united states government order form - fs form 7600b · 2020. 10. 19. · title: united states...

United StateS government interagency agreement (iaa) agreement Between Federal agencies order requirements and Funding information (order) Section LEAD. TRANSFORM. DELIVER.

IAA Number Servicing Agency’s Agreement GT&C # Order # Amendment # / Mod # Tracking Number (Optional)

PRIMARY ORGANIZATION /OFFICE INFORMATION 24. Requesting Agency Servicing Agency Primary Organization / Office Name Responsible Organization / Office Address

ORDER REQUIREMENTS INFORMATION 25. Order Action (Check One)

New

Modification (Mod) - List affected Order blocks being changed and explain the changes being made. For Example: for a performance period mod, state the new performance period for this Order in Block 27. Fill out the Funding Modification Summary by Line (Block 26) if the mod involves adding, deleting, or changing Funding for an Order Line.

Cancellation - Provide a brief explanation for Order cancellation and fill in the Performance Period End Date for the effective cancellation date.

26. Funding Modification Summary by Line

Line # Line # Line # Total of All Other Lines (attach

funding details)

Total

Original Line Funding Cumulative Funding Changes From Prior Mods [addition (+) or reduction (-)] Funding Change for This Mod TOTAL Modified Obligation Total Advance Amount (-) Net Modified Amount Due

27. Performance Period Start Date End Date For a performance period mod, insert MM-DD-YYYY MM-DD-YYYY the start and end dates that reflect the new performance period.

FS Form 7600B (04-12) Department of the Treasury | Bureau of the Fiscal Service June 2017 - page 1 of 5

Description of Products and/or Service,



28. Order Line / Funding Information Line Number Requesting Agency Funding Information Servicing Agency Funding Information

ALC Component TAS (required by 10/1/2014)

SP ATA AID BPOA EPOA A MAIN SUB SP ATA AID BPOA EPOA A MAIN SUB

and/or current TAS format BETC Object Class Code (Optional) BPN BPN + 4 (Optional) Additional Accounting Classification / Information (Optional) Requesting Agency Funding Expiration Date

MM-DD-YYYY

Requesting Agency Funding Cancellation Date

MM-DD-YYYY

Project Number & Title

including the Bona Fide Need for this Order (State or attach a description of products/services, including the Bona Fide need for this Order.)

North American Industry Classification System (NCAIS) Number (Optional) Breakdown of Reimbursable Line Costs and/or Breakdown of Assisted Acquisition Line Cost: Unit of Measure Contract Cost

Quantity Unit Price Total Servicing Fees Total Obligated Cost

Overhead Fees and Charges Advance for Line (-)

Total Line Amount Obligated Net Total Cost

Advance Line Amount (-) Assisted Acquisition Servicing Fees Explanation

Net Line Amount Due

Type of Service Requirements

Severable Service Non-Severable Service Not Applicable


United StateS government interagency agreement (iaa) agreement Between Federal agencies order requirements and Funding information (order) Section

IAA Number Servicing Agency’s Agreement Tracking Number (Optional) GT&C # Amendment # / Mod # Order #

29. Advance Information (Complete Block 29 if the Advance Payment for Products/Services was checked“Yes”on the GT&C)

Total Advance Amount for the Order [All Order Line Advance amounts (Block 28) must sum to this total.]

Revenue Recognition Methodology (according to SFFAS 7)(Identify the Revenue Recognition Methodology that will be used to account for the Requesting Agency’s expense and the Servicing Agency’s revenue.)

Straight-Line Provide amount to be accrued and Number of Months

Accrual Per Work Completed Identify the accounting post period:

Monthly per work completed & invoiced

Other Explain other regular period (bimonthly, quarterly, etc.) for posting accruals and how the accrual amounts will be communicated if other than billed.

30. Total Net Order Amount: [All Order Line Net Amounts Due for reimbursable agreements and Net Total Costs for Assisted Acquisition Agreements

(Block 28) must sum to this total] 31. Attachments (State or list attachments)

Key Project and/or acquisition milestones (Optional except for Assisted Acquisition Agreements)

Other Attachments (Optional)

BILLING AND PAYMENT INFORMATION 32. Payment Method (Check One) [Intra-governmental Payment and Collection (IPAC) is the Preferred Method.]

Requesting Agency Initiated IPAC Servicing Agency Initiated IPAC

Credit Card Other Explain other payment method and reasoning:

33. Billing Frequency (Check One) [An Invoice must be submitted by the Servicing Agency and accepted by the Requesting Agency BEFORE

funds are reimbursed (i.e., via IPAC transaction)]

Monthly Quarterly Other Billing Frequency (include explanation): 34. Payment Terms (Check One)

7 Days Other Payment Terms (include explanation):

LEAD. TRANSFORM. DELIVER.

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35. Funding Clauses / Instructions (Optional) (State and/or list funding clauses/instructions such as Subject to the Availability of Funds)

36. Delivery / Shipping Information for Products (Optional) Agency Name Point of Contact (POC) Name & Title POC Email Address Delivery Address / Room Number POC Telephone Number Special Shipping Information

APPROVALS AND CONTACT INFORMATION 37. Program Officials The Program Officials, as identified by the Requesting Agency and Servicing Agency, must ensure that the scope of

work is properly defined and can be fulfilled for this Order. The Program Official may or may not be the Contracting Officer depending on each agency’s IAA business process.

Requesting Agency Servicing Agency Name Title Telephone Number Fax Number Email Address SIGNATURE Date Signed 38. Funding Officials — The Funds Approving Officials, as identified by the Requesting Agency and Servicing Agency, certify that the funds are accurately cited and can be properly accounted for per the purposes set forth in the Order. The Requesting Agency Funding Official signs to obligate funds. The Servicing Agency Funding Official signs to start the work, and to bill, collect, and properly account for funds from the Requesting Agency, in accordance with the agreement.

Requesting Agency Servicing Agency Name Title Telephone Number Fax Number Email Address SIGNATURE Date Signed




CONTACT INFORMATION 39. FINANCE OFFICE Points of Contact (POCs)

Requesting Agency (Payment Office) Servicing Agency (Billing Office) Name Title Office Address

Telephone Number Fax Number Email Address Signature & Date (Optional)

40. ADDITIONAL Points of Contact (POCs) (as determined by each Agency) This may include CONTRACTING Office Points of Contact (POCs).

Requesting Agency Servicing Agency Name Title Office Address


Name Title Office Address


Name Title Office Address



RESET FORM: Requesting AgencyPrimary Organization Office Name: Servicing AgencyPrimary Organization Office Name: Requesting AgencyResponsible Organization Office Address: Servicing AgencyResponsible Organization Office Address: Order Action New: OffOrder Action Modification: OffOrder Action Modification Explanation: Order Action Cancellation: OffOrder Action Cancellation Explanation: Line Number 1: Line Number 2: Line Number 3: Line Number 1 Original Funding Line: Line Number 2 Original Line Funding: Line Number 3 Original Line Funding: Original Funding Line Total of All Other Lines: Original Funding Line Total: 0Line Number 1 Cumulative Funding: Line Number 2 Cumulative Funding: Line Number 3 Cumulative Funding: Cumulative Funding Line Total of All Other Lines: Cumulative Funding Line Total: 0Line Number 1 Funding Changes: Line Number 2 Funding Changes: Line Number 3 Funding Changes: Funding Change Total of All Other Lines: Funding Change Total: 0Line Number 1 Total Modified Obligation: 0Line Number 2 Total Modified Obligation: 0Line Number 3 Total Modified Obligation: 0Modified Obligation Total of All Other Lines: 0Modified Obligation Total: 0Line Number 1 Total Advance Amount: Line Number 2 Total Advance Amount: Line Number 3 Total Advance Amount: Advance Amount Total of All Other Lines: Advance Amount Total: 0Line Number 1 Net Modified Amount Due: 0Line Number 2 Net Modified Amount Due: 0Line Number 3 Net Modified Amount Due: 0Net Modified Amount Total of All Other Lines: 0Net Modified Amount Total: 0Performance Period Start Date: Performance Period End Date: Order Number: Servicing Agency's Agreement Tracking Number: Line Number: Requesting Agency ALC: Servicing Agency ALC: Requesting Agency EPOA: Requesting Agency BETC: Servicing Agency BETC: Requesting Agency Object Class Code: Servicing Agency Object Class Code: Requesting Agency BPN: Servicing Agency BPN: Requesting Agency BPN+4: Servicing Agency BPN+4: Requesting Agency Additional Accounting Classification: Servicing Agency Additional Accounting Classification: Requesting Agency Funding Expiration Date: Requesting Agency Funding Cancellation Date: Project Number Title: Description of Products and Services: NCAIS Number: Unit of Measure: Contract Cost: Servicing Fees: Quantity: Unit Price: Total Quantity X Unit Price: 0Overhead Fees and Charges: Net Total Cost: 0Net Line Amount Due: 0Assisted Acquisition Servicing Fees Explanation: Type of Service Requirements: Severable ServiceTotal Advance Amount for Order: Recognition Methodology Straight Line: OffRecognition Methodology Accrual Per Work Completed: OffStraight Line amount to be accrued: Straight Line Number oF Months: Accrual, Monthly per work completed & invoiced: OffAccrual, Other: OffAccrual, Explanation: Total Net Order Amount: 0Attachments, Key Project: OffAccrual, Key Project Explanation: Attachments, Other: OffAccrual, Other Explanation: Payment Method, Requesting Agency IPAC: OffPayment Method, Credit Card: OffPayment Method, Servicing Agency IPAC: OffPayment Method, Other: OffPayment Method, Other Explanation: Billing Frequency, Explanation: Billing Frequency, Monthly: OffBilling Frequency, Quarterly: OffBilling Frequency, Other: OffBilling Frequency, Other Explanation: Payment Terms, Seven Days: OffPayment Terms, Other: OffPayment Terms, Other Explanation: Funding Instructions Clauses and Instructions: Delivery Address and Room Number: Special Shipping Information: Requesting Agency Program Official Name: Servicing Agency Program Official Name: Requesting Agency Program Official Title: Servicing Agency Program Official Title: Requesting Agency Program Official Telephone Number: Servicing Agency Program Official Telephone Number: Requesting Agency Program Official Fax Number: Servicing Agency Program Official Fax Number: Requesting Agency Program Official Email Address: Servicing Agency Program Official Email Address: Requesting Agency Program Official Date Signed: Servicing Agency Program Official Date Signed: Requesting Agency Funding Official Name: Servicing Agency Funding Official Name: Requesting Agency Funding Official Title: Servicing Agency Funding Official Title: Requesting Agency Funding Official Telephone Number: Servicing Agency Funding Official Telephone Number: Requesting Agency Funding Official Fax Number: Servicing Agency Funding Official Fax Number: Requesting Agency Funding Official Email Address: Servicing Agency Funding Official Email Address: Requesting Agency Funding Official Date Signed: Servicing Agency Funding Official Date Signed: Requesting Agency Payment Office Name: Servicing Agency Billing Office Name: Requesting Agency Payment Office Title: Servicing Agency Billing Office Title: Requesting Agency Payment Office Address: Servicing Agency Billing Office Address: Requesting Agency Payment Office Telephone Number: Servicing Agency Billing Office Telephone Number: Requesting Agency Payment Office Fax Number: Servicing Agency Billing Office Fax Number: Requesting Agency Payment Office Email Address: Servicing Agency Billing Office Email Address: Requesting Agency Additional Contact 1 Name: Servicing Agency Additional Contact 1 Name: Requesting Agency Additional Contact 1 Title: Servicing Agency Additional Contact 1 Title: Requesting Agency Additional Contact 1 Telephone Number: Servicing Agency Additional Contact 1 Telephone Number: Requesting Agency Additional Contact 1 Fax Number: Servicing Agency Additional Contact 1 Fax Number: Requesting Agency Additional Contact 1 Email Address: Servicing Agency Additional Contact 1 Email Address: Requesting Agency Additional Contact 2 Name: Servicing Agency Additional Contact 2 Name: Requesting Agency Additional Contact 2 Title: Servicing Agency Additional Contact 2 Title: Requesting Agency Additional Contact 2 Telephone Number: Servicing Agency Additional Contact 2 Telephone Number: Requesting Agency Additional Contact 2 Fax Number: Servicing Agency Additional Contact 2 Fax Number: Requesting Agency Additional Contact 2 Email Address: Servicing Agency Additional Contact 2 Email Address: Requesting Agency Additional Contact 3 Name: Servicing Agency Additional Contact 3 Name: Requesting Agency Additional Contact 3 Title: Servicing Agency Additional Contact 3 Title: Requesting Agency Additional Contact 3 Telephone Number: Servicing Agency Additional Contact 3 Telephone Number: Requesting Agency Additional Contact 3 Fax Number: Servicing Agency Additional Contact 3 Fax Number: Requesting Agency Additional Contact 3 Email Address: Servicing Agency Additional Contact 3 Email Address: Delivery Point of Contact Name and Title: POC Email Address: POC Telephone Number: GT&C Number0: Amendment Number / Mod Number0: GT&C Number1: Order Number1: Amendment Number / Mod Number1: Total Obligated Cost: 0Advance for Line: Total Line Amount Obligated: 0Advance Line Amount: GT&C Number2: Order Number2: Servicing Agency's Agreement Tracking Number2: Amendment Number / Mod Number2: Amendment Number / Mod Number3: Servicing Agency's Agreement Tracking Number3: Delivery Agency Name: GT&C Number3: Order Number3: GT&C Number 3: Order Number 3: Amendment Number / Mod Number 3: Servicing Agency's Agreement Tracking Number 3: Requesting Agency Additional Contact 1 Office Address: Servicing Agency Additional Contact 1 Office Address: Requesting Agency Additional Contact 2 Office Address: Servicing Agency Additional Contact 2 Office Address: Requesting Agency Additional Contact 3 Office Address: Servicing Agency Additional Contact 3 Office Address: Requesting Agency SP Component TAS: Requesting Agency ATA Component TAS: Requesting Agency AID Component TAS: Requesting Agency BPOA Component TAS: Requesting Agency A Component TAS: Requesting Agency MAIN Component TAS: Requesting Agency SUB Component TAS: Servicing Agency SP Component TAS: Servicing Agency ATA Component TAS: Servicing Agency AID Component TAS: Servicing Agency BPOA Component TAS: Servicing Agency EPOA Component TAS: Servicing Agency A Component TAS: Servicing Agency MAIN Component TAS: Servicing Agency SUB Component TAS: Requesting Agency Current TAS Format: Servicing Agency Current TAS Format:

united states government order form - fs form 7600b · 2020. 10. 19. · title: united states...

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