RFP_283-15-0458_Attach_4-12.pdf

RFP No. 283-15-0458 Attachment 4

VOUCHER REVIEW SHEET

Contract No.: _____________________________________ Contractor: ____________________________________ DUNS No.: _____________________

Received in DCM/OFR: ________________________ X Cost Reimbursement Today's Date: Fixed Price Date Due In DCM: IQC Work Order Date Due In PSC/DFS: Letter of Credit

Contract Financing Payment (N/A if Letter of Credit)

To: ___________________________ , Project Officer

From: __Craig Sager , Division of Contracts Management, OFR, SAMHSA 1 Choke Cherry Road

Subject: Voucher No.: ____________

Period Covered: ________________________________

Contractor Point of Contact: _____________________________ Telephone: _______________________

Project Officer:

Please review the Voucher, answer the following and return to DCM by date shown above.

YES NO

1. Are costs commensurate with efforts expended?

2. Are all elements of cost reasonable, in support of contract performance and _______ consistent with amounts negotiated?

3. Have deliverables received during the period been timely and acceptable _______

4. Do you recommend payment be made as claimed? _______

5. Do you question any costs claimed? If yes, explain below. _______

(ATTACH ADDITIONAL SHEET OF PAPER IF NEEDED):

P.O. sign and date here: Date: ____________________ Signature

To: Program Support Center: PAY THIS AMOUNT: $______________________ Division of Fiscal Services AMOUNT CLAIMED: $______________________ Room 16-23 AMOUNT TO BE SUSPENDED FROM PAYMENT: $______________________

In accordance with the Prompt Payment Provisions (Subsection (b)(4)), INTEREST IS, IS NOT payable under this Invoice or “Contract Financing Payment.” TO BE PAID NOT LATER THAN .

* NOTE: THIS INVOICE/VOUCHER IS APPROVED FOR PROVISIONAL PAYMENT ONLY.

All payments are subject to change pending final audit.

Reason for Suspension:

Approved for payment: Date: ___________________

Contract Specialist

Attachment 5

PACKAGING AND DELIVERY OF THE PROPOSAL

Your proposal shall be organized as specified in Section L.2., “Instructions to Offerors” - General Instructions.

Shipment and marking shall be as indicated below.

EXTERNAL PACKAGE MARKING

In addition to the address cited below, mark each package as follows:

“PROPOSAL—RFP NO. 283-15-0458”

TO BE OPENED BY AUTHORIZED GOVERNMENT PERSONNEL ONLY”

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY:

NUMBER OF COPIES

TECHNICAL PROPOSAL: ORIGINAL* AND 9 COPIES TO:

BUSINESS PROPOSAL: ORIGINAL* AND 4 COPIES TO:

WHEN UTILIZING THE U.S. POSTAL SERVICE:

Craig Sager

Substance Abuse and Mental Health Services Administration Division of Contracts Management, OFR 1 Choke Cherry Road, Room 7-1051 Rockville, Maryland 20857

WHEN UTILIZING SPECIAL / OVERNIGHT CARRIER SERVICE OR HAND DELIVERY:

Craig Sager

Substance Abuse and Mental Health Services Administration Division of Contracts Management, OFR 1 Choke Cherry Road, Room 7-1051 Rockville, Maryland 20850

Attachment 6: Billing Instructions

BILLING INSTRUCTIONS

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

DIVISION OF CONTRACTS MANAGEMENT

Guide for Preparing Vouchers Under Cost-Reimbursement Type Contracts

I. INTRODUCTION

A. GENERAL

This Guide presents procedures for the preparation of Contractor's reimbursement claims under (1) cost-reimbursement type contracts; (2) the cost-reimbursement portions of fixed-price contracts; (3) letter contracts which provide for reimbursement of costs; (4) time and material contracts; and (5) labor-hour contracts. The term "cost-reimbursement type contracts" as used in this Guide includes all of the foregoing contractual arrangements.

B. DESK AUDIT

To expedite final payment on contracts subject to desk audit, the contractor may be required to provide the information set forth in III, C, of this guide.

C. PRESCRIBED GOVERNMENT FORMS

Standard Form 1034 "Public Voucher for Purchases and Services Other Than Personal" (Figure 1), and Standard Form 1035, "Public Voucher for Purchases and Services Other Than Personal - Continuation Sheet" (Figure 2), should be utilized by Contractors to show the amount claimed for reimbursement under cost-reimbursement type contracts, and to provide the necessary supporting detail, respectively. The SF 1035 may also be used to furnish any additional information as may be required by the Contracting Officer in accordance with the terms of the contract. The voucher and continuation sheet may be on reproduced copies of the forms providing they conform to the official Government forms in format and are marked "original".

The Contractor may attach to the SF 1034, Public Vouchers for Purchases and Services Other Than Personal, Form HHS-646, Financial Report of Individual Project/Contract, or self-designed form may be used if it contains the information required by this Guide and is otherwise acceptable to the Contracting Officer.

D. TIME OF SUBMISSION

Vouchers may be submitted at the beginning of each billing period for costs incurred during the preceding billing period. Costs incurred earlier than the preceding billing period, but not previously billed for, may be included, but the amount and month(s)in which such costs were incurred must be stated in the SF 1035 or equivalent form. Vouchers shall not be submitted more frequently than once each month unless such arrangements are made with the Contracting Officer.

E. COST INCURRANCE PERIOD

Costs must be incurred within the contract performance period or the period covered by pre-contract cost provisions.

F. CONTRACTOR'S FISCAL YEAR

Vouchers must be prepared in such a manner that costs claimed can be associated or identified with the Contractor's fiscal year. This will ensure proper application of indirect cost rates to the direct costs of a particular fiscal year.

II. PREPARATION OF PUBLIC VOUCHERS

A. GENERAL

This information which a Contractor is required to submit in its public vouchers (SF 1034 and 1035) is set forth in the explanatory notes which follow. These notes are keyed to the entries on the illustrative public vouchers, Figures 1 and 2.

B. COMPLETION OF SF 1034

The following information is required to be submitted on SF 1034 or equivalent (Refer to Figure 1):

(a) U. S. Department, Bureau of Establishment and Location enter the complete address as shown in the contract.

(b) Date Voucher Prepared - insert the date on which the voucher was prepared.

(c) Contract Number and Date - insert the number and the date of the contract under which reimbursement is claimed.

(d) All blocks lettered (d) should normally be left blank.

(e) Voucher No. - insert the appropriate serial number of each voucher including the completion and final voucher. A separate series of consecutive numbers, beginning with number 1, shall be used by the Contractor for each contract.

(f) Payee's Name and Address - insert name and address of Contractor to which payment should be made. In the case of an assignment of claims, also insert the organization to which payments have been assigned.

(g) Payee's Account Number - this space may be used by the Contractor to record the account or job number assigned to the contract.

(h) Number and Date of Order - enter the number and date of the applicable order. (Applicable only when billings are consequent to work assignments of the cost occurrence period.)

(i) Date of Delivery/Services - show the month and year, beginning and ending dates of the cost incurrence period.

(j) Articles and Services - insert the following: "For detail see attached page(s)".

(k) Amount and Total - insert the amount claimed for the period indicated in (i) above.

(l) Identification - each voucher submitted must be prominently identified as one of the following:

(i) Interim Voucher - "Cost Reimbursable - Provisional Payment".

(ii) Completion Voucher - "Cost Reimbursable Completion Voucher".

(iii) Final Voucher - "Cost Reimbursable - Final Voucher".

(m) Type the following certification, signed by an authorized official, on the face of the SF 1034:

"I certify that all payments requested are for appropriate purposes and in accordance with the applicable); Total Contract Value; and Amount of Fee payable (if applicable).

Name of Official and Title

C. COMPLETION OF SF 1035

The following information is required to be submitted on SF 1035 or equivalent (refer to Figure 2):

(1) Insert the name of the Government Agency as shown under of the SF 1034.

(2) Insert the voucher number as shown on the SF 1034.

(3) Schedule No. - Leave blank.

(4) If more than one sheet is used, insert the sheet number in numerical sequence, showing Page of . Use as many sheets as necessary to show the required information.

(5) Insert payee's name and address as in the SF 1034.

(6) Insert the contract number as shown on the SF 1034.

(7) Insert the latest: total estimated cost; total fee (if applicable); total contract value; and amount of fee payable (if applicable).

(8) Insert: "Summary of claimed current and cumulative cost" and "fee earned", if applicable.

(9) Unless otherwise required by the contract, insert the major elements of incurred cost which are defined as follows:

(1) Direct Costs

(a) Direct Labor: This consists of salaries and wages for direct performance of the contract.

(b) Fringe Benefits: This represents fringe benefits applicable to direct labor and billed as direct cost. Fringe benefits included in indirect costs should not be identified here.

(c) Capitalized Nonexpendable Equipment: This represents personal property of a capital nature;

i.e., property acquired at a cost of $1000 or more and that has a service life of more than two years.

Form HHS 565, Report of Accountable Property as outlined in the HHS publication "Contractor's Guide for control of Government Property" will accompany the contractor's public voucher (SF 1034/SF 1035) as required.

(d) Material, Supplies and Non-capitalized Equipment: These are consumable materials, supplies and equipment other than those described in (c) above.

(e) Premium Pay: This is remuneration in excess of the basic hourly rate.

(f) Consultant's Fee: These are fees paid to consultants. List names, time, and charges for the current billing period. If required by the terms and conditions of the contract, cite the applicable COA number.

(g) Travel: Domestic travel is travel within the United States, its territories, possessions, and Canada. It should be billed separately from foreign travel.

(h) Other: List all other direct costs in total unless significant in amount. If significant, list costs elements and dollar amount separately; i.e., subcontracts.

2. Indirect Costs

(a) Overhead: Cite the formula (rate and bass) in effect during the time the costs were incurred and for which reimbursement is claimed.

(10) Insert the current costs claimed by major cost elements. Costs claimed for reimbursement can be only those amounts that are consistent with the term "costs" as defined in allowable cost and payment clause. Where it is found that amounts claimed do not meet this definition, such costs together with their associated costs and fee will be disallowed. All adjustments included herein must be explained in detail.

(11) Insert the cumulative costs claimed to date by major cost elements.

(12) Costs claimed for cost-typed subcontracts must be supported by information similar to the SF 1035 for each subcontractor. Costs for fixed-price subcontracts shall be on the basis of items delivered or services received, accepted and paid by the prime contractor.

(13) Insert the total costs for the current and cumulative periods.

(14) If the contract provides for an incentive or fixed-fee, insert the fee earned for the current and cumulative periods and the formula for such computation; e.g., if payment of the fee is based on a percentage of costs, the target incentive fee or fixed-fee earned shall be determined by applying the percentage ration of target incentive fee or fixed-fee to the total estimated cost of the contractor. However after payment of 85% of the fee, the Contracting Officer may withhold further payment of fee to establish a reserve to protect the interests of the Government. This reserve may not exceed 15% of the total fee, or $100,000, whichever is less.

For Example

Contract Estimated Cost $100,000 Fixed-Fee 6,000 Total CPFF $106,000

Maximum Fee Payable $ 5,100 (85% of 6,000)

Fixed-Fee $ 6,000 - 6% Estimated Cost $100,000

Therefore, fixed-fee may be billed at 6% of actual costs incurred until the maximum fee of $5,100 has been paid. Any fee withheld is payable upon submission of appropriate closing documents after final audit of the contract has been completed and all audit exceptions have been resolved.

(15) Insert the total costs claimed and the fee due for the current ad cumulative periods.

(16) If applicable, resubmission of any previously claimed amounts which were suspended should be shown below the current amount claimed and footnoted to cite the number of the public voucher on which the deduction was made and the date and number of the related suspension notice.

Suspensions from which the contractor has successfully appealed shall be identified by referencing the Contracting Officer's letter of approval.

(17) Insert the current amount claimed. Transfer this amount to SF 1034.

III. GENERAL INSTRUCTIONS

A. Costs Requiring Prior Authorization and Approval The contractor should be aware of the requirements for prior written approval from the Contracting Officer for certain costs (e.g., premium pay, foreign travel). Whenever the voucher includes such costs not authorized by the contract, reference must be made to the Contracting Officer's Authorization letter (COA).

B. Withholding and Releases of Contract Reserves Contractual provisions covering fees, patents, royalties, etc., usually provide for the accumulation of a withholding reserve until certain contract requirements are met to the satisfaction of the Contracting Officer. It is the contractor's responsibility to include appropriate adjustments in his reimbursement claims to cover the required accumulation and release of contract withholding reserves. The contractor should resolve any questions regarding the amount of these reserves with the Contracting Officer.

C. Contractor's Completion Voucher After all costs have been assigned to the contract and all contract performance provisions have been completed, the Contractor shall promptly submit, but in any event within twelve (12) months from the date of such completion, its completion voucher to the office designated in the contract directly to the Contracting Officer to finalize the financial settlement of the contract). This voucher must be specifically identified as the completion voucher and should include the remaining cost, fees, and reserves claimed to be due by the Contractor. It will not include items and amounts which may be set out in any qualifications in the Contractor's release of claims. A separate completion voucher shall be submitted for each individual project or task order for which a separate series of public vouchers has been submitted.

Final payment on prescribed contracts may be made on the basis of a desk audit. To expedite final settlement on these contracts, the Contracting Officer may request the Contractor to submit detailed support for costs claimed under one or more interim vouchers.

D. Contractor's Final Voucher and Closing Documents After completion of the final audit and all suspensions and/or audit exceptions have been resolved and there is mutual agreement between the Contractor and the Contracting Officer on the final allowable cost and fee, if any, the Contractor shall submit its final voucher and the appropriate closing documents to the office designated in the contract. The Contractor shall promptly submit it final voucher within twenty-four (24) months from the date of it contract expiration. The funds that are obligated against the contracts/task order are yearly funds and expire after 5 years. The final voucher is for any indirect rate adjustments that might have occurred. If the rate adjustments are not completed or submitted within 24 months after the expiration of the contract, the Government will have the authority to close the contract based of the rates that were used during the contract. The contractor will be notified of the closing. If the contract is closed due to time and the contractor fails or refuses to submit the closing documents, this will be noted in the file documentation, however the contract if officially closed.

This voucher shall be specifically identified as the final voucher, and must be supported by the following documents:

(1) Contractor's Release

(2) Assignee's Release, if applicable.

(3) Contractor's Assignment of Refunds, Rebates, Credits and Other Amounts

(4) Assignee's Assignment of Refunds, Rebates, Credits, and Other Amounts, if applicable

(5) Contractor's Affidavit or Waiver of Lien, when required by the contract

If final settlement of the contract is in the amount shown on the completion voucher, the Contractor need not submit a final voucher, but only the additional closing documents cited above.

E. Currency All Department contracts are expressed in the United States dollars. Where expenditures are made in a currency other than United States dollars, billings on the contract shall be expressed, and reimbursement by the United States Government shall be made, in that other currency at amounts coincident with the actual costs incurred. Currency fluctuation may not be on a basis of gain or loss to the Contractor. Notwithstanding the above, the total of all invoices paid under this contract may not exceed the United States dollars authorized.

F. Government Liaison Any questions concerning delays in payment of Contractor's vouchers should be addressed to the office designated to receive the voucher; matters relative to performance or the instructions set forth in this Guide, should be addressed to the Contracting Officer.

Exhibit A to Billing Instructions

In addition to the requirements of the billing Instructions for Cost-Reimbursement Type Contracts, the contractor agrees to included the following supplemental information on each invoice for the cost categories shown below:

Direct Labor

(1) Position Category

(2) Employee Identification Number or Name

(3) Hours Expended

(4) Hourly Rate

Travel

(1) Detail purpose of travel (i.e., seminar, course, site visit, etc.)

(2) Dates and duration of travel

(3) Point of departure and destination

(4) Names of individuals

(5) Per diem rate

(6) Travel costs (air fare, care rental (including mileage), taxis, etc.)

Material or Equipment (Rental or Purchase

(1) Description, quantity and amount of each item

(2) COA letter number, if applicable

Consultants

(1) Name

(2) Rate

(3) Number of days and dates

(4) COA letter number, if applicable

Indirect Costs

(1) Rate

(2) Base

Other Direct Costs All other expenditures must be described and the respective amounts shown.

Billing Instructions to be included in any subcontracts shall call for the supplemental information cited above. The prime Contractor shall provide, with each invoice that contains subcontract costs, a copy of the supplemental information provided by the subcontractor.

Contractor's Fiscal Year Invoices must be prepared in such a manner that costs claimed can be associated or identified with the Contractor's fiscal year.

SAMPLE INVOICE/FINANCING REQUEST

(a) Contracting Officer Division of Contracts Management

OFR, SAMHSA

1 Choke Cherry Road Room 7-1051 Rockville, Maryland 20857

(b) Invoice/Financing Request No.

(c) Date Voucher Prepared

(d) Contract No. and Date

(e) Payee's Name and Address

ABC CORPORATION

100 Main Street Anywhere, U.S.A. Zip Code

(f) Total Estimated Cost of Contract

Attention: Name, Title and Phone Number of Official to Whom Payment is Sent

(g) Total Fixed Fee

(h) This invoice/financing request represents reimbursable costs from August 1, 1992 through August 31, 1992.

(k) Direct Costs

(1) Direct Labor

(2) Fringe Benefits

(3) Accountable Personal Property (Attach HHS-565) Permanent General Purpose

(4) Materials and Supplies

(5) Premium Pay

(6) Consultant Fee Dr. Jones/1 day @ 100-COA #3

(7) Travel - Domestic (see detail) Foreign

(8) Subcontract Cost

(9) Other Total Direct Costs

(l) Cost of Money (Factor) or (Appropriate Base)

(m) Indirect Costs - Overhead % of Direct Labor or Other Base (Formula)

(n) Fixed-Fee Earned (Formula)

(o) Total Amount Claimed

(p) Adjustments Outstanding Suspensions

(q) Grand Totals

(i) Amount Billed for Current Period

$ 3,400

3,000 2,000 2,000

$ 0 $ 11,600

2,400

4,000

$ 18,700

$ 18,700

(j) Cumulative Amount From Inception to Date of this Billing

$ 6,800 1,200

8,000 2,000 4,000

$20,650

3,600

6,000

1,400

$31,650

$29,950

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

(Name of Official) (Title)

Attachment 7: SF LLL—Disclosure of Lobbying Activity

DISCLOSURE OF LOBBYING ACTIVITY

1. Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

a. bid/offer/application

b. Initial award

c. post-award

3. Report Type:

a. initial filing

b. material change For Material Change Only:

year ______ quarter _______ date of last report________

4. Name and Address of Reporting Entity:

G Prime G Subawar Tier_____, if know

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime

Congressional District, if known:

6. Federal Department/Agency:

7. Federal Program Name/Description CFDA Number, if applicable: __________________

8. Federal Action Number, if known:

9. Award Amount, if known:

10. a. Name and Address of Lobbying Entity (if individual, last name, first name, MI):

(attach Continuation Sheet(s)

b. Individual Performing Services (including address if different from No.

10a) (last name, first name, MI) SF-LLL-A, if necessary)

11. Amount of Payment (check all that apply):

$__________ G actual G planned

13. Type of Payment (check all that apply):

G a. retainer

G b. one-time fee

G c. commission

G d. contingent fee

G e. deferred

G f. other; specify: _____________________________

12. Form of Payment (check all that apply):

G a. cash

G b. in-kind; specify: nature_____________ value______________

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for payment indicated in Item 11:

(attach Continuation Sheet(s) SF-LLL-A, if necessary)

15. Continuation Sheet(s) SF-LLL-A attached:

Yes

No

16. Information requested through this form is authorized by title 31 U.S.C. section

1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each failure.

Signature:______________________________________

Print Name:_____________________________________

Title:__________________________________________

Telephone No.:_________________Date:____________

Federal Use Only

Authorized for Local Reproduction Standard Form--LLL

DISCLOSURE OF LOBBYING ACTIVITIES

CONTINUATION SHEET

Approved by OMB 0348-0046

Reporting Entity:_________________________________ Page _____ of _____

Authorized for Local Reproduction Standard Form--LLL-A

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee of prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing of attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee (e.g., the first subawardee of the prime is the 1st tier). Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known.

For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance

(CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract, grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a); Enter Last Name, First Name, and

Middle Initial (MI).

11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material charge report, enter the cumulative amount of payment made or planned to be made.

12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.

15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.

16. The certifying official shall sign and date the form, print his/her name, title and telephone number.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, D.C. 20503.

Attachment 8

Contact Points

CONTACT POINTS

Complete the following and return with the BUSINESS PROPOSAL.

Name, Title and Address* of Business Representative with whom daily contact is required.

Name: Telephone Number:

Institutional Title: FAX Number:

Institutional Office

Institution Name **Street Address City, State Zip Code:

Name, Institutional Title and Address of Proposed Project Director.

Name: Telephone Number:

Institutional Title: FAX Number:

Institutional Division, etc.

**Street Address City, State Zip Code:

These exact addresses are necessary to ensure that contact can be made with the proper indivual(s) in the most expeditious manner.

* May not necessarily be the same as legal address of Offeror.

** Please use actual street address, not P.O. Box.

Attachment 9

Breakdown of Proposed Estimated Cost (Plus Fee) and Labor Hours

BREAKDOWN OF PROPOSED ESTIMATED COST (PLUS FEE) AND LABOR HOURS

INSTRUCTIONS FOR USE OF THE FORMAT

1. Refer to Business Proposal Instructions, Section L of this solicitation. The Instructions contain the requirements for proper submission of cost/price data which must be adhered to.

2. This format has been prepared as a universal guideline for all solicitations issued by the Substance Abuse and Mental Health Services Administration. It may require amending to meet the specific requirements of this solicitation. For example, this solicitation may require the submission of cost/price data for three years listed on this form. (See Section F.1, Period of Performance, for the estimated duration of this project.) If this solicitation is phased, identify each phase in addition to each year. Total each year, phase, and sub-element.

3. This format must be used to submit the breakdown of all proposed estimated cost elements. List each cost element and sub-element for direct costs, indirect costs and fee, if applicable. In addition, provide detailed calculations for all items. For example:

a. For all personnel, list the name, title, rate per hour and number of hours proposed. If a pool of personnel is proposed, list the composition of the pool and how the cost proposed was calculated. List the factor used for prorating Year One and the escalation rate applied between years.

Offeror's proposal should be stated in the same terms as will be used to account for and record direct labor under a contract (i.e. percentage of effort is used for most faculty and professional employees at educational institutions). If percentages of effort are used, the basis to which such percentages are applied must also be submitted by the offeror. The attached format should be revised to accommodate direct labor proposed as a percentage of effort.

b. For all materials, supplies, and other direct costs, list all unit prices, etc., to detail how the calculations were made.

c. For all indirect costs, list the rates applied and the base the rate is applied to.

d. For all travel, list the specifics for each trip.

e. For any subcontract proposed, submit a separate breakdown format.

f. Justification for the need of some cost elements may be listed as an attachment, i.e., special equipment, above average consultant fees, etc.

4. If the Government has provided "uniform pricing assumptions" for this solicitation, the offeror must comply with and identify each item.

Attachment 9

Breakdown of Proposed Estimated Cost (Plus Fee) and Labor Hours

BREAKDOWN OF PROPOSED ESTIMATED COST (PLUS FEE) AND LABOR HOURS

Cost Element Year 1 Year

Year

Year

Year 5 Total

Direct Labor Labor Category - Title & Name Project Director Writer Conference Manager

Rate & Hours each year

Direct Labor Cost Total hrs $ $ $ $ $ $ Fringe Benefits (if applicable) % $ $ $ $ $ $ Total Labor & Fringe $ $ $ $ $ $ Overhead (if applicable) % $ $ $ $ $ $ Total Labor Costs $ $ $ $ $ $ Other Direct Costs Reproduction $ $ $ $ $ $ Telephone $ $ $ $ $ $ Supplies $ $ $ $ $ $ Subcontracts (separate line and name each) (subs proposal attached)

Consultants (have a breakdown of fee attached, breakdown by task by year)

Travel (have breakdown of travel attached, breakdown by task, by year)

Total ODC=s $ $ $ $ $ $ Subtotal of Total Labor & ODC=s $ $ $ $ $ $ G&A % $ $ $ $ $ $ Subtotal ** $ $ $ $ $ $ Base Fee (%calculated against subtotal

Award Fee(%calculated against subtotal

Total Estimated Costs $ $ $ $ $ $

Attachment 10

Proposal Intent Response Sheet

PROPOSAL INTENT RESPONSE SHEET

TITLE: “Substance Abuse and Mental Health Data Archives, (SAMHDA) ”

PLEASE REVIEW THE ATTACHED REQUEST FOR PROPOSAL. FURNISH THE INFORMATION

REQUESTED BELOW AND RETURN THIS PAGE BY THE EARLIEST PRACTICABLE DATE, BUT NOT

LATER THAN December 15, 2014. YOUR EXPRESSION OF INTENT IS NOT BINDING BUT WILL GREATLY

ASSIST US IN PLANNING FOR PROPOSAL EVALUATION.

[ ] DO INTEND TO SUBMIT A PROPOSAL

[ ] DO NOT INTEND TO SUBMIT A PROPOSAL FOR THE FOLLOWING REASONS:

COMPANY/INSTITUTION NAME:

AUTHORIZED SIGNATURE:

TYPED NAME AND TITLE:

COMPANY PHONE NUMBER:

COMPANY FAX NUMBER:

DATE:

PLANNED COLLABORATORS/CONSULTANTS/SUBCONTRACTORS

(PROVIDE NAME(S) AND ORGANIZATION)

RETURN TO:

Substance Abuse and Mental Health Services Administration Division of Contracts Management Attention: Craig Sager, Contract Specialist 1 Choke Cherry Road, Room 7-1070 Rockville, MD 20857

OR FAX TO: 240-276-1510

PLEASE RETURN THIS PAGE BY December 15, 2014

RFP NO. 283-15-0458

Attachment 11

Government Notice for Handling Proposals

NOTE: This Notice is for the Technical Evaluation Review Group who will be reviewing the proposals submitted in response to this RFP.

** THE OFFEROR SHOULD PLACE A COPY OF THIS NOTICE ON TOP OF EACH COPY

OF THE TECHNICAL PROPOSAL. **

GOVERNMENT NOTICE FOR HANDLING PROPOSALS

This proposal shall be used and disclosed for evaluation purposes only, and a copy of this Government notice shall be applied to any reproduction or abstract thereof. Any authorized restrictive notices which the submitter places on this proposal shall be strictly complied with. Disclosure of this proposal outside the Government for evaluation purposes shall be made only to the extent authorized by, and in accordance with, the procedures in HHSAR paragraph 352.215-1.

(f) If authorized in agency implementing regulations, agencies may release proposals outside the Government for evaluation, consistent with the following:

(1) Decisions to release proposals outside the Government for evaluation purposes shall be made by the agency head or designee;

(2) Written agreement must be obtained from the evaluator that the information (data) contained in the proposal will be used only for evaluation purposes and will not be further disclosed;

(3) Any authorized restrictive legends placed on the proposal by the prospective Contractor or subcontractor or by the Government shall be applied to any reproduction or abstracted information made by the evaluator;

(4) Upon completing the evaluation, all copies of the proposal, as well as any abstracts thereof, shall be returned to the Government office which initially furnished them for evaluation; and

(5) All determinations to release the proposal outside the Government take into consideration requirements for avoiding organizational conflicts of interest and the competitive relationship, if any, between the prospective Contractor or subcontractor and the prospective outside evaluator.

(g) The submitter of any proposal shall be provided notice adequate to afford an opportunity to take appropriate action before release of any information (data) contained therein pursuant to a request under the Freedom of Information Act (5 U.S.C. 552); and, time permitting, the submitter should be consulted to obtain assistance in determining the eligibility of the information (data) in question as an exemption under the Act. (See also Subpart 24.2, Freedom of Information Act.)

Attachment 12

SYSTEM NOTICE

09-30-0036

The following changes to System Notice No. 09-30-0036 were printed in the Federal Register, Vol. 59, No. 248, Wednesday December 29, 1994, beginning on page 67077.

Changes The following minor changes have been made to the system of records as follows:

09-30-0036

System Name:

Alcohol, Drug Abuse, and Mental Health Epidemiologic and Biometric Research Data, HHS/SAMHSA/OA.

Minor alterations have been made to this system of records notice. The following categories should be revised in their entirety:

SAFEGUARDS:

1. Authorized Users: Access to identifiers and to link files is strictly limited to those authorized personnel whose duties require such access.

Procedures for determining authorized access to identified data are established as appropriate for each location.

Personnel, including contractor personnel, who may be so authorized include those directly involved in data collection and in the design of research studies, e.g., interviewers and interviewer supervisors; project managers; and statisticians involved in designing sampling plans.

2. Physical safeguards: Records are stored in locked rooms, locked file facilities. Personal identifiers and link files are separated as much as possible and stored in locked files.

Computer data access is limited through the use of key words known only to authorized personnel.

3. Procedural safeguards:

Collection and maintenance of data is consistent with legislation and regulations in the protection of human subjects, informed consent, confidentiality, and confidentiality specific to drug and alcohol abuse patients where these apply. When a SAMHSA component or a contractor provides anonymous data to research scientists for analysis, study numbers which can be matched to personal identifiers will be eliminated, scrambled, or replaced by the agency or contractor with random numbers which cannot be matched.

Contractors who maintain records in this system are instructed to make no further disclosure of the records.

Privacy Act requirements are specifically included in contracts for survey and research activities related to this system. The HHS project directors, contract officers, and project officers oversee compliance with these requirements.

4. Implementation guidelines:

DHHS Chapter 45-13 and supplementary Chapter PHS.hf:

45-13 of the General Administration Manual and Part 6, "Automated Information Systems Security" of the HHS Information Resources Management Manual.

SYSTEM MANAGER(S)

AND ADDRESS:

Office of Applied Studies, Office of the Director, Room 16- 105, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857 Center for Substance Abuse Prevention, Office of the Director, Room 9D10, Rockwall II Building, 5600 Fishers Lane, Rockville, Maryland 20857 Center for Substance Abuse Treatment, Office of the Director, Room 10-75, Rockwall II Building, 5600 Fishers Lane, Rockville, Maryland 20857 Center for Mental Health Services, Office of the Director, Room 15-105, Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857

Systems Notice No. 09-30-0036 as printed in the Federal Register Vol. 58, No. 248, Wednesday, December 29, 1993, Beginning on page 68999.

09-30-0036

System Name:

Alcohol, drug abuse, and Mental Health Epidemiologic Data, HHS/SAMHSA/OA.

SECURITY

CLASSIFICATION:

None

SYSTEM LOCATION

Records are located at facilities which collect or provide service evaluations for this system under contract to the agency.

Contractors may include, but are not limited to, research centers, clinics, hospitals, universities, research foundations, national associations, and coordinating centers. Records may also be located at the Office of Applied Studies, Center for Substance Abuse prevention, the Center for Substance Abuse Treatment, and the Center for Mental Health services. A current list of sites is available by writing to the

Privacy Act – Systems Notice 09-30-0036 appropriate System manager at the address below.

CATEGORIES OF

INDIVIDUALS COVERED

BY THE SYSTEM:

Individuals who are the subjects of epidemiologic, methodologic, services, evaluations, and longitudinal studies and surveys of mental health and alcohol and drug use/abuse. These individuals are selected as representative of the general adult and/or child population or of special groups.

Special groups include, but are not limited to, normal individuals serving as controls;

clients referred for or receiving medical, mental health and alcohol and/or drug abuse related treatment and prevention services; providers of services;

demographic sub-groups as applicable, such as age, sex, ethnicity, race, occupation, geographic location; and groups exposed to hypothesized risks, such as relatives of individuals who have experienced mental health and/or alcohol, and/or drug abuse disorders, life stresses, or have previous history of mental alcohol and/or drug abuse related illness.

CATEGORIES OF

RECORDS IN THE

SYSTEM:

The System contains data about the individual as relevant to a particular study. Examples include, but are not limited to items about the health/mental health and/or alcohol or drug consumption patterns of the individual; demographic data;

social security numbers (voluntary); past and present life experiences; personality characteristics; social functioning; utilization of health/mental health, alcohol, and/or drug abuse services;

family history; physiological measures; and characteristics and activities of health/mental health; alcohol abuse, and/or drug abuse care providers.

AUTHORITY FOR

MAINTENANCE OF THE

SYSTEM:

SAMHSA: Public Health Service Act sections 301(42 U.S.C. 241), 322(42 U.S.C.

249(c)), 501 (42 U.S.C. 290aa), 503 (42 U.S.C. 290aa-2), and 505 (42 U.S.C. 290aa-4). CSAT:

Center for Substance Abuse Treatment, section 507-12 (42 U.S.C. 290bb et, seq.). CSAP Center for Substance Abuse Prevention section 515-18 (42 U.S.C. 290bb-21 et, seq.).

CMHS: Center for Mental Health Services, sections 506 (42 U.S.C. 290aa-5) and 520-35 (42 U.S.C. 290bb-31 et. seq.).

Protection and Advocacy for Individuals with Mental Illness Act of 1986 as amended (42 U.S.C. 10801 et seq.); Refugee Education Assistance Act of 1980, section 501(c) (8 U.S.C.

1522 note), Pub. L. 96-422;

Executive Order 12341; and Disaster Relief Act of 1974, section 413, Pub L. 93-288, as amended by section 416 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act, Pub L. 100-07.

PURPOSES(S):

The purpose of the system of records is to collect and maintain a data base for health services evaluations activities of the Center for Substance Abuse Prevention, the Center for Substance Abuse Treatment, and the Center for Mental Health Services. Analyses of these data involve groups of individuals with given characteristics and do not refer to special individuals.

The generation of information and statistical analyses will ultimately lead to a better description and understanding of mental, alcohol, and/or drug abuse disorders, their diagnosis, treatment, and prevention, and the promotion of good physical and mental health.

ROUTINE USES OF

RECORDS MAINTAINED IN

THE SYSTEM, INCLUDING

CATEGORIES OF USERS

AND THE PURPOSES OF

SUCH USES:

1. A record may be disclosed for an evaluation purpose, when the Department:

(a) Has determined that the use or disclosure does not violate legal or policy limitations under which the record was provided, collected, or obtained; e.g., disclosure of alcohol or drug abuse patient records will be made only in accordance with 42 U.S.C. 290 (dd-2).

(b) Has determined that the study purpose (1) cannot be reasonably accomplished unless the record is provided in individually identifiable form and (2) warrants the risk to the privacy of the individual that additional exposure of the record might bring:

(c) Has required the recipient to

(1) establish reasonable administrative technical and physical safeguards to prevent unauthorized use or disclosure of the record, and (2) remove or destroy the information that identifies the individual at the earliest time at which removal or destruction can be accomplished consistent with the purpose of the health services evaluation project, unless the recipient has presented adequate justification of an analytical or health nature for retaining such information, and (3) make no further use or disclosure of the record except

(A) in emergency circumstances affecting the health or safety of any individual, (B) for use in another health service research or evaluation project, under these same conditions, and with written authorization of the Department, (C) for disclosure to a properly identified person for the purpose of an audit related to the evaluation project, if information that would enable study subjects to be identified is removed or destroyed at the earliest opportunity consistent with the purpose of the audit or

(D) when required by law; and

(d) Has secured a written statement attesting to the recipient's understanding of and willingness to abide by these provisions.

2. Disclosure may be made to a congressional office from the record of an individual in response to a verified inquiry from a congressional office made at the written request of that individual.

3. In the event of litigation, where the defendant is (a) the Department, any component of the department, or any employee of the Department in his or her official capacity; (b) the United States where the Department determines that the claim, if successful, is likely to directly affect the operations of the Department or any of its components; or (c) any Department employee in his or her individual capacity where the Justice Department has agreed to represent such employee; the Department may disclose such records as it deems desirable or necessary to the Department of Justice to enable that Department to present an effective defense, provided such disclosure is compatible with the purpose for which the records were collected (e.g. disclosure may be made to the Department of Justice or other appropriate Federal agencies in defending claims against the United States when the claim is based upon an individual's mental or physical condition and is alleged to have arisen because of the individuals' participation in activities of a Federal Government supported research project).

4. The Department contemplates that it will contract with a private firm for the purpose of collecting, analyzing, aggregating, or otherwise refining records in this system.

Relevant records will be disclosed to such contractor.

The contractor shall be required to maintain Privacy Act safeguards with respect to such records.

POLICIES AND PRACTICES

FOR STORING

RETRIEVING, ACCESSING,

RETAINING AND

DISPOSING OF RECORDS

ON THE SYSTEM:

STORAGE:

Records may be stored on index cards, file folders.

computer tapes, and disks, microfiche, microfilm, and audio and video tapes. Normally, the factual data, with study code numbers are stored on computer tape or disk while the key to personal identifiers is stored separately without factual data, in paper files.

RETRIEVABILITY:

During data collection stages and follow up if any retrieval by personal identifier (e.g, name, social security number) in some studies), or (medical record number), is necessary. During the data analysis stage, data are normally retrieved by the variables of interest (e.g;

diagnosis, age, occupation).

SAFEGUARDS:

1. Authorized users: Access to identifiers and to link files is strictly limited to the authorized personnel whose duties require such access. Procedures for determining authorized access to identified data are established as appropriate for each location.

Personnel, including contractor personnel, who may be so authorized include those directly involved in data collection and in the design of research studies, e.g; interviewers and interviewer supervisors; project managers, statisticians involved in designing sampling plans.

2. Physical safeguards: Records are stored in locked rooms, locked file cabinets, and/or secured computer facilities.

Personal identifiers and link files are separated as much as possible and stored in locked files. Computer data access is limited through the use of key words known only to authorized personnel.

3. Procedure safeguards:

Collection and maintenance of data is consistent with legislation and regulations in the protection of human subjects informed consent, confidentiality, and confidentiality specific to drug and alcohol abuse patients where these apply. When an Institute Division or a contractor provides anonymous data to research scientists for analysis, study numbers which can be matched to personal identifiers will be eliminated, scrambled, or replaced by the agency or contractor with random numbers which cannot be matched.

Contractors who maintain records in this system are instructed to make no further disclosure of the records.

Privacy Act requirements are specifically included in contracts for survey and evaluation activities related to this system.

The HHS project directors, contract officers and project officers oversee compliance with these requirements.

4. Implementation guidelines:

DHHS Chapter 45- and supplementary Chapter PHS hf:

45-13 of the General Administration Manual and Part 6, "ADP System Security" of the HHS ADP Systems Security Manual.

RETENTION AND

DISPOSAL:

Personal identifiers are retained only as long as they are needed for the purposes of the current evaluation project, and for follow-up studies generated by the present study. Removal or disposal of identifiers is done according to the storage medium (e.g; erase computer tape, shred or burn index cards, etc.). A staff person designated by the System Manager will oversee and will describe and confirm the disposal in writing.

SYSTEM…