10-902 LWCF Project Agreement Form

LAND AND WATER CONSERVATION FUND STATE ASSISTANCE PROGRAM 54 U.S.C. §200301 et seq

10-902A LWCF Amendment to Project Agreement Form Draft 2023 Update

Grant Application

OMB: 1024-0031

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NPS Form 10-902A (Rev. 8/2023) OMB Control No. 1024-0031

National Park Service Expiration Date XX/XX/20XX


AMENDMENT TO PROJECT AGREEMENT

Land and Water Conservation Fund




Shape1 State:

Shape2 Project Amendment No.



Shape4 Shape3 THIS AMENDMENT to Project Agreement No. [Legacy # / FBMS #] is hereby made and agreed upon by the United States of America, acting through the Director of the National Park Service and by the State of pursuant to the Land and Water Conservation Fund Act of 1965, 78 Stat. 897 (1964).


The State and the United States, in mutual consideration of the promises made herein and in the agreement of which this is an amendment, do promise as follows:


That the above mentioned agreement is amended by adding the following:














In all other respects the agreement of which this is an amendment, and the plans and specifications relevant thereto, shall remain in full force and effect. In witness thereof the parties hereto have executed this amendment as of the date entered below.


THE UNITED STATES OF AMERICA STATE OF ______________________________________


Shape6 Shape5 By By

(Signature) (Signature)


Shape8 Shape7

(Title) (Title)

National Park Service

Shape9

United States Department of the Interior

(Agency)


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Date


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 document changes made to original grant agreement following the close-out of the grant. 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 hours per response including the time it takes to read, gather data, review instructions, and complete the form. Direct comments regarding this burden estimate, or any aspects of this form, to the Information Collection Clearance Officer, National Park Service, 13461 Sunrise Valley Drive, Mail Stop 244, Reston, VA 20192. Please do not send your form to this address.


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



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBaucum, Madonna
File Modified0000-00-00
File Created2023-10-05

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