Attachment Q Vendor_Request_Form_.pdf

Unified Financial Management System (UFMS) PrintForm

1. NEW UPDATE INACTIVATE

Vendor Request Form Only typed forms (not handwritten) will be accepted. All fields are REQUIRED. Vendor will not be processed if form is incomplete. Instructions located on page 2 and 3.

2. Is the vendor required to register in 3. If not, what is the FAR exemption?

SAM.gov (Y/N)?* (i.e. Non-Agency Personnel, Tort Claim, etc)

*If the vendor is required to register in SAM.gov, please have them do so before completing this form. SAM.gov registration exceptions can be found in FAR 4.1102. The Assumption is that the SAM.gov information is valid. If the information currently listed in SAM.gov or in UFMS is incorrect, then the vendor should be contacted to update their SAM.gov information.

If the vendor is not required to register, please complete all fields on this request.

FBI Contact Information (Required by FBI Contact)

4. Date of Request: (MM/DD/YYYY) 5. FBI Contact:

6. Office Phone Number: 7. Vendor Type: (COM, EMP, FOR, SLG)

8. Vendor Purpose (VCOM Only): (Direct Expense, Limited Warrant Program, Antenna Site, Tort)

Employee/Vendor/Payee Information (Required by the Employee/Vendor/Payee)

9. Vendor Name:

10. DUNS Number or DUNS+4: 11. EIN/SSN/TIN:

12. Street Address:

13. City, State, Zip Code:

14. Country: 15. E-mail Address:

16. Vendor Phone Number: 17. Fax Number:

18. Vendor Contact Name: (Last, First, MI)

Financial Institution Information (Required by the Employee/Vendor/Payee)

19. Bank Name:

20. ABA/Routing Number: 21. Account Number:

22. Account Type: 23. Payment Type: (PPD, CCD, CHECK)

PRIVACY ACT STATEMENT: The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). All information collected on this form is required under the provisions of 31 U.S.C. 3322 and 31 CFR 210. This information will be used by the Treasury Department to transmit payment data, by electronic means to vendor's financial institution.

Failure to provide the requested information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.

FBI Vendor Request Form March 2019

Unified Financial Management System (UFMS) UFMS Instructions for completing Vendor Request Form

Only typed forms (not handwritten) will be accepted. ALL FIELDS ARE REQUIRED. Vendor will not be processed if form is incomplete.

The following are the steps for completing the Vendor Request Form.

Box 1: This is a required field. Place a check in the box corresponding to the type of request required. Options are:

• New – select if vendor is not in UFMS

• Update – select if a Non-SAM vendor needs to be modified

• Inactivate – select if a non-SAM vendor is to be inactivated and prevent new spending

Box 2: Is the vendor required to register in SAM.gov? Select Y/N from drop down. (See note on form) Box 3: If not, what is the FAR Exemption? Select exemption from drop down.

FBI Contact Information

Box 4: Identify date request submitted.

Box 5: Identify FBI personnel responsible for originating UFMS form, establishing vendor, and point of contact in the event there is a question about request.

Box 6: Identify phone number of individual in Box 5.

Box 7: Using the drop-down arrow, identify Vendor Type from UFMS table listing:

• Commercial (COM)- Select for commercial vendors

• Employee (EMP)- Select for employee payees

• State and Local (SLG)-Select for State & Local Government vendors (Local Police Departments, Local Jails, etc.)

• Foreign Government (FOR)- Select for foreign government vendors

Box 8: Using the drop-down arrow, identify the purpose of the vendor request. (Required for VCOM Only)

Employee/Vendor/Payee Information

Box 9: Identify the name of the vendor to be added to the vendor table.

Box 10: Identify the Duns number (required for Commercial vendors and all other vendor types where applicable) Box 11: Identify EIN/SSN/TIN of vendor Box 12: Identify address of vendor Box 13: Identify city, state, zip of vendor Box 14: Assumed US – provide if foreign Box 15: Identify email address of vendor Box 16-17: Identify phone/fax number of vendor Box 18: Identify point of contact for vendor

Refer to Downdraft and Uplift Job Aids.

Emailing Form to Vendor:

Financial Institution Information

Box 19: Identify Banking Institution receiving funds Box 20: Identify Banking Institution ABA/Routing number*

Box 21: Identify Bank Account number*

Box 22: Identify Bank Account Type (i.e., Checking or Savings)

Box 23: Using the drop-down arrow, identify Default Payment type for this vendor

• CCD- Cash Concentration or Disbursement- Select for Corporate accounts

• Check- Select if vendor is requesting to be paid by check

• PPD- Prearranged Payment or Deposit- Select for Personal accounts

• CTX- Corporate Trade Exchange (only select if requested by the vendor)

* NOTE: Bank Routing and Account Numbers refer to ACH payments only and not Wire Transfers which have separate routing numbers. Wire Transfer payments cannot be disbursed using UFMS.

FINAL STEPS:

1) Validate vendor information

2) Attach the Vendor Request Form to the vendor document in UFMS. Refer to Attachment Job Aid.

FBI Request Form March 2019