of the grant Period of Performance. If there is a previously approved Waiver of Retroactivity; the waiver approval date is the Start Date.
End Date	Enter the End Date of the grant Period of Performance.
Grant Name	Enter Project Title from the agreement document in all caps, not to exceed 50 characters.
Element Name	Leave blank unless a consolidated project is being amended; use all caps, not to exceed 50 characters.
Sponsor Name	Enter name of grantee or sub-grantee, as applicable.
Address	Enter address of grantee or sub-grantee, as applicable.
Type	Enter the appropriate letter for type of grant. Use the definition below for guidance. A = Acquisition: grants for the acquisition of land or water or interest in land in water. 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. S = Stewardship: Any post-grant completion action such as a conversion.
Sponsor	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
Acreage Acquired	When the project type is either A or C, enter the total numbers of acres to be acquired for the project, rounded to the nearest tenth of an acre, regardless of number of parcels or their location (purchased acres + donated acreage)
Donated Acres	Indicate to the nearest tenth of an acre that portion of the acreage acquired through donation, if any.
Acquisition Assistance	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.
No. of Park Sites	Identify the number of separate park sites (distinct park units) being assisted under this project. Park information for each site is to be completed, using as many continuation sheets as needed. 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).
Total Cost	Enter the estimated total cost of project as shown on the grant agreement. For amendments, enter the total cost of the amendment.
Fund Amount	Enter the LWCF dollar share of the total cost, not to exceed 50 percent. For amendments, enter the LWCF dollar share of the amendment.
Source of Match	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” (e.g., CDBG). Note: the application of a negotiated indirect cost rate requires a State contribution and must be so identified.
PARK INFORMATION	Information related to each park or recreation area impacted by the grant (or added through a conversion). For projects involving more than one park/area, attach a Continuation Sheet for each. This information does not apply to planning and program administration grants.
Park Name	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 development is a named facility within a park (e.g., ABC Tennis Courts within XYZ Park), XYZ Park is to be entered.
County Name	Enter the county in which the funded park or recreation area is located. If in more than one county, list all.
City Name	Enter name of city (township, etc.) in which funded park or recreation area is located. For projects not located within a sub-county jurisdiction, enter name of jurisdiction located nearest to actual park site.
Zip & Zip +4 Codes	Enter the 5-digit + 4-digit zip codes in which the funded park or recreation area is located (00000-0000).
Congressional District	Enter the 2-digit number for the Congressional District in which the funded park or recreation area is located. If in more than one district, list all.
Prior LWCF Assistance	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”.
Latitude/Longitude	Enter the latitude and longitude coordinates in degrees, minutes, seconds, and direction for the park or recreation area. This coordinate 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.
New 6(f) Acres at Park	Enter the total acreage of the 6(f) area that is newly protected under this grant through acquisition, new development, redevelopment, or a combination project. 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.
Existing 6(f) Acres at Park	Enter the previously protected 6(f) acreage at the park or recreation area that is receiving assistance 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 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, existing 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.
Total Number of 6(f) Acres at Park	Enter the total number of 6(f) acres (new + existing) 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 estate at the facility as a result of both current and past LWCF involvement. This number should reflect changes resulting from conversions.
Special Indices	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.
Facility Codes	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 that add or delete facility codes previously entered, overwrite the facility codes originally entered with all those applicable as of the latest amendment.
Creation of a New Park Or Recreation Area (Reserved)	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).

RECORDS RETENTION - PERMANENT. Transfer all permanent records to NARA 15 years after closure. (NPS Records Schedule, Page 1 of 24

National Assistance Programs (Item 8.A.2) (N1-79-08-7))