ATT5-FWSForm3-2460_01-06-17.pdf

U.S. Fish and Wildlife Service Checklist for a New Financial Assistance Award

FWS 3-2460

January 6, 2017

Program Title:

DUNS Number:

(Enter date)

RESPONSE

1.

3.

4.

A.

B.

5.

6.

7.

8.

9.

10.

For each checklist item, select a response from the drop down list provided in the Response box. Where provided, select related statements from the drop down lists and use the checkboxes to indicate the location of required file documentation.

(Enter any program-generated application #)

CFDA Number:

Recipient Name:

Follow the instructions in the "Issuing a New Financial Assistance Award Guidance" posted on the Intranet at https://inside.fws.gov/go/post/FASOPOL-NewAwards to complete this form. Maintain the completed form in the official award file.

Recipient Type (select from drop down):

2.

(In perf. period start date field, enter "Signature date" or specific start date)

CHECKLIST ITEM

Perf. Period Start Date: Perf. Period End Date:

Funding tool evaluation: The project to be funded is financial assistance and not a contract/acquisition. The primary purpose of the award is to support or stimulate activities that are not for the direct benefit/use by the Service.

Program Application #:

Pre-award costs: Pre-award costs are approved under this award. The recipient’s written pre-award cost request will be maintained in the official award file.

Conflict of interest certifications: Not applicable to mandatory awards (select "N/A-MAND"). For this discretionary award, all staff and peer reviewers, evaluators, panel members, or advisors participating in the review/selection were provided a copy of DOI- AAAP-0008 and signed the required DOI conflict of interest certification. Signed certifications related to this award will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

Merit review: Not applicable to mandatory awards (select "N/A-MAND"). For this discretionary award, a merit review of this project was conducted following the requirements in DOI-AAAP-0009. All merit review documentation related to this award will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

All related documentation will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

Posted: A complete NOFO for the program/single source award was posted on Grants.gov. The required print screens dated prior to award will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

Indirect cost rate circumstance: Not applicable to awards to individuals (select "N/A-INDV"). For this award to an entity other than an individual, the applicant's indirect cost circumstance was considered during the budget review. The final approved budget and notice of award reflect those considerations. The recipient is (select the applicable circumstance from the drop down list):

Budget review: A budget review was conducted and documented following the requirements in DOI-AAAP-0062. All related documentation will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

Complete and final application: This award is made based on an approved application that: 1) includes complete and signed SF 424 Application (or OMB-approved alternate), SF 424 Assurances, and SF LLL Lobbying (if applicable) forms; 2) includes a complete SF 424, Budget form and a budget narrative (or OMB-approved alternates); 3) matches the award to be made in regards to funding amount and project scope; and 4) will be maintained in the official award file.

Single source award: This is a discretionary single source award meeting one or more criterion under 516 FW 6. A signed FWS Form 3-2452 will be maintained in the official award file.

Grants.gov NOFO (select either "Posted" or "Not Posted", and then complete either 4A or 4B below, as applicable to the award):

Not posted: a NOFO was not posted on Grants.gov. The justification for not posting a NOFO to Grants.gov is that the award is (select from the drop down list):

Award instrument determination: A determination was made. The financial assistance award instrument to be used is a (select from the drop down list):

Project Title:

The Service has authority to issue financial assistance awards under this program. See the Authorization section of the program’s CFDA.gov profile for authorizing legislation.

Grants.gov Funding Opportunity #:

U.S. Fish and Wildlife Service Checklist for a New Financial Assistance Award

FWS 3-2460

January 6, 2017

RESPONSE

11.

12.

13.

14.

15.

16.

19.

20.

NOTE: To save a locked or “flattened” version of this form once completed, print the file to PDF by selecting File>Print>Adobe PDF Printer (from the Printer drop down list). Following these steps will remove all fillable features and save the unique data entered on the form at the time it is printed.

Printed Name of person signing

Agreements Officer Sign and Date

Printed Name of person signing

I, as the last point of review before funds are obligated, certify that all required pre-award actions and documentation are complete.

All related documentation will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

Overlap/Duplication review: Not applicable to mandatory awards (select "N/A-MAND"). For this discretionary award, the applicant's required overlap/duplication statement was reviewed and any related concerns or issues along with specific recommendations for resolution will be maintained in the official award file.

17. SAM.gov registration status: Not applicable to awards to individuals (select "NA-INDV"). For this award to an entity other than an individual, the recipient’s SAM.gov registration status was reviewed prior to award. The entity (select from the drop down list):

18. SAM.gov Exclusions search: A search of the SAM Exclusions database was conducted for the intended recipient and key/principal project personnel on the same day as and prior to funds obligation. The results were that (select from the drop down):

The required dated SAM Exclusions search/review screen prints documenting the search/review results will be maintained in the official award file.

Payment method establishment: All steps required in the “Establishing a Recipient’s Payment Method Guidance” are complete.

Notice of award: A notice of award, either on the PRISM Cover Page or as a letter following the "Notice of Award Letter Template", was generated and signed by the authorized Service representative. A copy will be maintained in the official award file.

CHECKLIST ITEM

All related documentation will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

Risk assessment: FWS Form 3-2462 was completed. Monitoring activities will be incorporated into the notice of award following the requirements in the Service’s “Recipient Risk Assessment Guidance”. The completed form will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

I, as the last point of review before this award is passed to the Agreements Officer for obligation, certify that all pre-award actions and documentation that the program is required to complete are complete.

Program Representative Sign and Date

Section 106 NHPA review: A Section 106 NHPA review was conducted. The NHPA circumstance for this award is (select from the drop down list):

NEPA review: A NEPA review was conducted. The NEPA circumstance for this award is (select from the drop down list):

Section 7 ESA review: A Section 7 ESA review was conducted. The Section 7 ESA circumstance for this award is (select from the drop down list):

As applicable to the above circumstance, the required approved SAM waiver or SAM Entity Overview screen print dated prior to award showing an “Active” registration will be maintained in the official award file.

Legal review: An Office of the Solicitor review was requested. A copy of the request and any response received will be maintained in the official award file.

All related documentation will be maintained in the (check one): ____ official award file or ____ centralized subject-matter file.

FWS New Award