Opm Form 1616 – Fill Out and Use This PDF

1. REQUESTING AGENCY NUMBER:

U.S. Office of Personnel Management

3. EFFECTIVE DATE:

Presidential Management Fellows Program

Interagency/Intergovernmental Agreement

2. ESTIMATED AMOUNT:

4. EXPIRATION DATE:

(Instructions on Page 2)

6. REQUESTING AGENCY (Agency where appointment was made)

10. PERFORMING AGENCY (OPM)

a. Agency Name and Address (do not abbreviate):

a. Agency Name and Address:

U.S. Office of Personnel Management

DUNS# 126536929

Presidential Management Fellows Program

TAX ID# 52-1136517

1900 E Street, NW, Room 6500

AGENCY LOCATION

Washington, DC 20415

CODE: 24-00-0001

TREASURY ACCOUNT SYMBOL: 24X4571.24, BETC: COLL

b. Program Office Contact Name and Telephone Number, enter below:

b. Program Office Contact Name and Telephone Number:

PMF Program Office, (202) 606-1040

c. Program Office Fax Number:

c. Program Office Fax Number:

(202) 606-3040

d. Internet Email Address:

d. Internet Email Address:

pmffee@opm.gov

7. COMPLETE "SHIP TO" ADDRESS (if different than block 6a):

11. AUTHORITY. (This agreement is entered into pursuant to the following authority

and incorporates by reference any and all related implementing regulations and Office

of Management and Budget circulars.)

Ｚ Revolving Fund, 5 U.S.C. 1304(e)(1)

Point of Contact and Telephone Number (if different than block 6b):

ﾆ Economy Act, 31 U.S.C. 1535-1536

8. REQUESTING AGENCY FINANCE OFFICE ﾐ

ﾅ Intergovernmental Cooperation Agreement Act of 1968,

31 U.S.C. 6501-6508

a. 8-Digit Agency Location Code (ALC), enter below:

ﾆ Government Employees Training Act, 5 U.S.C. 4103-4119

b. Customer Obligating Document Number, enter below:

ﾆ 39 U.S.C. 411 (United States Postal Service)

ﾆ 22 U.S.C. 2357(a), (foreign governments)

c. Agency Accounting Data, enter below: (Including Treasury Account Symbol)

12. OPM\PMF FINANCE CONTACT NAME AND TELEPHONE NUMBER:

PMF Program Office

Direct:

(202) 606-1040

Fax: (202) 606-3040

d. Finance Office/Billing Address (if applicable):

13. OPM USE ONLY:

a.

b.

ﾆ New Agreement

ﾆ Draw Down

c.

d.

ﾆ Contract Delivered in Full

ﾆ Recorded in PMF Admin

e. Finance Office Contact Name, enter below:

e. PMF Revenue Code: 20111211BILL

f. Finance Office Telephone Number:

f. CBIS Agreement#:

g. Finance Office Fax Number:

g.

9. AUTHORIZING APPROVALS (REQUESTING AGENCY)

14. AUTHORIZING APPROVALS (OPM)

a. Program Office Name (printed) and Signature:

Date:

a. Program Office Name (printed) and Signature:

Date:

Rob Timmins

b. Finance/Contracting Office Name (printed) and Signature:

Date:

b. Finance/Contracting Office Name (printed) and Signature:

Date:

OPM Form 1616 (PMF 2010 Version)

Page 1 of 2

OGC Approved 11/05/1999

Rev. 02/2010

1. Funding. Unless otherwise noted on the Form 1616, upon execution of this

6. Publication or Sharing Results.

If either party

publishes or shares any

agreement, the requesting agency

will be billed based on the agreed upon de-

results coming w ithin the sphere of its

responsibility, they shall submit a pro-

liverables via IPAC, if available, or invoiced appropriately. Agencies have the

posed release to the cooperating party for prior review. Publication may be joint

option to mail P MF reimbursements to the address show n in block 10a.

Reim-

or independent, as agreed upon, alw ays giving due credit to the cooperation

bursements for “draw down” agreements will be made in accordance w

ith the

and recognizing within proper limits the rights of the indiv iduals doing the work.

pricing and payment schedule agreed upon.

Software and documents may

not be shared or used bey ond the scope speci -

2. Duties. The respective duties of OPM and the requesting agency are set out

fied in the Statement of Work (if applicable).

7. Disputes.

OPM and requesting agency employees responsible for the ad -

in the attached Statement of Work (if applicable) or described in block 5.

ministration of

this agreement are the program office contacts identified in

3. Compliance with Applicable Laws. Both parties agree to comply with au-

blocks 6b & 10b on the OPM Form 1616. Disputes must be submitted in writing

thorities cited in this agreement.

Both parties also agree to comply with any

to either of these persons. Any disputes that are not

resolved at this level may

laws or regulations related to the P rivacy Act, the FOIA, and GPO Printing laws

be referred to the appropriate OPM official, whose decision is final.

and regulations that apply. Specifically, the recipient agrees to comply fully with

8. Terminations. Either OPM or the requesting agency may terminate this

OPM requirements to av oid statistical disclosure and agrees to make no at -

tempts to identify individuals through data manipulation. U nless otherwise mu-

agreement at any time by sending written notice to the program office contact in

tually agreed to, the data are supplied solely for statistical research. The recipi-

writing 30 days prior to the effectiv e date of the termination. OPM will be enti-

ent further agrees to safeguard any data containing personal identifiers in ac-

tled to sufficient funds as necessary to cover the expenses incurred for terminat-

cordance with OPM's privacy and security standards. Any proposed publication

ing this Agreement and will provide a final accounting of the ex penses to the

for public information of data deliv ered under this agreement shall be approv ed

requesting agency 30 days after receipt of the termination notice.

by OPM prior to publication.

9. Property.

Property purchased from funds supplied under this agreement

4. Amendments or modifications of the agreement. A ny amendments or

shall become an asset of the agency bearing the cost of acquisition (The Econ-

modifications of this Agreement must be made in w riting and agreed to by both

omy Act of 1932, as amended (31 U

.S.C. 1535-1536, 33 C omp. Gen. 565)),

OPM and the requesting agency .

T o modify prices on a pricing schedule (if

unless otherwise agreed to by the cooperating parties.

applicable), the party proposing to modify the prices must notify the other party

90 days in advance of the proposed change. T he other party must respond to

10. Duration of the agreement. A greements contemplating performance ex -

the proposed change within 45 days of receipt of the proposed change. Indiv id-

tending beyond the fiscal year will be renewed automatically provided the agen-

ual fiscal y ear agreements may be renew ed by the execution of a new OPM

cies have executed a new OPM Form 1616 and sufficient funds are available to

Form 1616, provided that sufficient funds are available to the requesting agency

the requesting agency for obligation (if applicable).

for obligation.

11. Whole Agreement. This agreement, including the attached S tatement of

5. A-76 Certification. This certification is required by OMB Circular A-97 from

Work (if applicable) or as stated in block 5, constitutes the entire agreement

all State and Local governments, including DC Government. OMB Circulars A-

between OPM and the requesting agency of this Agreement.

76 and A-97 are incorporated by reference into this agreement. These circulars

are published at the OMB web site, http://www.omb.gov. In accordance with the

12. Purchase/Charge Cards.

If requesting agency

would prefer to use a

policies set forth in circular A-76, the requesting agency certifies that the ser-

government purchase/charge card as method of pay ment, contact the Program

vices ordered pursuant to this agreement cannot be procured reasonably and

Office identified in block 10. This method of pay ment is quicker and a receipt

expeditiously through ordinary business channels.

may either be mailed or faxed to you upon request.

OPM Form 1616 (PMF 2010 Version)

Page 2 of 2

OGC Approved 11/05/1999

Rev. 02/2010