Fms Form 7600B – Fill Out and Use This PDF

United States Government

Interagency Agreement (IAA) – Agreement Between Federal Agencies

Order Requirements and Funding Information (Order) Section

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 explains the changes being made. For Example: for a performance period mod, state 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

Total of All

Other Lines

Summary by Line

Line # ______

Line # _____

Line # ______

Total

(attach funding

details)

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.

FMS	Form	7600B	DEPARTMENT OF THE TREASURY
	04/12		FINANCIAL MANAGEMENT SERVICE

Page 1 of 5

IAA Order

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

Requesting Agency Funding

Servicing Agency Funding Information

Information

ALC

Component

SP

ATA

AID

BPOA

EPOA

A

MAIN

SUB

SP

ATA

AID

BPOA

E POA

A

MAIN

SUB

TAS Required

by 10/1/2014

OR Current TAS format

BETC

Object Class Code (Optional)

BPN

BPN + 4 (Optional)

Additional Accounting

Classification/Information

(Optional)

Requesting Agency Funding Expiration Date

Requesting Agency Funding Cancellation Date

______________

______________

MM-DD-YYYY

MM-DD-YYYY

Project Number & Title

Description of Products and/or Services, 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 (NAICS) Number (Optional) _______________________________________

Breakdown of Reimbursable Line Costs

OR

Breakdown of Assisted Acquisition Line Cost:

Unit of Measure

Contract Cost

$

Quantity

Unit Price

Total

Servicing Fees

$

$

Total

$

Obligated Cost

Overhead Fees & Charges

$

Advance for

$

Line (-)

Total Line Amount Obligated

$

Net Total Cost

$

Assisted Acquisition Servicing Fees Explanation

Advance Line Amount (-)

$

Net Line Amount Due

$

Type of Service Requirements

Severable Service

Non-severable Service

Not Applicable

FMS Form

7600B

DEPARTMENT OF THE TREASURY

04/12

FINANCIAL MANAGEMENT SERVICE

Page 2 of 5

IAA Order

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

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 posting 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 & PAYMENT INFORMATION

32.Payment Method (Check One) [Intra-governmental Payment and Collection (IPAC) is the Preferred Method.] If IPAC is used, the payment method must agree with the IPAC Trading Partner Agreement (TPA).

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): ___________________________________________________

FMS	Form	7600B	DEPARTMENT OF THE TREASURY
	04/12		FINANCIAL MANAGEMENT SERVICE

Page 3 of 5

IAA Order

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

35.Funding Clauses/Instructions (Optional) (State and/or list funding clauses/instructions.)

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

FMS	Form	7600B	DEPARTMENT OF THE TREASURY
	04/12		FINANCIAL MANAGEMENT SERVICE

Page 4 of 5

IAA Order

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

CONTACT INFORMATION

FINANCE OFFICE Points of Contact (POCs)

The finance office points of contact must ensure that the payment (Requesting Agency), billing (Servicing Agency), and advance/accounting information are accurate and timely for this Order.

39.

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

Requesting Agency

Servicing Agency

Name

Title

Office Address

Telephone Number

Fax Number

Email Address

Signature & Date (Optional)

Name

Title

Office Address

Telephone Number

Fax Number

Email Address

Signature & Date (Optional)

Name

Title

Office Address

Telephone Number

Fax Number

Email Address

Signature & Date (Optional)

FMS	Form	7600B	DEPARTMENT OF THE TREASURY
	04/12		FINANCIAL MANAGEMENT SERVICE

Page 5 of 5