Fillable GRANT AND COOPERATIVE AGREEMENT CLOSEOUT CHECKLIST (Office of Surface Mining)

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GRANT AND COOPERATIVE AGREEMENT CLOSEOUT CHECKLIST (Office of Surface Mining)

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BROWSE OFFICE OF SURFACE MINING (DC) FORMS

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GRANT AND COOPERATIVE AGREEMENT CLOSEOUT CHECKLIST
Grant Recipient _________________________________________________
Type of Grant: Regulatory (A&E)_____ Abandoned Mine Land_____
Watershed Cooperative Agreement_____
Other_____________________________________________
Grant Identifiers: Grant Number_____________________
Application Number_________________
Date Complete Closeout Information Received__________
Grant Closeout Due Date___________________________
Part A. Has the Recipient:
Y
N
NA
1. Stated in the transmittal that it considers the grant to be complete, that payments from
OSM for all allowable costs have been made, and that OSM is released from all obligations
under or arising from the grant?
2. Submitted an inventory of federally-owned property received under the grant?
3. Submitted an inventory of grant-purchased property requesting disposal or transfer to
another grant?
4. Reported program income and sale of equipment in accordance with the program
income option in the grant award?
Part B. Has the OSM Reviewing Office:
Y
N
NA
1. Reviewed documentation of in-kind services?
2. Checked that expenditures and drawdowns agree with amounts in FBMS?
3. Prepared a brief written evaluation of the recipient’s performance and placed a copy in
the grant file?
4. Approved the transfer or disposition of grant-purchased property to another grant?
5. Reconciled the inventory of federally-owned property reported to OSM records, and
approved the transfer to a subsequent grant?
6. Closed the grant or processed the final amendment?
GRANT AND COOPERATIVE AGREEMENT CLOSEOUT CHECKLIST - Continued
Part C. Closeout Documentation
DATE
Evaluation Report (Monitoring Statement)
Inventory of Grant-Purchased Equipment
Inventory of Federally-Owned Equipment
Closeout Checklist
Other Documents (Explain)
Part D. Financial Information
DATE
Amount Awarded
Less Expenditures
Amount Deobligated
$
$
$
Downtime, please explain:
Prepared by Date Prepared ____________
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GRANT AND COOPERATIVE AGREEMENT CLOSEOUT CHECKLIST (Office of Surface Mining)

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Completed 10 August 2020

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