Note: Upon notification of the selection committee results, prepare a CCSA with
attachments 1 and 2.
1. DOCUMENT CONTROL NUMBER – Enter the document control number provided by the field stations working with the cooperator(s). Use the following format 6XXXX0JXXX (station org code, fiscal year, J, next number in series).
2. PURCHASE REQUEST NUMBER – N/A – (completed).
3. TYPE OF AGREEMENT – N/A – (completed).
4. FWS CHALLENGE COST SHARE ADMINISTRATOR – N/A – (completed).
5. COOPERATOR ADMINISTROR – Enter cooperator information.
6. FWS PROJECT OFFICER – Enter the information of the field Station contact most familiar with overseeing the project.
7. COOPERATOR PROJECT OFFICER – Enter information, as indicated, for cooperator project officer.
8a. PROGRAM STATUTORY AUTHORITY – N/A – (completed).
8b. FUNDING AUTHORITY – N/A – (completed).
9. CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CFDA) – N/A – (completed).
10. DUNS AND EIN/TIN – Only complete if funding is being reimbursed to, or received from, the cooperator. Dun & Bradstreet number information available at www.grants.gov/applicants/request_duns_number.jsp.
11. PROJECT PERIOD – Enter the end date of the period of performance.
12. TYPE OF COOPERATOR(S) – Please check one (or more if more than one type of cooperator).
13. COST SHARE INFORMATION – Enter the amount of CCS funds and matching value from the cooperator(s) in the appropriate box. Also enter CCS accounting data in this format 6XXXX-126X-CXXX (org code; subactivity 1261 or 1263; Project Code) – all of this information is contained in the FY 2010 Challenge Cost Share Approved Project List.
14. PROVISIONS – N/A – (completed by CGS prior to obtaining signatures).
15. PROJECT TITLE AND BRIEF SUMMARY OF THE PURPOSE AND OBJECTIVES – Enter title of project and a brief summary.
Note: After the initial completion of the CCSA, the “Statement of Work” (Attachment 1), and the SF-424 (Attachment 2); forward the documents to the CCS Program Coordinator. Do not obtain the signature of the Cooperator until after the Regional Office (RO) edits and reviews the CCSA. After the CCSA has been reviewed, it will be forwarded back to the field station for the Cooperator’s signature.
Region 6, U.S. Fish and Wildlife Service
Instructions for Completing the Challenge Cost Share Agreement (CCSA)
16a. NAME AND TITLE OF SIGNER – Enter name and title of the cooperator.
16b. COOPERATOR SIGNATURE – Signature of cooperator representative.
16c. DATE SIGNED – Dated signed by cooperator.
Note: Forward the CCSA back the RO after the Cooperator signs the agreement to obtain the Regional Director’s signature. The funding will be obligated thereafter and a finalized official agreement will be forwarded back to the field station.
17a. NAME AND TITLE OF FWS OFFICIAL – N/A – (completed by RO).
17b. U.S. FISH AND WILDLIFE SERVICE BY – Signature of Regional Director.
17c. DATE SIGNED – Date signed by the RD.
Please direct any comments or questions to the CCS Coordinator at 303-236-4376
or James_Graves@fws.gov
