VA Form 40-0895-3 State or Tribal Government Cemetery Grants Service Space

OMB NUMBER: 2900-0559
Expiration Date: Xxx, 20XX
Respondent Burden: 3 hours

STATE OR TRIBAL GOVERNMENT CEMETERY GRANTS SERVICE
SPACE PROGRAM ANALYSIS - BUILDINGS
PROJECT LOCATION

PROJECT NAME

PROJECT FAI (Federal Application Identifier) NO.

1. SUPPORT FACILITIES
BUILDING NUMBER 1 - SUPPORT FACILITIES - 2,555 NSF
A. PUBLIC INFORMATION CENTER (PIC) 660 NSF (1.12 NG MULTIPLIER)
1. ENTRY VESTIBULE

PROPOSED
BY APPLICANT

VA
CRITERIA

TOTAL VA
ALLOWED

3,090 GSF
740 GSF
150 NSF

with KIOSK (GRAVE LOCATOR)
2. LOBBY
KIOSK CLOSET (Included)

280 NSF
(25 NSF)

ELECTRIC WATER COOLERS (2) (Included)
JANITOR CLOSET with Utility Sink (Included)
3. TOILETS MEN & WOMEN (1 each @ 115 NSF each)
B. ADMINISTRATIVE OFFICES - 1,030 NSF (1.24 NG Multiplier)
1. WAITING ROOM - Seats 4-6 persons
2. RECEPTION/SECRETARY/CEMETERY REPRESENTATIVE
3. CLOSET (coats & storage)
4. OPERATIONS (COPY/WORK/FILES)
5. DIRECTOR
6. CONFERENCE
7. HALL
8. TOILET (1 unisex) wheelchair accessible
9. MECHANICAL/ELECTRICAL/COMMUNICATIONS
C. SHARED/HON GD/MAINTENANCE STAFF - 865 NSF (1.24 NG Multiplier)
1. HONOR GUARD - (meeting room with 1 - 2 tables/chairs)
Kitchenette unit with under counter recycling containers (Included)
Lockers/Bench in changing area (Included)
VA FORM
OCT 2010

40-0895-3

(40 NSF)
230 NSF
1,275 GSF
155 NSF
150 NSF
10 NSF
150 NSF
165 NSF
165 NSF
90 NSF
50 NSF
95 NSF
1,075 GSF
260 NSF
(175 NSF)
(35 NSF)
PAGE 1 OF 3

BUILDING NUMBER 1 - SUPPORT FACILITIES (Continued from previous page)

PROPOSED
BY APPLICANT

VA
CRITERIA

TOTAL VA
ALLOWED

(50 NSF)

Toilet unisex (Included)

605 NSF

2. MAINTENANCE STAFF

(140 NSF)

(1) FOREMAN

(110 NSF)

(2) BOOTS & LOCKERS with bench to change shoes

(10 NSF)

(3) CLOSET (housekeeping)

(75 NSF)

(4) SHOWER & TOILET (1 unisex)

(105 NSF)

(5) HALL

(165 NSF)

(6) BREAK ROOM
BUIDLING NUMBER 2 - MAINTENANCE SERVICE/GARAGE - 2,465 NSF

2,465 NSF
1,365 NSF

A. MAINTENANCE SERVICE AREA

(540 NSF)

1. OPTIONAL WASH BAY #1 (open or open 3 sides or closed)
with Optional wash equipment room TBD

(600 NSF)

2. SERVICE BAY #1/#2
for routine maintenance with work bench at rear or side, heated and air-conditioned by climate
location.
Optional - Heavy lift if equipment is not sent out for maintenance.

(150 NSF)

3. PARTS AND TOOL STORAGE CAGE

(50 NSF)

4. AIR COMPRESSOR ROOM

(25 NSF)

5. FLAMMABLE STORAGE CABINET

1,100 NSF

B. VEHICLE AND EQUIPMENT STORAGE GARAGE
unheated area at most locations

1,025 GSF

BUIDLING NUMBER 3 - COMMITTAL SHELTER

(900 GSF)

1. COVERED AREA - open on 3 sides
with Bier to hold casket, seating for 20 persons, with 2 speakers

(125 GSF)

2. STORAGE closet
locate behind the Bier, with 2 wall sconces and the 5-service seals, locate at the front of the
shelter, include shelf for equipment to play Taps, include storage of cleaning equipment,
pressure wash, include storage to stack extra chairs

200 GSF

3. UNCOVERED PAVED AREA
with standing room for 20-30 additional persons
COMPUTATIONS
PROPOSED BY APPLICANT
VA FORM 40-0895-3, OCT 2010

TOTAL VA ALLOWED
PAGE 2 OF 3

CERTIFICATION: I certify that this accurately reflects the proposed space program analysis for this project.
SIGNATURE OF A & E FIRM REPRESENTATIVE

DATE SIGNED

SIGNATURE OF STATE OR TRIBAL GOVERNMENT PROJECT MANAGER

DATE SIGNED

SIGNATURE OF DESIGNATED STATE OR TRIBAL GOVERNMENT OFFICIAL

DATE SIGNED

SIGNATURE OF STATE CEMETERY GRANTS SERVICE REVIEWER

DATE SIGNED

Respondent Burden: Public reporting burden for this collection of information is estimated to average 3 hours. Statutory authority for a State
Cemetery Grant is 38 U.S.C. 2408. The information requested is necessary to provide documentation on the appropriate size of the building, based
on VA guidance on the net and gross square footage standards for cemetery buildings. VA may not conduct or sponsor and you are not required to
respond to this collection of information unless it displays a valid OMB number. Respond to this collection is voluntary. Send comments regarding
the burden estimate or any other aspects of this collection of information, including suggestions for reducing the burden to VA Clearance Officer
(005R1B), 810 Vermont Avenue NW, Washington, DC 20420. SEND COMMENTS ONLY. Please do not send applications for a grant to this
address.

VA FORM 40-0895-3, OCT 2010

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