10-903 LWCF Description and Notification Form

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

10-903 LWCF Description and Notification Form 2023 Update Final Draft

Conversion of Use

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NPS Form 10-903 (rev. 8/2023) OMB Control No. 1024-0031

National Park Service Expiration Date XX/XX/20XX

DESCRIPTION AND NOTIFICATION FORM

Land and Water Conservation Fund

State

Legacy Grant #

Amend #

For NPS

Date Received

Date Approved

Start Date

End Date

Use:

Grant Name

Sub-Grantee Agency

Sub-grantee Address

Email:

Co-Sponsor Agency

Co-Sponsor Address

Type

A = Acquisition

D = New Development

R = Renovation Dev’t.

P = Planning

C = Combination

S = Stewardship

Sponsor

L = Local

C = County

S = State

Number of Parks *

Acreage Acquired

Donated Acres

Federal Acquisition

$ Share

Federal Acquisition

% Share

Source(s) of Match

Fed State Local

PARK INFORMATION (SITE 1)

Park Name

Park County

Park City

Zip Code

+4 Zip Code

Park Street Address

Cong. Dist.

Prior LWCF Assistance?

Yes No

New LWCF Acres at Park

Existing LWCF Acres

at Park

Total LWCF Acres

at Park

Latitude

Longitude

SPECIAL INDICES

Leased land – federal

Leased land - expired

National Historic Register

School park

Leased land – non-federal (public)

Transferred to federal agency

National Natural Landmark

National Recreation Trail

Leased land – private

Less than fee title

National Historic Landmarks

Sponsored by Tribal Gov’t

FACILITY CATEGORIES

CAMPING

AQUATIC

INDOOR SUPPORT BUILDING

INFRASTRUCTURE

Individual camp sites

Beach

Administration / Maintenance

General site improvements

Group campground

Pool

Restroom / Bathhouse

Individual picnic sites

Cabins/yurts

Spray feature

Concession / Score Box

Group picnic shelter/pavilion

Fishing

Visitor or Interpretive Center

Lighting

ATHLETICS/SPORTS

Boating

Utilities

Field sports

Marina

LAND MANAGEMENT

Parking / Roads

Diamond sports

Restoration

Signs / Exhibits

Court sports

TRAILS

Lake impoundment

Amphitheater

Firearms and archery

Hiking / Nature

Stream improvement

Community garden

Golf

Equestrian

Wildlife habitat

Dog park

Disc Golf

Bicycle

Energy conservation

Equestrian

Off-road vehicles

SHELTERED/ENCLOSED

Park entry plaza

Skateboard/BMX

Water

Shelter

Playground

Track

Fitness

Pool or Ice Rink

Winter sports

Trailhead

Other recreation:

HUNTING

NATURAL AREA

PASSIVE PARK

OTHER:

DESCRIPTION AND NOTIFICATION FORM

Instructions (Rev. 8/2023)

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	Summery 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)
Legacy Grant No.	Enter the five-digit legacy number for the grant if known, (e.g., 00456; to be verified by NPS)
Amendment No.	Enter the sequential amendment number, if applicable (to be verified by NPS).
Date Received	(Completed by NPS) Enter the date on which an actionable application or amendment request was 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.
Approval Date	(Completed by NPS) Enter the date the project application or amendment was approved as shown on the project agreement or amendment form.
Start Date	(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.
End Date	(Completed by NPS) Enter the End Date of the grant Period of Performance if different from the date used on the SF-424.
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.
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 co-sponsor agency.
Co-Sponsor Address	Enter the address of the co-sponsor
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 of land. 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
No. of Parks	Identify the number of separate park sites (distinct park units) being assisted under this project. Complete the park information section for each site separately, 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).
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.
Federal Acquisition $ Share	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.
Federal Acquisition % Share	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.
Source(s) of Match	Identify the source(s) of the non-LWCF share of the project cost by selecting the appropriate box(es). Other federal programs authorized by law to serve as non-federal cost share 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 site. This information does not apply to planning grants.
Park Name	Enter the official name of the park or recreation area (XYZ Park, Recreation Area, State Natural Area, etc.). If unknown, enter a generic name as a place holder for subsequent correction. Do not repeat descriptors often found in the Grant Name that 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.
Park County	Enter the county in which the funded park or recreation area is located. If in more than one county, list all.
Park City	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.
Zip + 4 Codes	Enter the 5-digit + 4-digit zip codes (if available) in which the funded park or recreation area is located (00000-0000).
Park Street Address	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.
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.”
New LWCF Acres at Park	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, if the park has expanded since the last time an LWCF grant was received, the additional acreage being incorporated into the existing LWCF boundary would count as new acres). 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 LWCF Acres at Park	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.
Total Number of LWCF Acres at Park	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.
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 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.
Special Indices	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.
Facility Codes	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.
Camping – Individual Sites	Inclusive of tent sites and RV sites
Athletics – Field sports	Inclusive of specialized and multi-sport fields for activities like soccer, football, lacrosse, etc. as well as general purpose playfields
Diamond sports	Inclusive of fields for baseball, T-ball, softball, etc.
Court sports	Inclusive of sports such as tennis, basketball, pickleball, volleyball, and other court-based sports
Firearms and archery	Inclusive of rifle/pistol ranges, trap/skeet field, archery
Golf	Inclusive of 18-hole, 9-hole, par 3, driving range, pitch and putt, and miniature golf
Equestrian	Inclusive of recreation activities that involve horses, including rodeo facilities but excluding trails
Winter sports	Inclusive of facilities and equipment for skiing (lifts, slopes, jumps, snow-making, cross-country trails), sledding/tobogganing, outdoor ice skating rinks, and warming huts
Aquatic – Boating	Inclusive of launch ramps for motorized and non-motorized boats, docks, berths, boat lifts, other boating access/facilities
Fishing	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
Sheltered/Enclosed	If the project is to construct only the shelter but not the underlying pool or ice rink, check shelter only. If the project is inclusive of the shelter AND the pool or ice rink, check both categories. If the DNF is being submitted with a sheltered facility request, check Shelter and Other Recreation and provide the type of recreation that will be sheltered.
Infrastructure -- General site improvements	Landscaping, walkways (connections among recreation facilities), park furniture/equipment (e.g., benches, trash cans)

RECORDS RETENTION – PERMANENT ACTIVE (NPS Records Schedule, National Assistance Programs (Item 8.A.2) (N1-79-08-7)) Page 1 of 31

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Baucum, Madonna
File Modified	0000-00-00
File Created	2023-10-05