10-903 LWCF Description and Notification Form

NPS Form 10-903 (rev. 12/2019)
National Park Service

OMB Control No. 1024-0031
Expiration Date xx/xx/xxxx

DESCRIPTION AND NOTIFICATION FORM
Land and Water Conservation Fund

State

Grant #

Amend #

For NPS
Use:

Date Received

Date Approved

Start Date

End Date

Grant Name
Sub-Grantee Agency
Sub-grantee Address

Email:

Co-Sponsor Agency
Co-Sponsor Address
Type

Select One

A = Acquisition
D = New Development
R = Renovation Dev.

Acreage Acquired

Park Name

P = Planning
C = Combination
S = Stewardship

Donated Acres

Sponsor

Federal Acquisition
$ Share

L = Local
C = County
S = State

Number of Parks *

Federal Acquisition
% Share

PARK INFORMATION (SITE 1)
Park County
Park City

Park Street Address
New LWCF Acres at Park

Select One

Source of Match
Fed
State
Local

Zip Code
Cong. Dist.

Existing LWCF Acres
at Park

Total LWCF Acres
at Park

Latitude

+4 Zip Code

Prior LWCF Assistance?
Yes
No
Longitude

SPECIAL INDICES
Leased land – federal
Leased land – non-federal (public)
Leased land – private

Leased land - expired
Transferred to federal agency
Less than fee title

National Historic Register
National Natural Landmark
National Historic Landmarks

School park
National Recreation Trail

FACILITY CATEGORIES
CAMPING
Individual camp sites
Group campground
Cabins/yurts
ATHLETICS/SPORTS
Field sports
Diamond sports
Court sports
Firearms and archery
Golf
Disc Golf
Equestrian
Skateboard/BMX
Track
Winter Sports

AQUATIC
Beach
Pool
Spray feature
Fishing
Boating
Marina
TRAILS
Hiking/Nature
Equestrian
Bicycle
Off-Road
Water
Fitness
Trailhead

INDOOR SUPPORT BUILDING
Administration/Maintenance
Restroom/Bathhouse
Concession/Score Box
Visitor or Interpretive Center
LAND MANAGEMENT
Restoration
Lake Impoundment
Stream Improvement
Wildlife Habitat
SHELTERED/ENCLOSED
Shelter
Pool or Ice Rink
Other Recreation:

RECORDS RETENTION – PERMANENT ACTIVE (NPS Records Schedule, National Assistance Programs (Item 8.A.2)
(N1-79-08-7))

INFRASTRUCTURE
General Site Improvements
Individual Picnic Sites
Group Picnic Shelter/Pavilion
Lighting
Utilities
Parking/Roads
Signage/Exhibits
Amphitheater
Community garden
Dog Park
Energy Conservation
Park entry plaza
Playground
HUNTING
NATURAL AREA
PASSIVE PARK
OTHER:

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NPS Form 10-903 (Rev. 11/2019)
National Park Service

OMB Control No. 1024-0031
Expiration Date xx/xx/xxxx

DESCRIPTION AND NOTIFICATION FORM
Continuation Sheet

Site #

Park Name

Grant #

Park County

PARK INFORMATION
Park City

Zip Code

Park Street Address
New LWCF Acres at Park

Cong. Dist.
Existing LWCF Acres
at Park

Total LWCF Acres
at Park

+4 Zip

Prior LWCF Assistance?
Yes
No

Latitude

Longitude

SPECIAL INDICES
Leased land – federal
Leased land – non-federal (public)
Leased land – private

Leased land – expired
Transferred to federal agency
Less than fee title

National Historic Register
National Natural Landmark
National Historic Landmarks

School park
National Recreation Trail

FACILITY CATEGORIES
CAMPING
Individual camp sites
Group campground
Cabins/yurts
ATHLETICS/SPORTS
Field sports
Diamond sports
Court sports
Firearms and archery
Golf
Disc Golf
Equestrian
Skateboard/BMX
Track
Winter Sports

AQUATIC
Beach
Pool
Spray feature
Fishing
Boating
Marina
TRAILS
Hiking/Nature
Equestrian
Bicycle
Off-road vehicles
Water
Fitness
Trailhead

INDOOR SUPPORT BUILDING
Administration/Maintenance
Restroom/Bathhouse
Concession/Score Box
Visitor or Interpretive Center
LAND MANAGEMENT
Restoration
Lake impoundment
Stream improvement
Wildlife habitat
SHELTERED/ENCLOSED
Shelter
Pool or Ice Rink
Other recreation:

INFRASTRUCTURE
General site improvements
Individual picnic sites
Group picnic shelter/pavilion
Lighting
Utilities
Parking/Roads
Signage/Exhibits
Amphitheater
Community garden
Dog Park
Energy Conservation
Park entry plaza
Playground
HUNTING
NATURAL AREA
PASSIVE PARK
OTHER:

Page 2 of 5

NPS Form 10-903 (Rev. 12/2019)
National Park Service

OMB Control No. 1024-0031
Expiration Date xx/xx/xxxx

DESCRIPTION AND NOTIFICATION FORM
Instructions (Rev. 11/2019)
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 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.
GRANT INFORMATION
State
Grant No.
Amendment No.
Date Received
Approval Date
Start Date
End Date
Grant Name
Element Name

Summery information for the entire grant or amendment regardless of number of specific park areas or parcels
involved.
Enter the appropriate two-digit FIPS State Code (e.g., California = 06)
Enter the five-digit number for the Grant if known, (e.g., 00456; to be verified by NPS)
Enter the sequential Amendment Number (to be verified by NPS).
(Completed by NPS) Enter the date on which an actionable application or amendment request is received by 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.
(Completed by NPS) Enter the date the project application or amendment was approved as shown on the project
agreement or amendment form.
(Completed by NPS) Enter the Start Date of the grant Period of Performance if different from the date used on the SF-424.
If there is a previously approved Waiver of Retroactivity; the waiver approval date is the Start Date.
(Completed by NPS) Enter the End Date of the grant Period of Performance if different from the date used on the SF-424.
Enter Project Title from the agreement document in all caps, not to exceed 50 characters.
Leave blank unless a consolidated project is being amended; use all caps, not to exceed 50 characters.

Sub-grantee Agency

Enter the name of the sub-grantee agency.

Sub-grantee Address

Enter the address of the sub-grantee agency.

Co-Sponsor Agency

If a second agency is a co-signer to the grant (e.g., because the project site is under a lease), enter the name of the cosponsor agency.

Co-Sponsor Address

Enter the address of the co-sponsor

Type

Sponsor

No. of Parks

Acreage Acquired
Donated Acres

Federal Acquisition $
Share

Federal Acquisition %
Share
Source of Match

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 of land.
S = Stewardship: Any post-grant completion action such as a conversion.
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
Identify the number of separate park sites (distinct park units) being assisted under this project. Complete the park
information section for each site, 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).
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)
Indicate to the nearest tenth of an acre that portion of the acreage acquired through donation, if any.
Enter the amount of LWCF 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
“0” should be entered in this field. If the total acres acquired are larger than the donated acres acquired, acquisition
assistance is to be entered.
If LWCF assistance is being provided to cover actual cash outlay for real property purchased, enter the % share of the
purchase price the LWCF assistance will cover.
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.
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NPS Form 10-903 (Rev. 12/2019)
National Park Service

PARK INFORMATION

Park Name

Park County
Park City
Zip + 4 Codes
Park Street Address
Congressional District
Prior LWCF Assistance

New LWCF Acres at Park

Existing LWCF
Acres at Park

Total Number of
LWCF Acres at Park
Latitude/Longitude

Special Indices

Facility Codes

Camping – Individual
Sites
Athletics – Field sports
Diamond sports
Court sports
Firearms and archery
Golf
Equestrian
Winter sports
Aquatic – Boating

OMB Control No. 1024-0031
Expiration Date xx/xx/xxxx

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 site. This information does not
apply to planning 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 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, list all.
Enter the name of the city (or township, etc.) in which the funded park or recreation area is located. For projects not located
within a sub-county jurisdiction, enter the name of the jurisdiction located nearest to the actual park site.
Enter the 5-digit + 4-digit zip codes (if available) in which the funded park or recreation area is located (00000-0000).
Enter the street address of the primary entrance of the park, if available. If there is no formal addresses, the name of the
street only, or an intersection reference (if applicable), could be used.
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.
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 total acreage of the LWCF area that is being newly protected as a result of this grant due to an acquisition, new
development, redevelopment, or a combination project. The area should be clearly shown on the LWCF Boundary Map
and in most cases will include the acreage of the entire park. If the park is already protected under the LWCF and no
acreage is being added, enter 0 (however, one exception might be parks that have expanded since the last time an LWCF
grant was received and the new acreage is being incorporated into the existing LWCF boundary).
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.
If the park is already protected under LWCF, enter the amount of previously protected LWCF 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 LWCF 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 LWCF area.
Enter the total number of LWCF 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.
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 LWCF area as is feasible. In all cases, the coordinates
should correspond to area within the LWCF Boundary. For projects involving linear parks, such as trails, the reference
point should relate to the middle of the trail.
These indices reflect special/unusual features of a proposal. Select all that are relevant. For amendments that 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 categories (primary plus subcategories) as necessary to describe the specific facilities being
developed. For acquisition projects, select only the primary categories (Bolded Text) that represent the future planned
use(s) of the site. For combination projects, select the primary categories plus appropriate subcategories.
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.
Inclusive of tent sites and RV sites
Inclusive of specialized and multi-sport fields for activities like soccer, football, lacrosse, etc. as well as general purpose
playfields
Inclusive of fields for baseball, T-ball, softball, etc.
Inclusive of sports such as tennis, basketball, pickleball, volleyball, and other court-based sports
Inclusive of rifle/pistol ranges, trap/skeet field, archery
Inclusive of 18-hole, 9-hole, par 3, driving range, pitch and putt, and miniature golf
Inclusive of recreation activities that involve horses, including rodeo facilities but excluding trails
Inclusive of facilities and equipment for skiing (lifts, slopes, jumps, snow-making, cross-country trails),
sledding/tobogganing, outdoor ice-skating rinks, and warming huts
Inclusive of launch ramps for motorized and non-motorized boats, docks, berths, boat lifts, other boating access/facilities
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NPS Form 10-903 (Rev. 12/2019)
National Park Service

Fishing

OMB Control No. 1024-0031
Expiration Date xx/xx/xxxx

Inclusive of piers and other fishing access facilities

Trails – Off-road Trail

Inclusive of any off-road motorized vehicle including ATVs and snowmobiles

Land Management -Restoration

Inclusive of activities to rehabilitate land damaged by natural disasters, convert land from a previously developed use, etc.
but excluding landscaping

Stream improvements

Activities designed to improve habitat for sport fish to increase fishing opportunity

Wildlife management

Plantings to support bird or animal species to increase wildlife viewing or hunting opportunity

Infrastructure -- General
site improvements

Landscaping, walkways (connections among recreation facilities), park furniture/equipment (e.g., benches, trash cans)

NOTICES
Paperwork Reduction Act Statement
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), please note the following. This information collection is authorized by the Land and
Water Conservation Fund Act of 1965 (54 U.S.C. 200301 et. seq.). Your response is required to obtain or retain a benefit. We use this information to
record and track grant project details and to analyze trends in requests for program funding. We may not conduct or sponsor and you are not required to
respond to a collection of information unless it displays a currently valid Office of Management and Budget control number. OMB has assigned control
number 1024-0031 to this collection.
Estimated Burden Statement
Public reporting burden for this form is estimated to average 1 hour per response, including the time it takes to read, gather and maintain data, review
instructions, and complete the form. Direct comments regarding this burden estimate, or any aspects of this form, to Phadrea Ponds, Acting NPS
Information Collection Clearance Officer, 1201 Oakridge Drive, Fort Collins, CO 80525. Please do not send your form to this address.

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