Attachment_B_-_Billing_Instructions.docx

ATTACHMENT B - BILLING INSTRUCTIONS

A. RECEIVING PAYMENT UNDER ATTACHED AWARD

1. You must be able to accept electronic payments.

2. You must have a valid TIN and DUNS Number and be registered in the System for Award Management (SAM) database (http://www.sam.gov). The Contractor shall maintain registration during performance and through final payment of this contract. Keep in mind if your bank merges with another bank or you change banks you are responsible for updating the data in the SAM database and reporting it to the paying office cited at G.5.6.

B. SUBMITTING INVOICES

1. The Contractor shall submit Payment requests to hrsainvoices@hrsa.gov using Standard Form 1034, Public Voucher for Purchase and Services Other Than Personal. Supporting documentation necessary to substantiate your request may be requested by the Contracting Officer Representative (COR) or the Contract Specialist (CS).

2. Submit the SF 1034 and all supporting documentation in PDF format. An electronic copy of the SF1034 in PDF format may be found at www.gsa.gov/portal/forms/download/115462.

3. The Contractor agrees to include the following information on the voucher:

· In block entitled, Voucher No., enter the number of the voucher.

· In block entitled, U.S. Department, Bureau or Establishment and Location enter:

· In the block entitled, Date Voucher Prepared, enter the date the voucher is prepared.

· In the block entitled, Contract Number and Date, enter the contract number under which reimbursement is claimed and the date the contract was signed.

· In the block entitled, Requisition Number and Date, leave blank.

· In the block entitled, Payee’s Name and Address, enter the name and address as it appears on the contract. In the case of assignment of claims, also supply the remit to address of the organization to which payments are assigned. Enter the DUNS number in this block.

· In the block entitled, Number and Date of Order, leave blank.

· In the block entitled, Date of Delivery or Service, if billing monthly, enter the specific month/year that the cost were incurred. If billing for a period other than monthly, enter the beginning and ending dates of the cost incurrence period.

· In the block entitled, Articles or Services, enter a description of the articles or service provided. If additional space is needed, provide in an attachment. Include the signed statement, “I certify that all payments requested are for appropriate purposes and in accordance with the contract.”

· In blocks entitled, Amount and Total, enter the total dollar amount claimed for this billing.

VOUCHERS WITHOUT ALL REQUIRED INFORMATION WILL BE DENIED UNTIL THE PROPER INFORMATION IS SUBMITTED.

4. Inquiries:

Regarding payment, call (301) 443-3020;

Regarding receiving, inspection and acceptance, or technical issues, call your Contracting Officer Representative (COR);

Regarding suspension or rejection, call your Contract Specialist.

Note: Your respective COR does not have the authority to (1) solicit proposals, (2) modify the stated terms of the award (i.e. change in price, change in scope of work), (3) issue instructions to the contractor to start or stop work, or (4) approve any action that will result in additional charges to the government. These changes are the sole responsibility of the Contracting Officer. The Government will not be responsible for cost overruns or unauthorized procurements made by the vendor.

Standard Form 1034 Revised October 1987 Department of the Treasury

1 TFM 4-2000

1034-122

PUBLIC VOUCHER FOR PURCHASES AND

SERVICES OTHER THAN PERSONAL

VOUCHER NO.

REQUISITION NUMBER AND DATE

PAYEE’S

NAME

AND

ADDRESS

DATE INVOICE RECEIVED

DISCOUNT TERMS

PAYEE’S ACCOUNT NUMBER

SHIPPED FROM

TO

WEIGHT

GOVERNMENT B/L NUMBER

NUMBER

AND DATE

OF ORDER

DATE OF

DELIVERY

OR SERVICE

ARTICLES OR SERVICES

(Enter description, item number of contract or Federal supply schedule, and other information deemed necessary)

QUAN-

TITY

|_| PROVISIONAL

=$1.00

|_| PARTIAL

|_| FINAL

Amount verified; correct for

|_| ADVANCE

Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment.

(Date)

(Authorized Certifying Officer)2

(Title)

ACCOUNTING CLASSIFICATION

1 When stated in foreign currently, insert name of currency.

2 If the ability to certify and authority to approve are combined in one person, one signature only is necessary; otherwise the approving officer will sign in the space provided, over his official title.

3 When a voucher is receipted in the name of a company or corporation, the name of the person writing the company or corporate name, as well as the capacity in which he signs, must appear. For example: "John Doe Company, per John Smith, Secretary" or "Treasurer", as the case may be.

PER

TITLE

PRIVACY ACT STATEMENT

The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of disbursing Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will hinder discharge of the payment obligation.