DOE O 412.1

4-20-99

**U.S. DEPARTMENT OF ENERGY**

**FIELD WORK PROPOSAL**

<table style="width:100%;">
<colgroup>
<col style="width: 26%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 2%" />
<col style="width: 0%" />
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<col style="width: 9%" />
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<col style="width: 0%" />
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<tbody>
<tr class="odd">
<td colspan="3"><p><strong>1. Work Proposal Number:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="6"><p><strong>2. Revision Number:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="3"><p><strong>3. Date Prepared:</strong></p>
<p><strong>     </strong></p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="8"><p><strong>4. Work Proposal Title:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p><strong>5. Budget and Reporting Code:</strong></p>
<p><strong>     </strong></p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="12"><strong>6. Work Proposal Term: Begin <u>     </u> End
<u>      </u></strong></td>
<td></td>
</tr>
<tr class="even">
<td colspan="8"><p><strong>7. Name: (Last, First, MI) (Phone
Number)</strong></p>
<p><strong>DOE Program Manager</strong></p>
<p><strong>     </strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p><strong>8. DOE Organization:</strong></p>
<p><strong>     </strong></p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="8"><p><strong>9. DOE Field Element Work Proposal
Reviewer:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p><strong>10. DOE Field Element:</strong></p>
<p><strong>     </strong></p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="8"><p><strong>11. Contractor Work Proposal
Manager:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="4"><p><strong>12. Contractor Name:</strong></p>
<p><strong>     </strong></p></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="12"><p><strong>13. Proposal Description (Approach,
Anticipated Benefit in 200 Words or Less):</strong></p>
<p><strong>     </strong></p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"><strong>14. Contractor Work Proposal
Manager:</strong></td>
<td colspan="7"><strong>15. DOE Field Element Official:</strong></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td colspan="3"><strong>     </strong></td>
<td colspan="6"><strong>     </strong></td>
<td><strong>     </strong></td>
<td></td>
</tr>
<tr class="even">
<td><strong>(Signature)</strong></td>
<td></td>
<td colspan="2"><strong>(Date)</strong></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"><strong>(Signature)</strong></td>
<td></td>
<td colspan="2"><strong>(Date)</strong></td>
</tr>
<tr class="odd">
<td colspan="12"><p><strong>16. Detail Attachments: ( See
Attachments)</strong></p>
<p> <strong>a. Facility Requirements</strong> <strong>f. Technical
progress</strong> <strong>k. Deliverables</strong></p>
<p> <strong>b. Publications</strong> <strong>g. Future
Accomplishments</strong> <strong>l. Perform
measures/expectations</strong></p>
<p> <strong>c. Purpose</strong> <strong>h. Relationships to Other
Projects</strong> <strong>m. ES&amp;H Considerations</strong></p>
<p> <strong>d. Background</strong> <strong>i. NEPA Requirements</strong>
<strong>n. Human/Animal Subjects</strong></p>
<p> <strong>e. Approach</strong> <strong>j. Milestones</strong>
<strong>o. Other (Specify)</strong></p></td>
<td></td>
</tr>
</tbody>
</table>

DOE O 412.1

4-20-99

**WORK PROPOSAL REQUIREMENTS FOR OPERATING/EQUIPMENT**

**OBLIGATIONS AND COSTS**

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<td colspan="4"><p><strong>Contractor Name:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="3"><p><strong>Work Proposal #:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="3"><p><strong>Rev. No.:</strong></p>
<p><strong>     </strong></p></td>
<td colspan="2"><p><strong>Date Prepared:</strong></p>
<p><strong>     </strong></p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2"><strong>Prior Years</strong></td>
<td colspan="2"><strong>BY -1</strong></td>
<td colspan="3"><strong>Budget Year</strong></td>
<td><strong>BY + 1</strong></td>
<td colspan="2"><strong>BY + 2</strong></td>
<td><strong>Total to Complete</strong></td>
</tr>
<tr class="odd">
<td><strong>17. Staffing (staff years):</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td><strong><u>Request</u></strong></td>
<td colspan="2"><strong><u>Authorized</u></strong></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="3"><p>a. Scientific</p>
<p>b. Other Direct</p>
<p>c. Total Direct</p></td>
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="odd">
<td><strong>18. Operating Expense:</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="even">
<td rowspan="2"><p>a. Total Obligations</p>
<p>b. Total Costs</p></td>
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td><strong>19. Equipment:</strong></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td>a. Equipment Obligations</td>
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="even">
<td>b. Equipment Costs</td>
<td colspan="2"><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
<td colspan="2"><strong>     </strong></td>
<td><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="2"><strong>20. Milestone Schedule:</strong></td>
<td colspan="6"><u>Proposed</u></td>
<td colspan="4"><u>Authorized</u></td>
</tr>
<tr class="even">
<td colspan="2"><strong>     </strong></td>
<td colspan="6"><strong>     </strong></td>
<td colspan="4"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="12"><p><strong>21. Reporting Requirements
(Description):</strong></p>
<p><strong>     </strong></p></td>
</tr>
</tbody>
</table>

DOE O 412.1

4-20-99 **DOE FIELD WORK PROPOSAL INSTRUCTIONS**

A. The two page DOE Field Work Proposal is optional but may be required
by a program office for planning and budget formulation. It may be used
as all or part of the documentation of a Work Authorization. The form
may also be used by an M&O contractor to describe prospective work. The
form is intended to provide an overview of the effort, including each of
the tasks

necessary for project completion. Proposals should be limited to a
single project to allow reporting of costs, obligations, and other
information.

B. Page 1 of the Form.

**Item 1.** Enter a unique seven character number for the proposal. The
first two characters of this number are to signify the DOE
organizational code used when assigning regular contract numbers, such
as EM, SC, and DP. The third character is to be the letter

"W." The remaining four characters will be a unique sequential number
assigned by the requesting organization.

**Item 2.** If the initial proposal is changed, a revision is indicated
by placing a number in this space, starting with the number "1\" and
proceeding in sequence.

**Item 3.** The month, day, and year on which form is prepared; for
example: 10/01/99.

**Item 4.** A descriptive title of the work being proposed.

**Item 5.** The B&R Code in accordance with the B&R

Classification Codes set forth on the Chief Financial Officer home page,
[www.cfo.doe.gov](http://www.cfo.doe.gov/).

**Item 6.** The start and estimated completion date of the proposal. Use
a two-numerical format for month, day, and yea; for example: 10/01/99.
For proposals initiated for an indefinite period of time, the completion
date should be shown as "OPEN."

**Item 7.** When known, enter the name and phone number of the DOE
Program Manager responsible for the overall program.

**Item 8.** The DOE HQ Office responsible for the overall program.

**Item 9.** When known, enter the name and phone number of the DOE Field
Office individual responsible for reviewing the proposal.

**Item 10.** The DOE Field element responsible for the work

proposal.

**Item 11.** When known, enter the name and phone number of the M&O
contractor individual responsible for the proposal.

**Item 12.** Enter the name of the M&O contractor responsible for the
proposal.

**Item 13.** A description of the proposal in 200 words or less,
highlighting the purpose, approach, and anticipated benefits the
proposal will provide in the program's mission.

**Item 14.** The signature of the contractor representative

responsible for the proposal and the date are to be entered when the
proposal is given to the reviewing official.

**Item 15.** The signature of the reviewing official and the date are to
be entered when the proposal is forwarded to the Program Manager.

**Item 16.** Detailed attachments are to be completed if they are
necessary to understand or will enhance the proposal. Any attachments
accompanying the proposal should be indicated by checking the
appropriate blocks. Each attachment page should include the contractor
name, the proposal number, and the date prepared.

a\. Facility requirements. If execution of the proposal requires the use
of existing or approved facilities, briefly describe the required use
and location, with associated gross square footage and impact on site
utility services by fiscal year in which the proposal begins and each
subsequent fiscal year during the anticipated life of the

proposal. Facility needs will be reviewed in context of overall site
planning and utilization and expressed in terms of space function: e.g.,
office, storage space, site utilities, etc.

b\. Publications. List all publications pertaining to the proposal
during the prior fiscal year. Provide the title or subject and planned
date of publications of all topical reports over the life of the
proposal. Periodic progress reports are to be listed in this section.

c\. Purpose. Provide the reason(s) for the proposal and the objectives
that will accomplish the stated purpose. The objective(s) should be the
single highest level of measurable achievement that can serve as a
criterion for measuring the success or failure of the proposal.

d\. Background. Present a brief historical overview of the proposal or
preview work or theories that have led to the proposal.

e\. Approach. Explain the management controls and methodology that will
be used to execute the proposal in all fiscal years.

f\. Technical Progress. Attach the last Technical Progress Report if
required by the DOE program. Also, describe the technical progress in
BY-3 (the last complete fiscal year) and expected progress for BY-2,
BY-1, and BY.

g\. Future Accomplishments. Describe any anticipated benefits that will
accrue in the future which are attributable to the proposal.

h\. Relationship to Other Projects. Provide a description of any
relationships, interrelationships or dependencies which the proposal has
with other known Federally-funded projects.

i\. NEPA Considerations. In accordance with the National

Environmental Policy Act of 1969, describe the long-term and short term
potential impacts and effects of the work package upon the ecosystem and
NEPA documentation that must be prepared.

j\. Milestones (if applicable). A detailed explanation of the

milestones presented on the second page of the proposal (item 20) should
be given. For basic research, the only milestone may be the submission
of a yearly progress report.

k\. Deliverables. An itemized list of deliverables under the proposal
excluding reports in item 21.

l\. Performance measures and expectations. A description of the
performance measures described as outcomes and the expectations for
achieving those measures by which the success of the proposal will be
measured.

m\. ES&H Considerations. A description of the ES&H hazards arising from
performance of the proposed work and mitigating actions to protect the
workers, public and the environment.

n\. Human/Animal Subjects Research. Briefly describe any anticipated
human subjects or animal subjects research activity that may occur as
part of the proposed work.

o\. Other. Any other attachments should be specified in the space
provided on the work package form.

C. Page 2 of the Form - General. Header information on this page should
be filled in as it appears on page 1. The "Authorized" column is not
completed unless requested by the program when funds have been
authorized. The column heading designations on page 2 of the

DOE Field Work Proposal Form are defined below. The

relationship between the Fiscal Years (FY) for which information is
being provided is illustrated in the table below. Prior Years. For
proposals related to projects, information for all prior years in which
work has been performed should be provided to allow total project cost
and other information to be calculated. This column is optional and
should only be completed when requested by the program in the program
guidance.

**Item 17.** Designate personnel staffing in full time equivalent
person-years. Enter the numbers of scientific and other direct
person-years for all columns.

**Item 18.** Enter estimates for total obligations and total costs per
year for all columns. This should include inventories.

**Item 19.** Enter estimates for total obligations and total costs per
year for all columns for equipment directly related to the proposal.

**Item 20.** Enter the titles of the supporting tasks in the "Milestone
Schedule" column. Each task should be followed by the total obligations
in thousands of dollars in the "Proposed BY" column. The dates (MO/YR)
on which the tasks are projected for start and completion should be
entered in the "Proposed Schedule" columns,

will be completed if requested by the Program Manager, when funds have
been authorized. Based on the allocation of funds, enter the dates for
the planned start and completion of the respective tasks when requested.

**Item 21.** Enter all reporting required for the proposed work to
include a description and frequency for each report.

CALENDAR YEAR THAT DOE PREPARED BUDGET (BY)

> 2000 2001 2002 2003

BY-3 FY 1999 FY 2000 FY 2001 FY 2002

BY-2 FY 2000 FY 2001 FY 2002 FY 2003

BY-1 FY 2001 FY 2002 FY 2003 FY 2004

BY FY 2002 FY 2003 FY 2004 FY 2005

2001 2002 2003 2004

CALENDAR YEAR THE CONGRESS CONSIDERS BUDGET (BY)