BIA-4314 U.S. DEPARTMENT OF THE INTERIOR Page 1 of 1
Rev June 2018 BUREAU OF INDIAN AFFAIRS
REQUISITION
1. Date: ___________________
2. Requisition No: ___________________
3. Vendor
Name and Address
4. Ship To
(Name and Address)
5. Requested
Delivery Date:
NOTE: Block 7 - The accounting code strip must be entered below each Line No. Description.
7. Description and Accounting Code Strip
Subject to the Availability of funds.
ACCOUNTING LINE:
Justification:
12. TOTAL ESTIMATED COST:
13a. Requested by:
Printed Name/Signature/Date
13b. Supervisor/Office Budget Review: (if required)
This ensures the certifying official has confirmation of funds by their group
budget manager or the purchaser's supervisor.
Printed Name/Signature/Date
14. Approving Official Certification: I certify the above items are authorized for this program
and funds are available.
(Printed Name and Title of Approving Official)
Approving Official’s Signature/Date
15. Property Management Certification: (if required)
I certify that except as noted, items are not available from sources under my control. Additionally,
I have reviewed cited BOC and Accounting Strip information for accuracy and appropriateness.
(Printed Name and Title of Approving Official)
Property Management Signature/Date
IA Division of Acquisition Management
