FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Solicitation number
- 36C26227Q0030
About this file
This is a Vendor Information form used by the Department of Veterans Affairs (VA) to collect and verify vendor registration data for federal contracting purposes.
The form captures essential vendor identification and business information including company name, physical and mailing addresses, tax identification number or social security number, contact details, and payment address. It requires vendors to disclose existing federal contracts, prompt payment discount terms, and payment method preferences such as purchase card acceptance. The form also mandates collection of the vendor's Dun and Bradstreet number and Central Contractor Registration (CCR) status. Section 13 requires vendors to identify their business type under the Federal Procurement Data System (FPDS) categories as Small, Large, Outside VA, or Other Entities. Section 14 requests socioeconomic classifications including disadvantaged business, veteran-owned, woman-owned, HUBZone, and Historically Black College/University certifications. Before vendor information may be entered into the VA database, the form requires mandatory verification checks at three federal sites: Dun and Bradstreet (http://www.dnb.com), Central Contractor Registration (http://www.ccr.gov), and two exclusion databases (http://epls.arnet.gov and http://exclusions.oig.hhs.gov) to ensure vendor eligibility and compliance with federal government business requirements.
View the file
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Text version
VENDOR INFORMATION
1. REQUESTOR:
2. SERVICE:
3. EXTENSION:
4. VENDOR NAME:
Doing Business As/Legal Name:
5. VENDOR ADDRESS
Physical Location:
Mailing Address:
City:
State/Zip:
6. VENDOR TAX IDENTIFICATION NO. or
SOCIAL SECURITY NUMBER:
(Mandatory field must enter one or the other)
TIN:
SSN:
7. VENDOR PHONE & FAX NUMBER:
Phone:
Fax:
Email: :
8. PAYMENT STREET ADDRESS:
Address:
City:
State/Zip:
9. POINT OF CONTACT:
10. ACCOUNT NUMBER:
11. Does Vendor have an existing contract? YES NO If answer is YES, please enter Contract Number:
(i.e. GS-, V797 or any other contract with payment terms N/30 and expiration date) Beginning Date: Expiration Date:
FOB: Destination Origin Prompt Payment Discount: _________ (i.e. 2%/10; 1%/20 or N/30)
12. 1099 Vendor Indicator: YES (Always YES except if FEDERAL Government) NO
13. Business Type (FPDS) (Must check one): Small Large Outside VA Other Entities
14. Socioeconomic Group: (Please check all that apply) Sm Disadvantage Bus Javits-Wagner-O’Day Hubzone Small Business Veteran-Owned Small Bus Woman-Owned Small Business Historically Black College & Univ./Min Institute Veteran-Owned Large Bus Woman-Owned Large Business None of the other business Veteran-Service Disabled
15. Purchase Card Accepted YES NO
16. DUN and BRADSTREET NUMBER: ___________________________ (Mandatory-if vendor does not have one they need to go to http://www.dnb.com to register.
17. Is Vendor registered with Central Contractor Registration (CCR)? YES NO (Mandatory-if vendor is not registered they can accomplish the task at: http://www.ccr.gov to register.
18. Before we may enter any new vendor information within the VA database the mandatory registration sites shall be checked along with the status of the vendor’s ability to do business within the Federal Government. Failure to check the mandatory field(s) could result in administrative action. The following two sites are your final check .
http://epls.arnet.gov/ & http://exclusions.oig.hhs.gov/
File details come from the government source that posted it. Updated .