Attachment_C_Invoice_Instructions.pdf

NOW THAT I HAVE A GOVERNMENT CONTRACT

HOW DO I GET PAID?

A. RECEIVING PAYMENT UNDER ATTACHED AWARD

You must be able to accept electronic payments and you must be registered in the System for Award Management (SAM) database (http://www.sam.gov). Your DUNS number and banking information must be current. Keep in mind that you must make changes in SAM if your bank merges with another bank or you change banks. You are responsible for updating the data in the SAM database and for re-registering before your expiration date. SAM will notify users by e-mail that their file is due to expire beginning 60 days prior to expiration, then 30 days and finally 15 days before expiration.

B. SUBMITTING REQUEST FOR PAYMENT

1. The contractor shall submit payment requests to hrsainvoices@hrsa.gov using Standard Form 1034, Public Voucher for Purchases and Services Other Than Personal. Supporting documentation necessary to substantiate your request may be submitted along with the SF 1034. Attached for your convenience is a SF 1034.

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. Only one SF 1034 may be attached to your submission. An e-mail with more than one voucher will be returned to you.

4. Complete the SF 1034 following the directions below:

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

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

HHS/Health Resources and Services Administration Office of Acquisition Management and Policy 5600 Fishers Lane, Room 14W26 Rockville, MD 20857

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. If billing for work done under a task order or BPA call, enter the contract number or Blanket Purchase Agreement number against which the order or call was issued. If you are simply billing for deliverables under a Purchase Order, leave this block blank and enter the order number in the block entitled, Number and Date of Order.

http://www.sam.gov/ mailto:hrsainvoices@hrsa.gov http://www.gsa.gov/portal/forms/download/115462

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, enter the number and date of the Purchase Order, task order or BPA call number.

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.

5. Inquiries:

Regarding payment, contact the Accounts Payable Section:

PSC/FMP/AS

U.S. Department of Health and Human Services Program Support Center 7700 Wisconsin Ave., Suite 9000 Bethesda, MD 20814 Telephone: 301-492-5233 Fax: 301-480-5089 Email: pscinvoiceinquiries@psc.hhs.gov

Regarding voucher submission, e-mail your concerns to hrsainvoices@hrsa.gov.

Regarding technical issues, inspection and acceptance, call your Contracting Officer Representative (COR).

Regarding suspension or rejection of costs submitted, 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.

mailto:pscinvoiceinquiries@psc.hhs.gov mailto:hrsainvoices@hrsa.gov

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.

U.S.DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION DATE VOUCHER PREPARED SCHEDULE NO.

Health Resources & Services Administration 5600 Fishers Lane, 14W26 Rockville, MD 20857

CONTRACT NUMBER AND DATE PAID BY

REQUISITION NUMBER AND DATE (Optional)

PAYEE’S

NAME

AND

ADDRESS

Address as it appears on the Contract/Order:

Remit to address (where payment is to be sent) :

DUNS No.___________________________

DATE INVOICE

RECEIVED

DISCOUNT TERMS

PAYEE’S ACCOUNT

NUMBER

SHIPPED FROM TO WEIGHT

GOVERNMENT B/L

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

UNIT PRICE AMOUNT

COST PER (1)

Date: (mm/dd/yyyy) From:

(mm/dd/yyyy)

To:

Order No.:

(mm/dd/yyyy)

HHSH________________

I certify that all payments requested are for appropriate purposes and in accordance with the contract”.

X______________________________________

(Name of Official) (Title) (Date)

(Use continuation sheets if necessary) (Payee must NOT use the space below) TOTAL

PAYMENT: APPROVED FOR EXCHANGE RATE DIFFERENCES

PROVISIONAL =$ =$1.00

COMPLETE BY2

PARTIAL

FINAL Amount verified; correct for

PROGRESS TITLE (Signature or initials)

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

CHECK NUMBER

ON ACCOUNT OF U.S.

TREASURY

CHECK NUMBER ON (Name of bank)

CASH DATE PAYEE3

When stated in foreign currently, insert name of currency.

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.

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

Previous edition usable NSN 7650-00-634-4206

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.