ATTACHMENT18-Invoice_NIHRC-4.pdf

NIH(RC)4

Revised 7/2013 1

INVOICE/FINANCING REQUEST AND CONTRACT FINANCIAL REPORTING INSTRUCTIONS

Format:

Number of Copies:

Frequency:

Cost Incurrence Period:

Billing of Costs Incurred:

Contractor's Fiscal Year:

Currency:

Costs Requiring Advance Approval:

Invoice/Financing Request Identification:

Interim Invoice/Contract Financing Request:

Completion Invoice:

Final Invoice:

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All information must be legible or the invoice will be considered improper and returned to the Contractor.

Designated Billing Office Name and Address:

Contractor's Name, Address, Point of Contact, TIN, and DUNS or DUNS+4 Number: the Contractor's name and address exactly as they appear in the contract. Any invoice identified as improper will be sent to this address. Also include the name, title, phone number, and e mail address of the Point of Contact in case of questions. If the remittance name differs from the legal business name, both names must appear on the invoice. Provide the Contractor’s Federal Taxpayer Identification Number (TIN) and Data Universal Numbering System (DUNS) or DUNS+4 number. The DUNS number must identify the Contractor’s name and address exactly as stated in the contract, and as registered in the System for Award Management (SAM) database.

When an approved assignment of claims has been executed, the Contractor shall provide the same information for the assignee as is required for the Contractor (i.e., name, address, point of contact, TIN, and DUNS number), with the remittance information clearly identified as such.

Invoice/Financing Request Number: Identify each payment request by a unique invoice number, which can only be used one time regardless of the number of contracts or orders held by an organization. For example, if a contractor has already submitted invoice number 05 on one of its contracts or orders, it cannot use that same invoice number on any other contract or order. Payment requests with duplicate invoice numbers will be considered improper and returned to the contractor.

The NIH does not prescribe a particular numbering format but suggests using a job or account number for each contract and order followed by a sequential invoice number (example:

867530905). Invoice numbers are limited to 30 characters. There are no restrictions on the use of special characters, such as colons, dashes, forward slashes, or parentheses.

If all or part of an invoice is suspended and the contractor chooses to reclaim those costs on a supplemental invoice, the contractor may use the same unique invoice number followed by an alpha character, such as “R” for revised (example: 867530905R).

Date Invoice/Financing Request Prepared:

Contract Number and Order Number (if applicable):

Contract Title:

Current Contract Period of Performance:

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Total Estimated Cost of Contract/Order:

Total Fixed-Fee:

Note:

Two-Way/Three-Way Match:

Office of Acquisitions:

Central Point of Distribution:

Billing Period:

Amount Billed - Current Period:

Amount Billed - Cumulative:

Direct Costs:

Direct Labor:

Fringe Benefits: List any fringe benefits applicable to direct labor and billed as a direct cost.

Cite the rate(s) used to calculate fringe benefit costs, if applicable.

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Accountable Personal Property:

Materials and Supplies:

Premium Pay:

Consultant Fee:

Travel:

Subcontract Costs:

Other:

Cost of Money (COM):

Indirect Costs:

Fixed-Fee:

Note:

Total Amounts Claimed:

Adjustments:

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Grand Totals

Certification:

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

Note: The contract may require additional certifications (See Invoice Submission Instructions in Section G of the Contract Schedule)

The Contracting Officer may require the Contractor to submit detailed support for costs claimed on one or more interim payment requests.

FINANCIAL REPORTING INSTRUCTIONS:

Column A - Expenditure Category:

Column B - Cumulative Percentage of Effort/Hrs. - Negotiated:

Column C - Cumulative Percentage of Effort/Hrs. - Actual:

Column D - Amount Billed - Current:

Column E - Amount Billed - Cumulative:

Column F - Cost at Completion:

Column G - Contract Amount:

Column H - Variance (Over or Under):

Modifications:

Expenditures Not Negotiated:

Revised 7/2013 6

ABC CORPORATION

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