Fillable ureau of Indian Affairs/Education Program Electronic Purchase Request (Bureau of Indian Affairs)

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ureau of Indian Affairs/Education Program Electronic Purchase Request (Bureau of Indian Affairs)

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The ureau of Indian Affairs/Education Program Electronic Purchase Request (Bureau of Indian Affairs) form is 4 pages long and contains:

  • 5 signatures
  • 20 check-boxes
  • 226 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Bureau of Indian Affairs

BROWSE BUREAU OF INDIAN AFFAIRS (VA) FORMS

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2017-9v3
Page 1 of 4
Please enter the following information to submit a proper purchase request to your Financial and Business Management
System (FBMS) Requisitioner. Prior to routing the form to your FBMS Requisitioner, you must obtain approval from your
program office supervisory approver. Be sure to complete the entire form before forwarding it to your FBMS
Requisitioner; incomplete forms will result in processing delays.
Section I. PR Requestor Information
Today’s Date:
a. Last Name:
b. First Name:
c. MI:
d. Phone #:
e. Region (Issuing Office):
Section II. PR Information (FBMS Header Info Tab)
a. Type of Requirement:
New Requirement (Includes
Micro Purchases)
Pre-Award Change
PR #:
Post-Award Change
Award #:
Line Item:
b. Ratification Required?
No
c. PR Type:
PR Title:
g. FBMS Supervisory Approver:
h. Approver User IDs. If entered on the FBMS PR, approvers will receive an email when PR is awaiting their approval
FBMS Ad Hoc Approver:
FBMS Certifying Funds Approver:
Section III. PR Description (FBMS Header Text Tab)
Use this section to document relevant information to assist the Buyer, Contracting Officer (CO), or Grants Specialist. Relevant PR
information may include the name of the FA Awarding Personnel or Buyer/CO of the IDIQ or BPA if this is TO/DO or BPA call;
the name/phone number of the DOI-Certified COR. Content limited to 1650 characters; include additional pages if necessary.
Suggested Vendor(s):
Vendor Name
Data Universal Numbering System (DUNS)
or Vendor ID# (if known)
ureau of Indian Affairs/Education
Program Electronic Purchase Request
PR#:___________________
f. Originating Office:
e.
d. PR Title:
IT Approval:
Is this an IT Sensitive Property micro purchase? Yes No
Funded PR (Used for all funded Acquisition award types: Purchase Orders, Contracts, Task Orders, Delivery
Orders, BPA Calls, etc.) -- Note: REQUIRED for all sensitive property purchases regardless of dollar amount
Unfunded Contract PR (BPA, IDIQ) -- Note: Use the "Funded PR" option for PRs marked as SAF
Grants Funded PR:
AutoChoice PR
Post-Award PR:
IAA PR (Intra-Agency Agreement)
Micro Purchase -- Note: Do not use if purchasing sensitive property
f. FBMS Receiving Official (N/A for Fin. Assistance PRs:
If yes, an IT cover sheet is required to be submitted with the
PR package. The "Funded PR" options must be selected.
Select one
Select one
Bureau of Indian Affairs/Education
Program Purchase Request
2017-9v3
Page 2 of 4
Section IV. PR Items List
If extra lines are needed, attach additional copies of pages 2 and 3.
10
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) PoP Start-End Dates (services)
Responsible Cost Center (for assets)
20
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) / PoP Start-End Dates (services)
Responsible Cost Center (for assets)
30
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) / PoP Start-End Dates (services)
Responsible Cost Center (for assets)
40
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) / PoP Start-End Dates (services)
Responsible Cost Center (for assets)
50
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) / PoP Start-End Dates (services)
Responsible Cost Center (for assets)
60
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) / PoP Start-End Dates (services)
Responsible Cost Center (for assets)
70
Description (max. 40 characters)
Item Category
Unit Price
UPC
Line Item Total
SAF?
Deobligate?
Delivery Date (goods) / PoP Start-End Dates (services)
Responsible Cost Center (for assets)
Grand Total
Requisitioners, remember to use the appropriate unit of measure in FBMS (e.g., AU, EA).
Quantity UoM
Quantity UoM
Quantity UoM
Quantity UoM
Quantity UoM
Quantity UoM
Quantity UoM
By Quantity (Goods)
$0.00
Select One
Select One
Select One
$0.00
Select One
Select One
Select One
$0.00
Select One
Select One
Select One
$0.00
Select One
Select One
Select One
$0.00
Select One
Select One
Select One
$0.00
Select One
Select One
Select One
$0.00
Select One
Select One
$0.00
Bureau of Indian Affairs/Education
Program Purchase Request
Page 3 of 4
Section V. Item Details - Accounting Info
Line item numbers in Section IV should correspond with line item numbers specified in the table below. Complete a new row for each separate line of accounting or WBS
being used to fund a given line item. Goods (“By Quantity”) may be allocated across lines of accounting by percentage or quantity; services (“By Dollars”) may be
allocated across accounting lines by percentage or dollar amount. Note that FBMS depletes funding evenly across accounts.
Use same accounting information for all lines items on the PR
Line
Item
Quantity / $ Amount
or % Allocated
Cost Center Functional Area WBS or Work Order (if
applicable)
Fund
Section VI.
Item Details – Delivery Address
Specify the line item number when multiple delivery addresses are required.
Use same delivery address for all lines items on the PR
Line
Item
Address Line 1 Address Line 2 City State Zip Phone #
2017-9v3
Bureau of Indian Affairs/Education
Program Purchase Request
2017-12v4
Page 4 of 4
Section VII. Supporting Documentation
Check all that apply
Additional Accounting Information
Additional Delivery Information
Additional Line Items
Independent Government Cost Estimate
Justification for Other than Full and Open
PR Approvals
Quotes/Market Research
SOW/PWS/SOO (applies to services)
Request for Reprographic Equipment
IT approval documents
Drawings/Maps/Specifications
Suggested 8(a) vendor
Tech. Evaluation Criteria
Tech. Evaluation Panel
Clearances (EA, Arch, ROW, etc.)
Budget
Fleet Justification
Other:
Section VIII. Signature
Use the section below to document supervisory approval. Depending on your program or purchase, additional approvals may
be required and should be included in the space provided below.
Program Supervisory Approver
Printed Name
Signature
Date
Additional Approver
Printed Name
Signature
Date
Additional Approver
Printed Name
Signature
Date
(e.g., Property Approver, Certifying Funds Approver)
Additional Approver
Printed Name Signature Date
Capitalized Property - Accountable personal property (not including museum property) with an original cost to the
Government of $15,000 or more is capitalized. Installation, shipping and handling, and configuration costs are included as
part of the original acquisition value and are capitalized. Real Property is capitalized at $100,000.
Sensitive Property - Property which is controlled, regardless of value, by detailed property accountability records and
which is determined to be sensitive because of its high probability of theft or misuse; or misappropriation; or because it has
been designated as sensitive by management. Sensitive property designated by IA include, weapons, vehicles, trailers, iPads,
Tasers, Laptops, Central Processing Units (CPUs), Radio Communication Equipment, (RCU), Ballistic , Vests, Weapons,
Ammunition, Explosives and all-terrain vehicles (ATVs).
Additional Approver
Printed Name Signature Date
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ureau of Indian AffairsEducation Program Electronic Purchase Request (Bureau of Indian Affairs)

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Completed 19 July 2020

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