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pdfINSTRUCTIONS FOR COMPLETING THE ANNUAL FINANCIAL REPORT
1 Enter your financial information in the dark grey cells on each of the following worksheets. Cells not highlighted in dark
grey are automatically calculated and should not be changed.
2 Use the tab key or arrow keys to move through the cells in each worksheet.
3 In the "Type of Entity" area on the Concessioner Information worksheet, make the appropriate selection using the
dropdown menu.
4 Manually enter the correct concessioner ID. Concessioner ID's take the form ABCD-###, where ABCD represents the
alphanumeric code for the park and the numbers are a contract number.
5 To move a comment box, place the cursor on the comment box, left click and hold, then drag the comment box to to
another place on the screen.
6 The signature(s) on the Concessioner Info worksheet should be typed rather than written.
7 Do not enter zeroes, NA, dashes or anything else in cells which are not applicable to your operation. Leave these cells
blank.
8 For help, email [email protected]
NPS Form 10-356B (Rev. 12/2019)
OMB Control No. 1024-0029
Expiration XX/XX/XXXX
National Park Service
CONCESSIONER: -
PERIOD ENDING: MM/DD/YYYY
For the Period from:
to:
Concessioner ID
Concessioner Name
Park Unit
Contract or Permit Number
Effective Date
Expiration Date
Type of Entity
Schedule N - Special Account Annual Reconciliation
Schedule O - Special Account Project Expenditures
TABLE OF CONTENTS
Schedule R - Add-On Reconciliation
ANNUAL FINANCIAL STATEMENT CERTIFICATION (Either one or both of the certifications below may be completed)
COMPLETE THE CERTICATION BELOW IF YOU ARE THE CONCESSIONER AND COMPLETED THE ANNUAL FINANCIAL REPORT
By typing my name below, I certify that I am authorized to complete and submit this report. This report has been examined by me and to the best of my knowledge
and belief is a true, correct, and complete report.
Name of Person Responsible for Report Information
Title
Date
COMPLETE THE CERTIFICATION IF YOU ARE A CPA WHO HAS EITHER COMPILED, REVIEWED OR AUDITED THE CONCESSIONER'S FINANCIAL STATEMENTS AND
HAVE COMPLETED THE ANNUAL FINANCIAL REPORT.
By typing my name in the box below, I certify that I have been authorized to complete and submit this report on behalf of the concessioner. This report has been
completed and prepared under my supervision using data/information from the company's compiled/reviewed/audited financial statements and/or other financial
records and to the best of my knowledge and belief is a true, correct, and complete report.
Name of Person Responsible for Report Information
Title
Date
CONCESSIONER CONTACT INFORMATION
Mailing Address
City
State
Zip Code
Telephone
Email Address
RECORDS RETENTION. TEMPORARY. Destroy/Delete 3 years after closure. (NPS Records Schedule, Commercial Visitor Services, (Item 5D) (N1-79-08-4))
NPS Form 10-356B (Rev. 12/2019)
National Park Service
OMB Control No. 1024-0029
Expiration XX/XX/XXXX
NOTICES
PRIVACY ACT STATEMENT
Authority: 16 U.S.C. 5966, Commercial Use Authorizations.
Purpose: The purposes of the system are (1) to assist NPS employees in managing the NPS Commercial
Services program allowing commercial uses within a unit of the National Park System to ensure that business
activities are conducted in a manner that complies with Federal laws and regulations; (2) to monitor resources
that are or may be affected by the authorized commercial uses within a unit of the National Park System; (3) to
track applicants and holders of commercial use authorizations who are planning to conduct or are conducting
business within units of the National Park System; and (4) to provide to the public the description and contact
information for businesses that provide services in national parks.
Routine Uses: In addition to those disclosures generally permitted under 5 U.S.C.552a(b) of the Privacy Act,
records or information contained in this system may be disclosed outside DOI as a routine use pursuant to 5
U.S.C. 552a(b)(3) to other Federal, state and local governments, tribal organizations, and members of the
general public upon request for names, addresses and phone numbers of Commercial Use Authorizations
(CUA) holders conducting business within units of the National Park System for the purpose of informing the
public of the availability of the services offered by the CUA holder. In addition, records or information contained
in this system may be disclosed outside DOI based on an authorized routine use when the disclosure is
compatible with the purpose for which the records were compiled as described under the system of records
notice for this system.
Disclosure: Voluntary, however, failure to provide the requested information may impede our ability to 1)
manage the National Park Service (NPS) Commercial Services Program allowing commercial uses within a unit
of the NPS, 2) monitor resources that are or may be affected by the authorized commercial uses, and 3) provide
the public the description and contact information for businesses that provide services in national parks.
PAPERWORK REDUCTION ACT STATEMENT
We collect this information under the authority of Title IV of the National Parks Omnibus Management Act of
1998 (Pub. L. 105–391). We use this information to determine the franchise fees of the concessioner. Your
response is required to obtain or retain a benefit. We may not collect or sponsor and you are not required to
respond to a collection of information unless it displays a currently valid OMB control number. OMB has
approved this collection of information and assigned Control No. 1024-0029.
ESTIMATED BURDEN STATEMENT
We estimate that it will take you 2 hours to complete this form, including time to review instructions, gather and
maintain data, and complete and review the form. You may send comments on the burden estimate or any
aspect of this form to the Information Collection Clearance Officer, National Park Service, 1201 Oakridge Drive,
Fort Collins, CO 80525. Please do not send your completed form to this address.
CONCESSIONER: -
SUPPLEMENTAL SCHEDULE N - SPECIAL ACCOUNT ANNUAL RECONCILATION
PERIOD ENDING: MM/DD/YYYY
CALCULATION OF ANNUAL SPECIAL ACCOUNT
CONTRIBUTION
1 Account Description (CIA, GIA, Campground, etc.)
A
B
Total All Columns
C
(Account Description) (Account Description)
2 Calculation Method (Flat Fee, Percentage, or Mixed)
(Calculation Method) (Calculation Method)
3
4
5
6
7
8
9
10
Dollar Amount (If Stated in the Authorization)
Gross Receipts Pursuant to Account
Less - Adjustments to Gross Receipts
Gross Receipts Subject to Fee Calculation
Special Account Percentage of Gross Receipts
Amount Due to Special Account for Percentage Fee
(Describe Other Method)
Accrued Amount Due to Special Account for the Current
Year (Carry to Schedule A, Line 10)
11 Current Year Special Account Expenditures (Schedule O,
Line 40)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
13
14
15
16
17
SPECIAL ACCOUNT COMBINED RECONCILIATION
Balance in Special Account from Prior Year
Plus: Current Year Deposits
Less: Current Year Expenditures
Plus: Current Year Interest
Less: Current Year Bank Charges
Balance in Special Account at Year End
0
0
0
0
0
0
18
19
20
21
22
23
ALLOCATION OF YEAR END BALANCE
(List Encumbered Project and Amount)
(List Encumbered Project and Amount)
(List Encumbered Project and Amount)
Total Encumbered Project Amount
Total Unencumbered Balance
Total Encumbered and Unencumbered Amount
0
0
0
0
0
0
DEPOSIT RECONCILIATION
24 Deposits for Prior Year Liabilities
25 Deposits for Current Year Liabilities
26 Total Deposits Made in Current Year
0
0
0
27 Accrued Liability not yet Deposited for Current Year
0
28 Accrued Amount Due to Special Account for the Current
Year
0
0
0
0
0
0
0
0
EXPENDITURES RECONCILIATION
29 Expenditures for Prior Year Liabilities
30 Expenditures for Current Year Liabilities
31 Total Expenditures
Page 4
CONCESSIONER: -
SUPPLEMENTAL SCHEDULE N - SPECIAL ACCOUNT ANNUAL RECONCILATION
PERIOD ENDING: MM/DD/YYYY
PERIOD ENDING: MM/DD/YYYY
CALCULATION OF ANNUAL SPECIAL ACCOUNT
CONTRIBUTION
1 Account Description (CIA, GIA, Campground, etc.)
A
D
Total All Columns
E
(Account Description) (Account Description)
2 Calculation Method (Flat Fee, Percentage, or Mixed)
(Calculation Method) (Calculation Method)
3
4
5
6
7
8
9
10
Dollar Amount (If Stated in the Authorization)
Gross Receipts Pursuant to Account
Less - Adjustments to Gross Receipts
Gross Receipts Subject to Fee Calculation
Special Account Percentage of Gross Receipts
Amount Due to Special Account for Percentage Fee
(Describe Other Method)
Accrued Amount Due to Special Account for the Current
Year (Carry to Schedule A, Line 10)
11 Current Year Special Account Expenditures (Schedule O,
Line 40)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
13
14
15
16
17
SPECIAL ACCOUNT COMBINED RECONCILIATION
Balance in Special Account from Prior Year
Plus: Current Year Deposits
Less: Current Year Expenditures
Plus: Current Year Interest
Less: Current Year Bank Charges
Balance in Special Account at Year End
0
0
0
0
0
0
18
19
20
21
22
23
ALLOCATION OF YEAR END BALANCE
(List Encumbered Project and Amount)
(List Encumbered Project and Amount)
(List Encumbered Project and Amount)
Total Encumbered Project Amount
Total Unencumbered Balance
Total Encumbered and Unencumbered Amount
0
0
0
0
0
0
DEPOSIT RECONCILIATION
24 Deposits for Prior Year Liabilities
25 Deposits for Current Year Liabilities
26 Total Deposits Made in Current Year
0
0
0
27 Accrued Liability not yet Deposited for Current Year
0
28 Accrued Amount Due to Special Account for the Current
Year
0
0
0
0
0
0
0
0
EXPENDITURES RECONCILIATION
29 Expenditures for Prior Year Liabilities
30 Expenditures for Current Year Liabilities
31 Total Expenditures
Page 5
CONCESSIONER: -
SUPPLEMENTAL SCHEDULE N - SPECIAL ACCOUNT ANNUAL RECONCILATION
PERIOD ENDING: MM/DD/YYYY
PERIOD ENDING: MM/DD/YYYY
CALCULATION OF ANNUAL SPECIAL ACCOUNT
CONTRIBUTION
1 Account Description (CIA, GIA, Campground, etc.)
A
F
Total All Columns
G
(Account Description) (Account Description)
2 Calculation Method (Flat Fee, Percentage, or Mixed)
(Calculation Method) (Calculation Method)
3
4
5
6
7
8
9
10
Dollar Amount (If Stated in the Authorization)
Gross Receipts Pursuant to Account
Less - Adjustments to Gross Receipts
Gross Receipts Subject to Fee Calculation
Special Account Percentage of Gross Receipts
Amount Due to Special Account for Percentage Fee
(Describe Other Method)
Accrued Amount Due to Special Account for the Current
Year (Carry to Schedule A, Line 10)
11 Current Year Special Account Expenditures (Schedule O,
Line 40)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12
13
14
15
16
17
SPECIAL ACCOUNT COMBINED RECONCILIATION
Balance in Special Account from Prior Year
Plus: Current Year Deposits
Less: Current Year Expenditures
Plus: Current Year Interest
Less: Current Year Bank Charges
Balance in Special Account at Year End
0
0
0
0
0
0
18
19
20
21
22
23
ALLOCATION OF YEAR END BALANCE
(List Encumbered Project and Amount)
(List Encumbered Project and Amount)
(List Encumbered Project and Amount)
Total Encumbered Project Amount
Total Unencumbered Balance
Total Encumbered and Unencumbered Amount
0
0
0
0
0
0
DEPOSIT RECONCILIATION
24 Deposits for Prior Year Liabilities
25 Deposits for Current Year Liabilities
26 Total Deposits Made in Current Year
0
0
0
27 Accrued Liability not yet Deposited for Current Year
0
28 Accrued Amount Due to Special Account for the Current
Year
0
0
0
0
0
0
0
0
EXPENDITURES RECONCILIATION
29 Expenditures for Prior Year Liabilities
30 Expenditures for Current Year Liabilities
31 Total Expenditures
Page 6
CONCESSIONER: -
SUPPLEMENTAL SCHEDULE O - SPECIAL ACCOUNT PROJECT EXPENDITURES
PERIOD ENDING: MM/DD/YYYY
Project Number
Special Account Name
Project Description
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40 TOTAL SPECIAL ACCOUNT PROJECT EXPENDITURES
Page 7
Estimated
Percent
Complete
Current Year
Expenditures
0
SUPPLEMENTAL SCHEDULE R - ADD-ON RECONCILIATION
CONCESSIONER: -
Type
PERIOD ENDING: MM/DD/YYYY
Location
Amount Approved
Collected Amount Over/Under AFR Reference*
Notes
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
*Identify which Schedule(s) and Line(s) each add-on or pass-through is Reported on in the AFR
Page 8
Schedule N, Calculation Method
Flat Fee
Percentage
Mixed
Schedule K, Type
C
G
L
I
M
P
Concessioner Info, Type of Entity
C Corporation
S Corporation
B Corporation
Limited Liability Company
Partnership
Sole Proprietorship
Other
| File Type | application/pdf |
| File Modified | 2019-12-10 |
| File Created | 2019-11-04 |