(Check appropriate boxes) **PAGE 2**

[ٱ]{dir="rtl"}**THE PERFORMING ORGANIZATION CERTIFIES THAT IT IS:**

**OR**

[ٱ]{dir="rtl"}**THE SPONSORING ORGANIZATION CERTIFIES THAT IT IS:**

Type of Performing/Sponsoring Organization:

(Check one only)

[ٱ]{dir="rtl"} USDA/RE&E Laboratory

[ٱ]{dir="rtl"} Other Federal Research Agency

[ٱ]{dir="rtl"} State Agricultural Experiment Station (SAES)

[ٱ]{dir="rtl"} Land-Grant University of 1862

[ٱ]{dir="rtl"} Land-Grant University of 1890 or Tuskegee University

[ٱ]{dir="rtl"} Private University or College

[ٱ]{dir="rtl"} Public University or College (Non Land-Grant)

[ٱ]{dir="rtl"} Private Profit-making

[ٱ]{dir="rtl"} Private Non-profit

[ٱ]{dir="rtl"} State or Local Government

[ٱ]{dir="rtl"} Veterinary School or College

[ٱ]{dir="rtl"} Cooperative Extension Service

[ٱ]{dir="rtl"} Small Business

[ٱ]{dir="rtl"} Minority Owned Business

[ٱ]{dir="rtl"} Female Owned Business

[ٱ]{dir="rtl"} Individual

[ٱ]{dir="rtl"} Other (specify)

Please provide the organization's/individual's:

Tax Identification Number (TIN)
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}

OR

Employer Identification Number (EIN)
[\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}

OR

Social Security Number (SSN)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

***Agreement No. 58-\_\_\_\_-0-\_\_\_\_ Page 3 of 4***

***Name of Cooperator - City, State***

**OBJECTIVE:**

The objective of this cooperative research project is to\...\...\.....
***(This information is obtained from the AD-416 for soft funds \$25,000
and over. For incoming funds under \$25,000 where an AD-416 is not
required, this information must be obtained from the ADODR).***

**APPROACH:**

***(This information is obtained from the AD-416 for soft funds \$25,000
and over and/or from the ARS-425 under "Type of Work to be Completed".
For incoming funds under \$25,000 where an AD-416 is not required, this
information must be obtained from the ADODR).***

**STATEMENT OF MUTUAL INTEREST**:

Both parties are actively engaged in independent projects which
\...\...\..... ***(Relate to project title).*** The parties agree that
meeting the objectives of this project will strengthen and enhance
ongoing work within the scope of this agreement. ***(Identify
independent and mutual interest in the project)***

**THE SPONSOR AGREES TO:**

1.  Work closely with ARS in planning, conducting and evaluating the
    work outlined below.

2.  Share in the cost of this work effort by contributing \$ payable to
    ARS, [upon execution of this Agreement]{.underline} for the
    development of work described herein. Work will not commence prior
    to payment. If [all]{.underline} funds are not to be received by ARS
    upon execution, an incremental payment schedule is required from the
    Sponsor, at this time, and will be incorporated into the agreement
    below. The final incremental payment is required prior to expiration
    of the agreement.

[  AMOUNT  ]{.underline} [   DATE      ]{.underline}

PAYMENT SCHEDULE [                      ]{.underline}
[                     ]{.underline}

[                      ]{.underline} [                     ]{.underline}

[                      ]{.underline} [                     ]{.underline}

[                      ]{.underline} [                     ]{.underline}

3.  Cite Cooperative Agreement No. , on all checks payable to the U.S.
    Department of Agriculture, Agricultural Research Service. Payment
    should be remitted to the Budget and Fiscal Office whose name and
    address can be found on Form ARS-451.

4.  Conduct at Sponsor facilities and elsewhere as appropriate, work
    directed toward accomplishing the cooperative efforts of the
    agreement. Such activities include:

> a\.
>
> b\.
>
> c\.

***(Clause number 4. is applicable only if the Sponsor is going to
perform and have specific duties and responsibilities necessary for
successful completion of the project objective(s)).***

**ARS AGREES TO:**

1.  Work closely with the Sponsor in planning, conducting and evaluating
    the work outlined in this cooperative agreement.

2.  Conduct work directed toward accomplishing the cooperative efforts
    of this agreement. Such activities include:

> a\.
>
> b\.
>
> c\.

***(Outline specific duties and responsibilities necessary for
successful completion of the project objectives).***

3.  Assign personnel, equipment, supplies, transportation, and
    facilities as needed to this cooperative effort. Such equipment and
    facilities will remain the property of ARS subject to its
    disposition.

**MUTUAL AGREEMENTS:**

***Use this section to apply terms/conditions that: (1) are unique to
the agreement or Sponsor and are not already referenced in the general
provisions (Form REE-22, or (2) have precedence and justifiably
supercede the TFCA/RCA General Provisions' (REE-22).***