NAWI Cost Share Reporting Form

Cash and In-kind cost share are a critical part of our program’s success and are tracked quarterly. Member organizations of the NAWI Alliance have agreed to report the time, travel, and meeting venues they and their staff contribute to support our program. The principal NAWI activities where cost share is anticipated from Alliance members includes: • Roadmapping activities • Attendance at roadmapping planning or execution meetings, conference calls, briefings or webinars • Time spent conducting research in support of roadmapping activities • Time spent preparing, reviewing and revising documents, reports, and other NAWI roadmap products • Travel and attendance at NAWI meetings, webinars, and tours • Travel expenses are allowable cost share contributions up to U.S. Federal per Diem rates • Support for NAWI meetings, webinars, and tours • Providing venues and logistical support for NAWI meetings and workshops • Providing supplies and staff support Allowable Costs: All expenditures must be allowable, allocable, and reasonable in accordance with the applicable Federal cost principles. Refer to the following Federal cost principles for more information: • Federal Acquisition Regulation (FAR) Part 31 for For-Profit entities; and • 2 CFR Part 200 Subpart E - Cost Principles for all other non-federal entities Alliance members may not use Federal funds for cost-sharing obligations unless otherwise allowed by Federal law. If you are a staff member of a Federal Agency, please report your time and other contributions using this form: they may be considered as “leveraged resources” as part of our program financial review. The certifier should be the person who performed the work or went on travel. You may also use a more detailed Excel form to submit (https://drive.google.com/file/d/1UA54tiEHmGIDuVr7ub9kiUuOypP1f-20/view?usp=sharing) to provide labor and travel for multiple personnel and/or trips. For questions, please email nawi-finance@lbl.gov. Thank you for your support!

Labor

Please enter your Last Name and First Name

(e.g. “attended NAWI roadmap team calls, researched treatment cost baselines, corresponded with roadmap team members, drafted and reviewed a summary report on Ocean Desalination”)

Period of Performance

(30-day range max please)

Enter the total hours of all activities during this period

Please select the direct hourly compensation range your organization pays you. DOE/AMO caps the cost share credit at $120/hr.

Select or enter value
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If your organization has an established fringe and overhead rate on your labor hours, please select from the list below the rate closest to, but below that rate. If your organization does not have an established rate, or you are not aware of the current rate, please select “don’t know” and we’ll research this with your organization.

Select or enter value
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Travel

If no travel, skip to the certification section.

(e.g. NAWI Roadmapping Review)

(City, STATE)

(City, STATE)


Venue and Meeting Expenses

If your organization provided meeting space, equipment, supplies, refreshments, staff time for a NAWI meeting, you can claim cost share here.

Please add the venue, location, and how space was used for NAWI (e.g. provided a 90-person conference room, with tables, chairs, projector, screen, and facilities coordinator for 6 hours).

The fair market value of the venue and support for this event.

I certify the cost share information provided is applicable, reasonable, verifiable, and allowable to NAWI and is not from or included as a contribution to any other federally-assisted project or effort.