Standart Form 1411 PDF Details

Are you looking for a way to easily and accurately submit information related to an individual’s disability benefits? Look no further than Standard Form 1411! This form is designed by the U.S. Department of Veterans Affairs (VA) as part of their Benefits Delivery System program and is required when applying for benefits related to service-connected disabilities such as VA health care, pension, education, Vocational Rehabilitation & Employment, insurance or burial. Read on to learn more about the purpose of Standard Form 1411 and its importance in accessing important services.

QuestionAnswer
Form NameStandart Form 1411
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namessf1411, standard form 1411 fillable, 1411, txr 1411 form

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CONTRACT PRICING PROPOSAL COVER SHEET

(Cost or Pricing Data Required)

1. SOLICITATION/CONTRACT/MODIFICATION NUMBER

OMB No.: 9000-0013 Expires:

Public reporting burden for this collection of information is estimated to average 4 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition Policy, GSA, Washington, DC 20405.

2a. NAME OF OFFEROR

 

 

 

 

 

 

3a. NAME OF OFFEROR’S POINT OF CONTACT

 

 

 

 

 

 

 

 

 

Office of Research Administration and Advancement

 

 

 

 

 

 

 

 

 

 

 

 

3c. TELEPHONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2b. FIRST LINE ADDRESS

 

 

 

 

 

 

3b. TITLE OF OFFEROR’S POINT OF CONTACT

 

 

AREA CODE

 

NUMBER

 

University of Maryland, College Park

 

 

 

 

 

 

Contract Administrator

 

 

 

 

 

301

 

 

405-6269

 

2c. STREET ADDRESS

 

 

 

 

 

 

 

 

4. TYPE OF CONTRACT ACTION (Check)

 

 

 

 

3112 Lee Building

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

NEW CONTRACT

 

 

 

 

d.

LETTER CONTRACT

2d. CITY

 

 

 

2e. STATE

2f. ZIP CODE

 

 

 

b.

CHANGE ORDER

 

 

 

 

e.

UNPRICED ORDER

 

College Park

 

 

MD

20742-5141

 

 

 

c.

PRICE REVISION/

 

 

 

 

f.

OTHER (Specify)

 

 

 

 

 

 

 

 

 

 

5. TYPE OF CONTRACT (Check)

 

 

 

 

 

 

REDETERMINATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FFP

 

CPFF

CPIF

CPAF

 

 

 

 

 

6. PROPOSED COST (A+B=C)

 

 

 

 

FPI

 

OTHER (Specify)

 

 

 

 

 

A. COST

 

B. PROFIT/FEE

 

 

 

 

 

C. TOTAL

 

 

 

 

 

 

 

 

 

 

 

$

$

0.

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. PERFORMANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

a.

University of Maryland

 

 

 

 

 

 

 

 

P

a.

 

 

 

 

 

 

 

L

 

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

A

 

 

 

 

 

 

 

 

 

 

 

 

R

 

 

 

 

 

 

 

 

C

b.

 

 

 

 

 

 

 

 

 

 

 

I

b.

 

 

 

 

 

 

 

E

 

 

 

 

 

 

 

 

 

 

 

O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D

 

 

 

 

 

 

 

 

8.

List and reference the identification, quantity and total price proposed for each contract line item. A line item cost breakdown supporting this recap is required unless

 

 

 

 

otherwise specified by the Contracting Officer. (Continue on reverse, and then on plain paper, if necessary. Use same headings.)

 

 

 

 

 

 

 

 

 

 

a. LINE ITEM NO.

b. IDENTIFICATION

c. QUANTITY*

d. TOTAL PRICE

e. PROP. REF. PAGE

(continued on reverse)

*Not separately priced

9. PROVIDE THE FOLLOWING (If available)

NAME OF CONTRACT ADMINISTRATION OFFICE

 

 

 

NAME OF AUDIT OFFICE

 

 

 

 

 

 

ONRRR - Atlanta Regional Office

 

 

 

 

DHHS Office of Audit, Region III

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

 

STREET ADDRESS

 

 

 

 

 

 

 

100 Alabama Street NW, Suite 4R15

 

 

 

 

150 South Independence Mall West, Suite 3161

 

 

 

 

CITY

 

 

 

STATE

 

ZIP CODE

CITY

 

 

 

 

STATE

 

ZIP CODE

Atlanta

 

 

 

GA

 

30303-3104

 

Philadelphia

 

 

 

 

PA

 

19106-4501

TELEPHONE

 

AREA CODE

 

NUMBER

 

 

TELEPHONE

 

AREA CODE

 

NUMBER

 

 

(404)

 

 

562-1600

 

(215)

 

861-4501

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10. WILL YOU REQUIRE THE USE OF ANY GOVERNMENT PROPERTY IN THE

11a.

DO YOU REQUIRE GOVERNMENT

 

11b. TYPE OF FINANCING (Check one)

PERFORMANCE OF THIS WORK? (If “yes,” identify)

 

 

 

 

CONTRACT FINANCING TO PER-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM THIS PROPOSED CON-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TRACT? (If “yes,” complete Item 11b.)

 

 

ADVANCE

PROGRESS

 

 

 

 

 

 

 

 

 

 

 

 

PAYMENT

PAYMENTS

YES

NO

 

 

 

 

YES

NO

 

 

GUARANTEED LOANS

12. HAVE YOU BEEN AWARDED ANY CONTRACTS OR SUBCONTRACTS FOR THE

13.

IS THIS PROPOSAL CONSISTENT WITH YOUR ESTABLISHED ESTIMATING AND

SAME OR SIMILAR ITEMS WITHIN THE PAST 3 YEARS? (If “yes,” identify

 

ACCOUNTING PRACTICES AND PROCEDURES AND FAR PART 31, COST

 

item(s), customer(s) and contract number(s) on reverse of form.)

 

 

 

 

PRINCIPLES? (If “no,” explain on reverse of form.)

 

 

 

 

YES

NO

 

 

 

 

YES

NO

 

 

 

 

 

 

 

14. COST ACCOUNTING STANDARDS BOARD (CASB) DATA (Public Law 91-379 as amended and FAR PART 30)

 

 

 

 

 

 

a. WILL THIS CONTRACT ACTION BE SUBJECT TO CASB REGULATIONS? (if

b. HAVE YOU SUBMITTED A CASB DISCLOSURE STATEMENT (CASB DS-1 or 2)?

“no,” explain in proposal.)

 

 

 

(If “yes,” specify in proposal the office to which submitted and if determined to

 

 

 

 

 

 

 

 

be adequate.)

 

 

 

 

 

 

 

YES

NO

 

 

 

 

YES DHHS-Div. of Cost Allocation-Adequate DS-2

 

NO Proposal Submitted 12/20/96

c. HAVE YOU BEEN NOTIFIED THAT YOU ARE OR MAY BE IN NONCOMPLIANCE

d. IS ANY ASPECT OF THIS PROPOSAL INCONSISTENT WITH YOUR DISCLOSED

WITH YOUR DISCLOSURE STATEMENT OR COST ACCOUNT STANDARDS? (If

PRACTICES OR APPLICABLE COST ACCOUNTING STANDARDS? (if “yes,”

 

“yes,” explain in proposal.)

 

 

 

explain in proposal.)

 

 

 

 

 

 

YES

NO

 

 

 

 

YES

NO

 

 

 

 

 

 

This proposal is submitted in response to the solicitation, contract, modification, etc. in Item 1 and reflects our estimates and/or actual costs as of this date and conforms with the instructions in FAR 15.804- 6(b)(1), and Table 15-2. By submitting this proposal, the offeror, if selected for negotiation, grants the contracting officer and authorized representative(s) the right to examine, at any time before award, those records, which include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of whether such items are in written form, in the form of computer data, or any other form, or whether such supporting information is specifically referenced or included in the proposal as the basis for pricing, that will permit an adequate evaluation of the proposed price.

15. NAME OF OFFEROR (Type)

15. TITLE OF OFFEROR (Type)

16. NAME OF FIRM

 

 

University of Maryland at College Park

17. SIGNATURE

18. DATE OF SUBMISSION

AUTHORIZED FOR LOCAL REPRODUCTION

STANDARD FORM 1411 (REV. 10-95)

Previous edition is not usable.

Prescribed by GSA - FAR (48 CFR) 53.215-2(a)

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