Fillable United States Government Interagency Agreement (IAA) Agreement Between (National Oceanic and Atmospheric Administration)

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United States Government Interagency Agreement (IAA) Agreement Between (National Oceanic and Atmospheric Administration)

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The United States Government Interagency Agreement (IAA) Agreement Between (National Oceanic and Atmospheric Administration) form is 5 pages long and contains:

  • 12 signatures
  • 2 check-boxes
  • 226 other fields

Country of origin: US
File type: PDF

U.S.A. forms for National Oceanic and Atmospheric Administration (NOAA)

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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) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 1 of 5
Form
04/12
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
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
the start and end dates that reflect the
new performance period.
MM-DD-YYYY
MM-DD-YYYY
RESET FORM
Gulf Coast Ecosystem Restoration
Council
500 Poydras St., Suite 1117, New
Orleans, LA 70130
✔
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 2 of 5
Form
04/12
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
E POA
A
MAIN
SUB
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
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
471X1770 (or 95X1770)
DISB
COLL
078863311
CATB6012
No Year Funds
See Attachment 9 Description of Work to be Performed
0.00
0.00
0.00
0.00
0.00
✔
IAA Order
I
AA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 3 of 5
Form
04/12
B
ILLING & 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).
R
equesting 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)]
M
onthly Quarterly Other Billing Frequency (include explanation)____________________________________
34. Payment Terms (Check One)
7 days Other Payment Terms (include explanation): ___________________________________________________
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 C
ompleted – Identify the accounting posting period:
M
onthly 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)
✔
✔
Attachment 4: Key Milestones Chart
✔
✔
Attachment 1: IAA Standard Terms and Conditions Attachment 7: Budget Detail Schedule
Attachment 2: Special Conditions Attachment 8: Budget Narrative
Attachment 3: Reporting Schedule Attachment 10: Observational Data Plan
Attachment 5: Approved Metrics Attachment 11: Preliminary Data Management Plan
Attachment 6: Cash Flow Forecast Schedule
✔
✔
✔
IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 4 of 5
Form
04/12
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
Agency-specific funding clauses will be included as Special Condition(s) (listed in Attachment 2).
Justin Ehrenwerth
Executive Director
(504) 444-3265
justin.ehrenwerth@restorethegulf.gov
Vaness Uko
Financial Management Specialist
(504) 239-8179
vanessa.uko@restorethegulf.gov
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IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 5 of 5
Form
04/12
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)
Bureau of Fiscal Svcs, Treasury
200 3rd St., Avery 5I, Parkersburg, WV 26106
(304) 480-7273
(866) 897-0856
500 Poydras St., Suite 1117, New
Orleans, LA 70130
Kristin Smith
Senior Grants Manager
500 Poydras Street, Suite 1117
New Orleans, LA 70130
(504) 444-3558
kristin.smith@restorethegulf.gov
500 Poydras Street, Suite 1117
New Orleans, LA 70130
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United States Government Interagency Agreement (IAA) Agreement Between (National Oceanic and Atmospheric Administration)

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Completed 10 August 2020

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