FSPIAP-NewProjectProposal-Form-2023.pdf

1 | PageFS-4000-0006 Project Number:

Project Summary (Briefly describe the project being developed) (limit 1,000 characters):

FS-PIAP Priorities Addressed (check all that apply)

Advancement in the proper use of pesticides (efficacy, efficiency, training, safety, etc.) because it is Forest Service policy to base actual and recommended uses of pesticides on analysis of effectiveness, specificity, environmental impacts, human exposure and economic efficiencies.

Proposals that address the efficacy and benefits of new uses of pesticides being considered for management of invasive and native forest pest insects, diseases, and plants.

Environmental toxicity, fate; soil mobility and uptake/metabolism, with emphasis on priority pesticides and/or adjuvants.

Year 1 FS-PIAP Total Year 2 FS-PIAP Total Total FS-PIAP Funds Total Funds (All)

Proposed Budget Summary (This table is auto-generated from Budget Information sections)

Years of Funding Requested: Final Year of Project:

Project Title:

Project Number:

Program Admin Region Submission (FY)* Additional Project ID Report Type

Project Information * The Submission (FY) refers to the current Fiscal Year.

Form Instructions: When copy and pasting into text fields please paste as “plain text”.

FOREST SERVICE PESTICIDE IMPACT ASSESSMENT PROGRAM (FS-PIAP)

NEW PROJECT PROPOSAL

Has this proposal been submitted to another FHP Special Project Program? YES NO

If yes, please list the Program and FY the project was submitted:

New Project (NP)

Year 3 FS-PIAP Total

2 | PageFS-4000-0006 Project Number:

Provide overview of proposed project (e.g. Who, What, How, When...) (limit 5,000 characters):

Background - Background, Justification, and Research Basis (i.e. Describe the forest management problem addressed, describe the importance of identified data gaps, research leading up to this approach, and identify how proposal will further forest pest management.) (limit 5,000 characters):

Project Details

3 | PageFS-4000-0006 Project Number:

Products/Measures of Success (e.g. Provide timeline of expected project accomplishments and enumerated deliverables) (limit 1,000 characters):

Describe proposed technology transfer and the expected impacts to Forest Health/Forest Management (e.g. How will the results be shared and how will it influence current forestry management?) (limit 2,500 characters):

Methods (limit 5,000 characters):

4 | PageFS-4000-0006 Project Number:

Citations of Relevant Research (5,000 characters):

5 | PageFS-4000-0006 Project Number:

* Funds allocated for “Travel to Meetings” in year 1 will only be approved for proposals requesting a single year of funding.

** Non-Federal Matching (cost sharing) funds are raised from outside sources to increase the level of support provided by the Federal Government. This includes both cash and in-kind contributions.

*** Leveraged Funds are raised from outside sources to increase the level of support provided by the Federal Government (including cash and in-kind contributions) beyond the non-Federal matching requirements.

Year 1 Notes (1,000 characters):

Overhead Rate % (Describe in Notes): Year 1 Total:

Budget Type Budget Requested FS-PIAP Funding Non-Federal Match** Leveraged Funds*** Match Source Leveraged Source

ADMINISTRATION Salary

Travel for Data Collection

Travel to Meetings*

Travel for Other

PROCUREMENT Contracting

Equipment

Supplies

INDIRECT Overhead

Other

SUBTOTAL

Fiscal Year (FY):

Year 1 Budget Information (For a summary of total project costs, see page 1)

6 | PageFS-4000-0006 Project Number:

Year 2 Notes (1,000 characters):

Overhead Rate %: Year 2 Total:

Budget Type Budget Requested FS-PIAP Funding Non-Federal Match Leveraged Funds Match Source Leveraged Source

ADMINISTRATION Salary

Travel for Data Collection

Travel to Meetings

Travel for Other

PROCUREMENT Contracting

Equipment

Supplies

INDIRECT Overhead

Other

SUBTOTAL

Year 2 Budget Information (For a summary of total project costs, see page 1)

7 | PageFS-4000-0006 Project Number:

Year 3 Notes (1,000 characters):

Overhead Rate %: Year 3 Total:

Budget Type Budget Requested FS-PIAP Funding Non-Federal Match Leveraged Funds Match Source Leveraged Source

ADMINISTRATION Salary

Travel for Data Collection

Travel to Meetings

Travel for Other

PROCUREMENT Contracting

Equipment

Supplies

INDIRECT Overhead

Other

SUBTOTAL

Year 3 Budget Information (For a summary of total project costs, see page 1)

8 | PageFS-4000-0006 Project Number:

Project Contacts (a single Funding Coordinator must be selected)

FHP Sponsor

Title:

Phone:

Time commitment:

Name:

Institution/Office:

Email:

Project Role: Funding Coordinator:

Principal Investigators

Title:

Phone:

Time commitment:

Name:

Institution/Office:

Email:

Project Role: Funding Coordinator:

Name: Title:

Institution/Office: Phone:

Email: Time commitment:

Project Role: Funding Coordinator:

Name: Title:

Institution/Office: Phone:

Email: Time commitment:

Project Role: Funding Coordinator:

Cooperators

Title:

Phone:

Time commitment:

Name:

Institution/Office:

Email:

Project Role: Funding Coordinator:

Name: Title:

Institution/Office: Phone:

Email: Time commitment:

Project Role: Funding Coordinator:

Name: Title:

Institution:/Office Phone:

Email: Time commitment:

Project Role: Funding Coordinator:

9 | PageFS-4000-0006 Project Number:

Keywords (limit 250 characters):

List additional documents being submitted in support of the project (e.g., letters from stakeholders, spreadsheets, human subject certification coordinated with US-EPA Human Studies Review Panel (if project involves human exposure)) (limit 2,000 characters):

Additional Documents and Keywords https://www.epa.gov/osa/human-studies-review-board