Insert in the space provided, in the line which begins, "Under the Authority of Public Law...," the number and the name of the Public Law which authorizes this award. On the line below, enter the title of the pertinent program.

Block 1 - Enter the project title as it appears in the SF-424 or equivalent application/proposal face sheet.

Block 2 - Place a checkmark in the box beside the appropriate financial assistance instrument.

Block 3 - Enter the name, address and telephone number of the applicant/proposer as it appears in the SF-424 or equivalent application/ proposal face sheet.

Block 4 - Enter the instrument number. (See DOE-FAPM.)

Block 5 - Enter the appropriate amendment number. (See DOE-FAPM for guidance.)

Block 6- Enter the starting date and expiration date for the current budget period. If a budget period is being changed, enter the starting date and expiration date for the budget period, as changed.

Block 7 - Enter the starting date and anticipated completion date for the project. If a project period is being changed, enter the starting date and anticipated completion date for the project period, as changed. Block 8- Enter the name and telephone number of the individual designated by the applicant/proposer as the director of the project:

Block 9- Enter the name and telephone number of the individual designated by the applicant/proposer as the contact for all business

matters.

Block 10 - Place a checkmark in the box opposite the term which identifies the type of action being taken. (The terms are defined in the DOE-FAPM.)

Block 11 - Enter the name, address and telephone number of the individual designated by the DOE program office as the project officer.

Block 12 - Enter the name, address and telephone number of the individual/organization who will administer the agreement for DOE.

Block 13 - Place a checkmark in the box beside the applicable recipient type. If the recipient is a for-profit organization also check one of the lower boxes as follows: "C" for Corporation, "P" for Partnership and "SP" for Sole Proprietorship. If the recipient is of a type not indicated place a checkmark in the box beside "Other," and identify the recipient type in the space provided.

Block 14 Enter where indicated, the appropriation symbol, B&R number, Fund Type (FT)/AFP Code (AFP)/Objective Class (OC) and CFA Number from the Procurement/Financial Assistance Request Authorization (DOE Form PR-799A). Completion of Block 14.d. is required only for awards made by Headquarters.

Block 15 - Enter the applicant's/proposer's Federal Employer Identification No. from the SF-424 or equivalent application/proposal face sheet, or if the applicant/proposer is an individual, enter his/her social security number.

0.5. GOVERMENT PRINTING OFFICE: 1901--522-056/4703

Block 16- Entries should be made as follows. (If no dollar entry is appropriate a zero should be entered to indicate there was no error of omission.)

Line a.(1) - Enter the amount of DOE funds obligated by this action. Line a.(2) - Enter the amount of DOE funds not expended in prior budget period(s), if any, authorized by DOE for expenditure in the current budget period.

Line a.(3) - Enter the amount of DOE funds previously obligated in the current budget period.

Line a.(4) - Enter DOE's share of the total approved budget shown on Line a.(6).

Line a.(5) - Enter the recipient's share of the total approved budget shown on Line a.(6).

Line a.(6) - Enter the total approved budget for the current budget period. (Add the amounts in lines a.(4) and a.(5).)

Line b.(1)- Enter the amount of DOE funds obligated in the current budget period. (Add the amounts in lines a.(1) and a.(3).)

Line b.(2) - Enter the amount obligated by DOE in prior budget periods.