Agreement for Individual Voluntary Services
(Public Law 92-300, as amended)
1. Name (Print
Last, First, Middle Initial) |
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2. Address (Street,
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3. Description of work to be performed |
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4.
All
of the above described work will be noncompensable. Except as otherwise provided, I understand
this service will not confer on me the status of a federal employee. |
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5.
I understand that either the Forest Service or I may cancel this agreement
at any time by notifying the other party.
I hereby volunteer my services as described above to assist the Forest
Service in its authorized work. |
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6. Signature (Volunteer) |
7. Date |
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8. Signature of Parent or Guardian, if under
18 years of age |
9. Date |
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ACCEPTANCE
FOR THE |
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The Forest
Service agrees while this agreement is in effect to: 1. Reimburse you for necessary incidental
expenses, to the extent funds are available, as follows: |
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a.
Subsistence |
Amount if yes: |
Remarks: |
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b.
Transportation allowance |
Yes |
No |
Rate if yes: |
Remarks: |
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c. Provide
lodging |
Yes |
No |
Remarks: |
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Yes |
No |
Remarks: |
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2. Consider you as a federal employee for the
purpose of tort claims and compensation for work injuries. |
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3.
Authorize you to operate federal motor vehicles when necessary,
provided you are licensed to operate a motor vehicle. |
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4. Signature |
5. Title |
6. Unit |
7. Date |
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Termination of agreement |
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1. Agreement Terminated on (Month, Day, Year) |
2. Signature (Unit Manager/Staff Officer) |
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3. Remarks: |
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ACCOMPLISHMENTS |
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Resource
Category (a) |
NIRP
Code (b) |
Unit
of measure (c) |
Amount
Accomp. (d) |
Hours
Contr. (e) |
Cost
to Govt. (f) |
Appraised
Value
(dollars) (g) |
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Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may
not conduct or sponsor, and a person is not required to respond to a collection
of information unless it displays a valid OMB control number. The valid OMB control number for this information
collection is 0596-0080. The time
required to complete this information collection is estimated to average 15
minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
The
To file a complaint of discrimination, write USDA, Director,
Office of Civil Rights,
Privacy Act Statement
Collection and use is covered by Privacy Act
System of Records USDA/OP-1 and is consistent with the provisions of 5 USC 552a
(Privacy Act of 1974), which authorizes acceptance of the information requested
on this form. The data will be used to
maintain official records of volunteers of the