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NEA 3/7/16
SAMPLE IN-KIND CONTRIBUTION FORMS
Page 1 of 5
Instructions:
Use the templates, or a similar form, on pages 2 and 3 to document in-kind contributions. In-kind
contributions are third-party donations of goods, facilities, or services used to meet the matching
requirement for an NEA award. Your organization is not required to use these exact forms if your
organization has other means to record the data.
Do not include property, facilities, or services contributed by your own organization. The third-party
donations must be necessary and reasonable for the project, and allowable per 2 CFR 200 Uniform
Guidance Subpart E – Cost Principles.
On the form, show how the value of each contribution was determined by filling in the appropriate
boxes.
For donated goods,
provide a description and number of items,
date provided, and
the total fair market value of the items;
For facilities,
the published rental rate and hours or dates the facility was used.
For volunteer services (one person per form),
list the number of hours worked,
date(s) of service,
type of service, and
rate of pay.
Examples of completed in-kind contribution reports are on pages 4 and 5 – Example A and B.
All in-kind items reported must:
Be provided by a third-party, either an individual or an organization, not the grant recipient.
Be for allowable costs and activities that were included in your approved project budget.
Be supported by documentation that corroborates the fair market value of the goods or
services provided.
While you may use allowable third-party in-kind contributions to meet the matching requirement for
your award, you cannot be reimbursed by the NEA for in-kind donations.
Additional guidance regarding in-kind contributions is located in 2 CFR 200 Uniform Guidance. See
especially, §200.306 Cost sharing or matching (b), (d) – (j).
See also the “General Terms and Conditions” and “How to Manage Your NEA Award Handbook” at
http://arts.gov/grants/manage-your-award.
If you have questions, please contact the Grants & Contracts Office at grants@arts.gov or (202) 682-
5403.
NEA 3/7/16
SAMPLE IN-KIND CONTRIBUTION FORMS
Page 2 of 5
GRANTEE ORGANIZATION:
Organization:
NEA Award #:
Project:
Authorizing Official:
Email:
Contact Person:
Email:
To the best of our knowledge the below goods and/or services were donated to our organization in support
of the project and are allowable costs per the approved project budget and 2 CFR 200 - Subpart E Cost
Principles.
DONOR DATA:
Donor’s Name (Print):
Donor’s Email:
Phone #:
Description of Donated Goods or Facilities
Date Provided
or Used
Fair Market
Value
TOTAL:
2 CFR §200.306
(j) For third-party in-kind contributions, the fair market value of goods and services must be documented and to
the extent feasible supported by the same methods used internally by the non-Federal entity.
$0
NEA 3/7/16
SAMPLE IN-KIND CONTRIBUTION FORMS
Page 3 of 5
GRANTEE ORGANIZATION:
Organization:
NEA Award #
Project:
Authorizing Official:
Email:
Contact Person:
Email:
To the best of our knowledge, the below volunteer performed the listed service(s) on the specified
date(s) and times.
VOLUNTEER DATA:
Volunteer’s Name (Print):
Volunteer’s Email:
Phone #
Date(s) of
Service:
Total
Hours
Worked:
Location(s) of Service:
Service Performed:
Fair Market
Value of
Service:
TOTAL
Rate based on:
2 CFR §200.306
(e)… Rates for third-party volunteer services must be consistent with those paid for similar work by the non-
Federal entity. In those instances in which the required skills are not found in the non-Federal entity, rates must
be consistent with those paid for similar work in the labor market in which the non-Federal entity competes for
the kind of services involved.
(j) For third-party in-kind contributions, the fair market value of goods and services must be documented and to
the extent feasible supported by the same methods used internally by the non-Federal entity.
$0
NEA 3/7/16
SAMPLE IN-KIND CONTRIBUTION FORMS
Page 4 of 5
EXAMPLE A
GRANTEE ORGANIZATION:
Organization:
Museum of Art
NEA Award #:
12-3456-7891
Project:
Exhibition and workshops
Authorizing Official:
Email:
thumb@otto.net
Contact Person:
Marcy Toe
Email:
toe@otto.net
To the best of our knowledge the below goods and/or services were donated to our organization in support
of the project and are allowable costs per the approved project budget and 2 CFR 200 - Subpart E Cost
Principles.
DONOR DATA:
Donor’s Name (Print):
Joe’s Supply Company. Owner Joe Smith
Donor’s Email:
joe@joessupplycompany.bus
Phone #:
555-555-5555
Description of Donated Goods or Facilities
Date Provided
or Used
Fair Market
Value
Paper
4/12 - 16/16
$50.00
Table Rentals
4/12- 16/16
$250.00
TOTAL:
$300.00
2 CFR §200.306
(j) For third-party in-kind contributions, the fair market value of goods and services must be documented and to
the extent feasible supported by the same methods used internally by the non-Federal entity.
NEA 3/7/16
SAMPLE IN-KIND CONTRIBUTION FORMS
Page 5 of 5
EXAMPLE B
GRANTEE ORGANIZATION:
Organization:
Art Center
NEA Award #
19-8765-4321
Project:
Summer Festival
Authorizing Official:
Tom Thumb
Email:
thumb@artcenter.net
Contact Person:
Marcy Toe
Email:
toe@artcenter.net
To the best of our knowledge, the below volunteer performed the listed service(s) on the specified
date(s) and times.
VOLUNTEER DATA:
Volunteer’s Name (Print):
Sally Doe
Volunteer’s Email:
doe@otto.net
Phone #
555-555-5555
Date(s) of
Service:
Total Hours
Worked:
Location(s) of Service:
Service Performed:
Fair Market
Value of
Service:
8/1/16-8/5/16
20
Art Center Gallery
Docent
$200.00
TOTAL
$200.00
Rate based on:
Center’s written policy of $10.00 an hour for tour leaders and docents.
2 CFR §200.306
(e)… Rates for third-party volunteer services must be consistent with those paid for similar work by the non-
Federal entity. In those instances in which the required skills are not found in the non-Federal entity, rates must
be consistent with those paid for similar work in the labor market in which the non-Federal entity competes for
the kind of services involved.
(j) For third-party in-kind contributions, the fair market value of goods and services must be documented and to
the extent feasible supported by the same methods used internally by the non-Federal entity.
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