Attachments_8_9_11_12_14_16_17_18_20_22.pdf

TECHNICAL PROPOSAL COST INFORMATION/SUMMARY OF LABOR

AND DIRECT COSTS

DIRECT LABOR:

Labor Category (Hours)

Year 1 (Hours)

Year 2 (Hours)

Year 3 (Hours)

Year 4 (Hours)

Year 5 (Hours)

Year 6 (Hours)

Year 7 (Hours) Total

(Title and Name - use additional pages as necessary)

Total Hours

DIRECT LABOR COST:

MATERIAL COST:

TRAVEL COST:

OTHER (Specify):

TOTAL DIRECT COST:

Specific Instructions:

1. Do not include any individual salary information

2. Do not include any indirect cost or fee.

3. Do not submit the total amount of proposal.

4. Submit this information as a portion of the Technical Proposal.

Technical Proposal Cost Information/Summary of Labor and Direct Costs Page 1 of 1 (1/2011)

SUMMARY OF RELATED ACTIVITIES

The following specific information must be provided by the offeror pertaining to the Project Director, Principal Investigator, and each of any other proposed key professional individuals designated for performance under any resulting contract.

a. Identify the total amount of all presently active federal contracts/cooperative agreements/grants and commercial agreements citing the committed levels of effort for those projects for each of the key individuals* in this proposal.

Professional's Name and Title/Position:

Identifying Number Agency Total Effort Committed

*If an individual has no obligation(s), so state.

b. Provide the total number of outstanding proposals, exclusive of the instant proposal, having been submitted by your organization, not presently accepted but in an anticipatory stage, which will commit levels of effort by the proposed professional individuals*.

Professional's Name and Title/Position:

Identifying Number Agency Total Effort Committed

*If no commitment of effort is intended, so state.

c. Provide a statement of the level of effort to be dedicated to any resultant contract awarded to your organization for those individuals designated and cited in this proposal.

Name Title/Position Total Proposed Effort

Summary of Related Activities Page 1 of 1

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

NATIONAL INSTITUTES OF HEALTH

PROPOSAL SUMMARY AND DATA RECORD

PROJECT TITLE (Title or RFP or Contract Proposal)

RFP/CONTRACT NUMBER

LEGAL NAME AND ADDRESS OF OFFEROR PLACE OF PERFORMANCE (Full address including ZIP)

TYPE OF CONTRACT PROPOSED

� COST-REIMBURSEMENT � FIXED PRICE

ESTIMATED TIME REQUIRED TO COMPLETE PROJECT

ESTIMATED DIRECT COSTS IN PROPOSED YEAR (From Budget

� COST-PLUS-FIXED-FEE

PROPOSED STARTING DATE

� OTHER

DOES THIS PROPOSAL INCLUDE A SUBCONTRACT � YES � NO (If yes, please furnish name and location of organization, description of services, basis for selection, responsible person employed by subcontractor and cost information.)

NAME AND TITLE OF PRINCIPAL INVESTIGATOR SOCIAL SECURITY

NO.

EST. HOURS

WEEKLY

AREA

CODE/TEL.NO.

NAME AND TITLE OF CO-INVESTIGATOR (Use attachment if necessary.)

NAME AND TITLE OF INDIVIDUAL(S) AUTHORIZED TO

NEGOTIATE CONTRACTS

AREA CODE/TELEPHONE NUMBER

NAME AND TITLE OF INDIVIDUAL(S) AUTHORIZED TO

EXECUTE CONTRACTS

AREA CODE/TELEPHONE NUMBER

DOES THIS PROPOSAL INVOLVE EXPERIMENTS WITH HUMAN SUBJECTS � YES � NO

Institution’s General Assurance re: Human Subjects DATE APPROVED � PENDING Institution’s Review Board’s Approval of this Proposal DATE APPROVED � PENDING An example of the informed consent for this study is enclosed � YES � NO A Clinical Protocol is enclosed � YES � NO

OFFEROR’S ACKNOWLEDGMENT OF AMENDMENTS TO THE RFP (Use attachment if necessary)

ERRATA NUMBER DATE ERRATA NUMBER DATE

NAME, ADDRESS, AND PHONE NUMBER OF

COGNIZANT GOVERNMENT AUDIT AGENCY

NUMBER OF EMPLOYEES CURRENTLY EMPLOYED

DOLLAR VOLUME OF BUSINESS PER ANNUM

THIS OFFER EXPIRES DAYS FROM THE

DATE OF THIS OFFER (120 days if not specified)

FOR THE INSTITUTION

SIGNATURE OF PRINCIPAL INVESTIGATOR SIGNATURE OF BUSINESS REPRESENTATIVE

TYPED NAME AND TITLE TYPED NAME AND TITLE

EMPLOYER IDENTIFICATION NUMBER DATE OF OFFER

NIH-2043

June 1982

Provision of the Social Security Number is voluntary. Social Security

Numbers are requested for the purpose of accurate and efficient identification, review, and management of NIH Extramural Programs.

Authority for requesting this information is provided by Title III, Section

301, and Title IV of the Public Health Service Act, as amended.

NIH-2043

June 1982

HHS.gov

Office Of Small And Disadvantaged Business Utilization Small Business Subcontracting Plan The following outline meets the minimum requirements of section 8(d) of the Small Business Act, as amended, and implemented by the Federal

Acquisition Regulations (FAR) Subpart 19.7. The U.S. Department of Health and Human Services (HHS), Office of Small and Disadvantaged Business

Utilization (OSDBU) recommend offerors use the following format to submit proposed Individual Subcontracting Plans, including modifications. It is not intended to replace any existing Corporate/Commercial Plan that is more extensive. A subcontracting Plan is required if the estimated cost of the contract may exceed $700,000 ($1,500,000 for construction) Small businesses are excluded. Questions should be forwarded to the Contracting

Officer or Operating Division (OPDIV) Small Business Specialist.

HHS Operating Division (OPDIV): _______________________________

SOLICITATION OR CONTRACT NUMBER: ______________________________

DATE OF PLAN : ___________________________________________________

CONTRACTOR : ____________________________________________________

ADDRESS : ________________________________________________________

STATE/ZIP CODE ___________________________________________________

DUNN & BRADSTREET NUMBER: _____________________________________

ITEM/SERVICE (Description): _______________________________________

NEW/INITIAL CONTRACT

PERIOD OF CONTRACT PERFORMANCE (MM/DD/YYYY – MM/DD/YYYY):__________________

Base (if options apply) $___________________ Performance Period/Quantity ____________

Option 1: $___________________ Performance Period/Quantity ____________

U.S. Department of Health & Human Services

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Option 2: $___________________ Performance Period/Quantity ____________

Option 3: $___________________ Performance Period/Quantity ____________

Option 4: $___________________ Performance Period/Quantity ____________

$___________________ Total Contract Cost

CONTRACT MODIFICATION (if applicable)

NEW PERIOD OF CONTRACT PERFORMANCE (MM/DD/YYYY – MM/DD/YYYY):__________________

Original/Base $___________________ Performance Period/Quantity _________

Modification $___________________ Performance Period/Quantity _________

Task Order $___________________ Performance Period/Quantity _________

$___________________ Modified Total Contract Cost

Failure to include the essential information of FAR Subpart 19.7 may be cause for either a delay in acceptance or the rejection of a bid or offer when a subcontracting plan is required. “SUBCONTRACT,” as used in this clause, means any agreement (other than one involving an employer-employee relationship) entered into by a Federal Government prime contractor or subcontractor requesting supplies or services required for performance of the contract or subcontract .

If assistance is needed to locate small business sources , contact the Small Business Specialist (SBS) supporting the OPDIV. SBS contact information is located on the OSDBU website (http://www.hhs.gov/about/smallbusiness/osdbustaff.html) or you may contact the OSDBU headquarters at (202) 690-7300.

HHS current subcontracting goal is 33.0% for Small Business (hereafter referred to as SB), 5.00% for Small Disadvantaged Business, including 8(a)

Program Participants, Alaska Native Corporations (ANC) and Indian Tribes (hereafter referred to as SDB), 5.00% for Women-Owned Small Business and Economically Disadvantaged Women-Owned Small Business (hereafter referred to as WOSB), 3.00% HubZone business (hereafter referred to as

HUBZone), 3.00% Veteran Owned Small Business (hereafter referred to as VOSB) and 3.00% Service Disabled Veteran-Owned Small Business

(hereafter referred to as SDVOSB) concerns for Fiscal Year (FY) 2016. For this procurement, HHS expects all proposed subcontracting plans to contain at a minimum the aforementioned percentages.

These percentages shall be expressed as percentages of the total estimated subcontracting dollars.

1. Type of Plan (check one)

_____ Individual plan (all elements developed specifically for this contract and applicable for the full term of this contract).

_____ Master plan (goals developed for this contract) all other elements standardized and approved by a lead agency Federal Official; must be renewed every three years and contractor must provide copy of lead agency approval.

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_____ Commercial products/service plan (goals are negotiated with the initial agency on a company-wide basis rather than for individual contracts) this plan applies to the entire production of commercial service or items or a portion thereof. The contractor sells commercial products and services customarily used for non-government purposes. The plan is effective during the offeror’s fiscal year (attach a copy). The Summary Subcontracting

Report (SSR) must include a breakout of subcontracting prorated for HHS and other Federal agencies.

2. Goals

Below indicate the dollar and percentage goals for Small Business (SB), Small Disadvantaged (SDB) including Alaska Native Corporations and Indian

Tribes, Women-owned and Economically Disadvantaged Women-Owned (WOSB), Historically Underutilized Business Zone (HUBZone), Veteran

Owned Small Business (VOSB), Service-Disabled Veteran-Owned (SDVOSB) Small Businesses and “Other than Small Business” (Other) as subcontractors. Indicate the base year and each option year, as specified in FAR 19.704 or project annual subcontracting base and goals under commercial plans. If any contract has more four options, please attach additional sheets which illustrate dollar amounts and percentages. PLEASE

NOTE: Zero dollars is not an acceptable goal for the SB, SDB, WOSB, HUBZone, VOSB or SDVOSB categories since this does not demonstrate a good faith effort throughout the period of performance of the contract. Formula for below: 2.b. + 2.h. = 2.a.

a. Total estimated dollar value of ALL planned subcontracting , i.e., with ALL types of concerns under this contract is _____ ____ (Base Period - if options apply).

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

b. Total estimated dollar value and percent of planned subcontracting with SMALL BUSINESSES (including SDB, WOSB, HUBZone, VOSB and

SDVOSB): (% of “a”)

$ ________________ and ________________% (Base Period - if options apply)

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

c. Total estimated dollar value and percent of planned subcontracting with SMALL DISADVANTAGED BUSINESSES: (% of “a”) $

________________ and ________________% (Base Period - if options apply)

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

d. Total estimated dollar value and percent of planned subcontracting with WOMEN-OWNED SMALL BUSINESSES: (% of “a”) $ ________________ and ________________% (Base Period - if options apply)

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

e. Total estimated dollar and percent of planned subcontracting with HUBZone SMALL BUSINESSES:

(% of “a”) $ ________________ and _________% (Base Period - if options apply)

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

f. Total estimated dollar and percent of planned subcontracting with Veteran-Owned SMALL BUSINESSES: (% of “a”) $ ____________and

________________% (Base Period - if options apply) st nd rd th st nd rd th st nd rd th st nd rd th st nd rd th

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FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

g. Total estimated dollar and percent of planned subcontracting with Service-Disabled Veteran-Owned SMALL BUSINESSES: (% of “a”) $

________________ and ________________% (Base Period - if options apply)

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

h. Total estimated dollar and percent of planned subcontracting with “OTHER THAN SMALL BUSINESSES” (As defined by the Small Business

Administration as “any entity that is not classified as a small business. This includes large businesses, state and local governments, non-profit organizations, public utilities, educational institutions and foreign-owned firms.) (% of “a”) $ ________________ and ________________% (Base

Period - if options apply)

FY ___1 Option FY ___2 Option FY ___3 Option FY ___4 Option

i. Provide a description of ALL the products and/or services to be subcontracted under this contract, and indicate the size and type of business supplying them (check all that apply):

Products and/or Services Other Small

Business

SDB WOSB Hubz VOSB SDVOSB st nd rd th st nd rd th st nd rd th

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j. Provide a description of the method used to develop the subcontracting goals for SB, SDB, WOSB, HUBZone and SDVOSB concerns. Address efforts made to ensure that maximum practicable subcontracting opportunities have been made available for those concerns and explain the method used to identify potential sources for solicitation purposes. Explain the method and state the quantitative basis (in dollars) used to establish the percentage goals. Also, explain how the areas to be subcontracted to SB, WOSB, HUBZone, VOSB and SDVOSB concerns were determined, how the capabilities of these concerns were considered contract opportunities and how such data comports with the cost proposal. Identify any source lists or other resources used in the determination process. (Attach additional sheets, if necessary.)

k. Indirect costs have ____ have not ____ been included in the dollar and percentage subcontracting goals above (check one).

l. If indirect costs have been included, explain the method used to determine the proportionate share of such costs to be allocated as subcontracts to

SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns:

3. Program Administrator:

NAME: ______________________________________________

TITLE: ______________________________________________

ADDRESS: ______________________________________________

TELEPHONE: ______________________________________________

E-MAIL: ______________________________________________

Duties : Does the individual named above have general overall responsibility for the company’s subcontracting program, i.e., developing, preparing, and executing subcontracting plans and monitoring performance relative to the requirements of those subcontracting plans and perform the following duties? (If NO is checked, please who in the company performs those duties, or indicate why the duties are not performed in your company on a separate sheet of paper and submit with the proposed subcontracting plan.)

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a. Developing and promoting company-wide policy initiatives that demonstrate the company’s support for awarding contracts and subcontracts to SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns; and for assuring that these concerns are included on the source lists for solicitations for products and services they are capable of providing; __yes __ no

b. Developing and maintaining bidder source lists of SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns from all possible sources; __yes __ no

c. Ensuring periodic rotation of potential subcontractors on bidder’s lists; __ yes __ no

d. Assuring that SB, SDB, WOSB, HUBZone, VOSB and SDVOSB businesses are included on the bidders’ list for every subcontract solicitation for products and services that they are capable of providing. __ yes __ no

e. Ensuring that Requests for Proposals (RFPs) are designed to permit the maximum practicable participation of SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns. __ yes __ no

f. Reviewing subcontract solicitations to remove statements, clauses, etc., which might tend to restrict or prohibit small, 8(a), SDB, WOSB, HUBZone, VOSB and SDVOSB small business participation. __ yes __ no

g. Accessing various sources for the identification of SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns to include the System for Award

Management ( http://sam.gov ), local small business and minority associations, local chambers of commerce and Federal agencies’ Small Business

Offices; ___ yes ___ no

h. Establishing and maintaining contract and subcontract award records; __ yes __ no

i. Participating in Business Opportunity Workshops, Minority Business Enterprise Seminars, Trade Fairs, Procurement Conferences, etc; __ yes __ no

j. Ensuring that SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns are made aware of subcontracting opportunities and assisting concerns in preparing responsive bids to the company; __ yes __ no

k. Conducting or arranging for the conduct of training for purchasing personnel regarding the intent and impact of Section 8(d) of the Small Business

Act, as amended; __ yes __ no

l. Monitoring the company’s subcontracting program performance and making any adjustments necessary to achieve the subcontract plan goals;

___yes ___ no

m. Preparing and submitting timely, required subcontract reports; ___ yes ___ no

n. Conducting or arranging training for purchasing personnel regarding the intent and impact of 8(d) of the Small Business Act on purchasing procedures; __ yes __ no

o. Coordinating the company’s activities during the conduct of compliance reviews by Federal agencies; and __ yes __ no

p. Other duties: ________________________________________________________

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4. Equitable Opportunity

Describe efforts the offeror will undertake to ensure that SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns will have an equitable opportunity to compete for subcontracts. These efforts include, but are not limited to, the following activities:

a. Outreach efforts to obtain sources:

1. Contact minority and small business trade associations; 2) contact business development organizations and local chambers of commerce; 3) attend SB, SDB, WOSB, HUBZone, VOSB and SDVOSB procurement conferences and trade fairs; 4) review sources from the System for Award

Management ( http://www.sam.gov); 5) review sources from the Small Business Administration (SBA), Dynamic Small Business Search database

(DSBS) http://dsbs.sba.gov/); 6) Consider using other sources such as the National Institutes of Health (NIH) e-Portals in Commerce, (e-PIC), (http://epic.od.nih.gov/)). The NIH e-PIC is not a mandatory source; however, it may be used at the offeror’s discretion; and 7) Utilize newspaper and magazine ads to encourage new sources.

b. Internal efforts to guide and encourage purchasing personnel:

1. Conduct workshops, seminars and training programs;

2. Establish, maintain, and utilize SB, SDB, WOSB, HUBZone, VOSB and SDVOSB source lists, guides, and other data for soliciting subcontractors; and

3. Monitor activities to evaluate compliance with the subcontracting plan.

Additional efforts:

5. Flow Down Clause

The contractor agrees to include the provisions under FAR 52.219-8, “Utilization of Small Business Concerns,” in all acquisitions exceeding the simplified acquisition threshold that offers further subcontracting opportunities. All subcontractors, except small business concerns, that receive subcontracts in excess of $700,000 ($1,500,000 for construction) must adopt and comply with a plan similar to the plan required by FAR 52.219-9, “Small Business Subcontracting Plan.” Note: In accordance with FAR 52.212-5(e) and 52.244-6(c) the contractor is not required to include flow-down clause FAR 52.219.-9 if it is subcontracting commercial items.

6. Reporting and Cooperation

The contractor gives assurance of 1) cooperation in any studies or surveys that may be required; 2) submission of periodic reports which illustrate compliance with the subcontracting plan; 3) submission of its Individual Subcontracting Report (ISR) and Summary Subcontract Report (SSR); and 4) subcontractors submission of ISRs and SSRs. ISRs and SSRs shall be submitted via the Electronic Subcontracting Reporting System (eSRS) website https://esrs.symplicity.com/index?_tab=signin&cck=1

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Reporting Period Report Due Due Date

Oct 1 - Mar 31 ISR 4/30

Apr 1 - Sept 30 ISR 10/30

Oct 1 - Sept 30 SSR 10/30

Contract Completion Year End SDB Report 30 days after completion

Please refer to FAR Part 19.7 for instruction concerning the submission of a Commercial Plan: SSR is due on 10/30 each year for the previous fiscal year ending 9/30.

a. Submit ISR (bi-annually) for the awarding Contracting Officer’s review and acceptance via the eSRS website.

b. Currently, SSR (annually) must be submitted for the HHS eSRS Agency Coordinator review and acceptance via the eSRS website. (Note: Log onto the OSDBU website to view the HHS Agency Coordinator contact information ( http://www.hhs.gov/grants/small-business-programs/index.html)

Note: The Request for Proposal (RFP) will indicate whether a subcontracting plan is required. Due to the nature and complexity of many HHS contracts, particularly the Centers for Medicare and Medicaid (CMS), the contractor may not be required to submit its subcontracting reports through the eSRS. The Contracting Officer will confirm reporting requirements prior to the issuance of an award. For more information, contact Agency Coordinator-eSRS on 202-690-7300.

7. Record keeping

FAR 19.704(a) (11) requires a list of the types of records your company will maintain to demonstrate the procedures adopted to comply with the requirements and goals in the subcontracting plan. The following is a recitation of the types of records the contractor will maintain to demonstrate the procedures adopted to comply with the requirements and goals in the subcontracting plan. These records will include, but not be limited to, the following:

a. SB, SDB, WOSB, HUBZone, VOSB and SDVOSB source lists, guides and other data identifying such vendors;

b. Organizations contacted in an attempt to locate SB, SDB, WOSB, HUBZone, VOSB and SDVOSB sources;

c. On a contract-by-contract basis, records on all subcontract solicitations over $100,000, which indicate for each solicitation (1) whether SB, SDB, WOSB, HUBZone, VOSB and/or SDVOSB concerns were solicited, if not, why not and the reasons solicited concerns did not receive subcontract awards;

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d. Records to support other outreach efforts, e.g., contacts with minority and small business trade associations, attendance at small and minority business procurement conferences and trade fairs;

e. Records to support internal guidance and encouragement provided to buyers through (1) workshops, seminars, training programs, incentive awards;

and (2) monitoring performance to evaluate compliance with the program and requirements; and

f. On a contract-by-contract basis, records to support subcontract award data including the name, address, and business type and size of each subcontractor. (This is not required on a contract–by–contract basis for commercial plans.)

g. Other records to support your compliance with the subcontracting plan: (Please describe)

8. Timely Payments to Subcontractors

FAR 19.702 requires your company to establish and use procedures to ensure the timely payment of amounts due pursuant to the terms of your subcontracts with SB concerns, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns.

Your company has established and used such procedures: ________ yes _________ no

9. Description of Good Faith Effort

Maximum practicable utilization of SB, SDB, WOSB, HUBZone, VOSB and SDVOSB concerns as subcontractors in Government contracts is a matter of national interest with both social and economic benefits. When a contractor fails to make a good faith effort to comply with a subcontracting plan, these objectives are not achieved, and 15 U.S.C. 637(d) (4) (F) directs that liquidated damages shall be paid by the contractor. In order to demonstrate your compliance with a good faith effort to achieve the SB, SDB, WOSB, HUBZone, VOSB and SDVOSB small business subcontracting goals, outline the steps your company plans to take. These steps will be negotiated with the contracting official prior to approval of the plan.

SIGNATURE PAGE

Signatures Required:

This subcontracting plan was submitted by:

Signature: __________________________________________________

Typed/Print Name: __________________________________________________

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Title: __________________________________________________

Date: __________________________________________________

This plan was reviewed by:

Signature: __________________________________________________

Typed/Print Name: __________________________________________________

Title: Contracting Officer Date: ______________

This plan was reviewed by:

Signature: __________________________________________________

Typed/Print Name: __________________________________________________

Title: HHS Small Business Specialist Date: ______________

This plan was reviewed by:

Signature: __________________________________________________

Typed/Print Name: __________________________________________________

Title: Small Business Administration Procurement Center Representative

Date: __________________________________________________

This plan was approved by:

Signature: __________________________________________________

Typed/Print Name: __________________________________________________

Title: Contracting Officer Date: ______________

Content created by Assistant Secretary for Financial Resources (ASFR)

Content last reviewed on July 26, 2016

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OFFEROR’S POINTS OF CONTACT

Complete the following and return with the BUSINESS PROPOSAL.

Business Representative (Name, Title, Address* and Contact Information of individual with whom daily contact is required.)

Name: Telephone:

Title: Fax:

Office: E-Mail:

Organization:

*Street Address:

City, State, Zip Code:

Proposed Principal Investigator (Name, Institutional Title, Address, and Contact Information)

Name: Telephone:

Title: Fax:

Office: E-Mail:

Organization:

*Street Address:

City, State, Zip Code:

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

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

Offeror’s Points of Contact Page 1 of 1

NIH(RC)-1

Rev. 7/2013 1

INVOICE/FINANCING REQUEST INSTRUCTIONS

FOR NIH COST-REIMBURSEMENT TYPE CONTRACTS, NIH(RC)-1

Format: Submit payment requests on the Contractor’s self-generated form in the manner and format prescribed herein and as illustrated in the Sample Invoice/Financing Request. Standard Form 1034, Public Voucher for Purchases and Services Other Than Personal, may be used in lieu of the Contractor’s self-generated form provided it contains all of the information shown on the Sample Invoice/Financing Request. DO NOT include a cover letter with the payment request.

Number of Copies: Submit payment requests in the quantity specified in the Invoice Submission Instructions in Section G of the Contract Schedule.

Frequency: Payment requests shall not be submitted more frequently than once every two weeks in accordance with the Allowable Cost and Payment Clause incorporated into this contract. Small business concerns may submit invoices/financing requests more frequently than every two weeks.

Cost Incurrence Period: Costs incurred must be within the contract performance period or covered by precontract cost provisions.

Billing of Costs Incurred: If billed costs include (1) costs of a prior billing period, but not previously billed, or (2) costs incurred during the contract period and claimed after the contract period has expired, the Contractor shall cite the amount(s) and month(s) in which the costs were incurred.

Contractor's Fiscal Year: Prepare payment requests in such a manner that the Government can identify costs claimed with the Contractor's fiscal year.

Currency: All NIH contracts are expressed in United States dollars. When the Government pays in a currency other than United States dollars, billings shall be expressed, and payment by the Government shall be made, in that other currency at amounts coincident with actual costs incurred. Currency fluctuations may not be a basis of gain or loss to the Contractor. Notwithstanding the above, the total of all invoices paid under this contract shall not exceed the United States dollars authorized.

Costs Requiring Advance Approval: Costs requiring advance approval by the Contracting Officer, which are not set forth in the Contract Schedule shall be identified by the Contracting Officer's Authorization (COA) Number as a separate expenditure category on the payment request. In addition, the Contractor shall show any cost limitation or ceiling set forth in the Contract Schedule, i.e. an Advance Understanding, as a separate expenditure category on the payment request.

Invoice/Financing Request Identification: Identify each payment as either:

(a) Interim Invoice/Contract Financing Request: These are interim payment requests submitted during the contract performance period.

(b) Completion Invoice: Submit the completion invoice promptly upon completion of the work, but no later than one year from the contract completion date, or within 120 days after settlement of the final indirect cost rates covering the year in which the contract is physically complete (whichever date is later). The Contractor shall submit the completion invoice when all costs have been assigned to the contract and all performance provisions have been completed.

(c) Final Invoice: A final invoice may be required after the amounts owed have been settled between the Government and the Contractor (e.g., resolution of all suspensions and audit exceptions).

Rev. 7/2013 2

Preparation and Itemization of the Invoice/Financing Request:

The Contractor shall furnish the information set forth in the instructions below. The instructions are arranged to match the entries on the Sample Invoice/Financing Request. All information must be legible or the invoice will be considered improper and returned to the Contractor.

(a) Designated Billing Office Name and Address: Enter the designated billing office name and address, as identified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(b) Contractor's Name, Address, Point of Contact, TIN, and DUNS or DUNS+4 Number: Show 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.

(c) 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:

8675309-05). 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: 8675309-05R).

(d) Date Invoice/Financing Request Prepared: Insert the date the payment request is prepared.

(e) Contract Number and Order Number (if applicable): Insert the contract number and order number (if applicable).

(f) Contract Title: Insert the contract title listed on the cover page of the contract and/or Section G of the Contract Schedule.

(g) Current Contract Period of Performance: Insert the contract start date/effective date through the current completion date of the contract.

(h) Total Estimated Cost of Contract/Order: Insert the total estimated cost of the contract, exclusive of fee. If billing under an order, insert the total estimated cost of the order, exclusive

Rev. 7/2013 3 of fee. For contracts/orders with options or incremental funding provisions, enter the amount currently obligated.

(i) Total Fixed-Fee: Insert the total fixed-fee (where applicable). For contracts/orders with options or incremental funding provisions, enter the amount currently obligated. Note: If the contract provides for another type of Fee, i.e. Award or Incentive Fee, insert the amount available to be earned as identified in the contract and indicate the type of fee to be billed on the payment request.

(j) Two-Way/Three-Way Match: Identify whether payment is to be made using a two-way or three-way match. To determine required payment method, refer to the Invoice Submission Instructions in Section G of the Contract Schedule.

(k) Office of Acquisitions: Insert the name of the Office of Acquisitions, as identified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(l) Central Point of Distribution: Insert the Central Point of Distribution, as identified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(m) Billing Period: Insert the beginning and ending dates (month, day, and year) of the period in which costs were incurred and for which reimbursement is claimed.

(n) Amount Billed - Current Period: Insert the amount claimed for the current billing period by major cost element, including any adjustments and fee. If the Contract Schedule contains separately priced line items, identify the contract line item(s) on the payment request and include a separate breakdown (by major cost element) for each line item.

(o) Amount Billed - Cumulative: Insert the cumulative amounts claimed by major cost element, including any adjustments and fee. If the Contract Schedule contains separately priced line items, identify the contract line item(s) on the payment request and include a separate breakdown (by major cost element) for each line item.

(p) Direct Costs: Insert the major cost elements. For each element, consider the application of the paragraph entitled "Costs Requiring Prior Approval" on page 1 of these instructions.

1) Direct Labor: Include salaries and wages paid (or accrued) for direct performance of the contract.

For Level of Effort contracts only, the Contractor shall provide the following information on a separate sheet of paper attached to the payment request:

- hours or percentage of effort and cost by labor category (as specified in the Level of Effort Article in Section F of the Contract Schedule) for the current billing period, and

- hours or percentage of effort and cost by labor category from contract inception through the current billing period. (NOTE: The Contracting Officer may require the Contractor to provide additional breakdown for direct labor, such as position title, employee name, and salary or hourly rate.)

2) 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.

Rev. 7/2013 4

3) Accountable Personal Property: Include permanent research equipment and general purpose equipment having a unit acquisition cost of $1,000 or more, with a life expectancy of more than two years, and sensitive property regardless of cost (see the HHS Contractor's Guide for Contract of Government Property). Show permanent research equipment separate from general purpose equipment.

On a separate sheet of paper attached to the payment request, list each item for which reimbursement is requested. Precede the item with an asterisk (*) if the equipment is below the $1,000 approval level. Include reference to the following (as applicable):

- item number for the specific piece of equipment listed in the Property Schedule, and

- Contracting Officer Authorization (COA) Number, if the equipment is not covered by the Property Schedule.

The Contracting Officer may require the Contractor to provide further itemization of property having specific limitations set forth in the contract.

4) Materials and Supplies: Include equipment with unit costs of less than $1,000 or an expected service life of two years or less, and consumable material and supplies regardless of amount.

5) Premium Pay: List remuneration in excess of the basic hourly rate.

6) Consultant Fee: List fees paid to consultants. Identify consultant by name or category as set forth in the contract or Contracting Officer Authorization (COA), as well as the effort (i.e., number of hours, days, etc.) and rate billed.

7) Travel: Include domestic and foreign travel. Foreign travel is travel outside of the United States and its territories and possessions. However, for an organization located outside the United States and its territories and possessions, foreign travel means travel outside that country. Foreign travel must be billed separately from domestic travel.

8) Subcontract Costs: List subcontractor(s) by name and amount billed.

9) Other: List all other direct costs in total unless exceeding $1,000 in amount. If over $1,000, list cost elements and dollar amounts separately. If the contract contains restrictions on any cost element, that cost element must be listed separately.

(q) Cost of Money (COM): Cite the COM factor and base in effect during the time the cost was incurred and for which reimbursement is claimed.

(r) Indirect Costs: Identify the indirect cost base (IDC), indirect cost rate, and amount billed for each indirect cost category.

(s) Fixed-Fee: Cite the formula or method of computation for fixed-fee, if applicable. The fixed-fee must be claimed as provided for by the contract. Note: If the contract provides for another type of Fee, i.e. Award or Incentive Fee, provide the same documentation for the amount claimed.

(t) Total Amounts Claimed: Insert the total amounts claimed for the current and cumulative periods.

Rev. 7/2013 5

(u) Adjustments: Include amounts conceded by the Contractor, outstanding suspensions, and/or disapprovals subject to appeal.

(v) Grand Totals

(w) Certification: The Contractor shall include the following certification at the bottom of each payment request:

“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.

Rev. 7/2013 6

SAMPLE INVOICE/FINANCING REQUEST

(a) Designated Billing Office Name and Address:

National Institutes of Health Office of Financial Management Commercial Accounts 2115 East Jefferson Street, Room 4B432, MSC Bethesda, MD 20892-8500

(b) Contractor’s Name, Address, Point of Contact, TIN, and DUNS or DUNS+4 Number:

ABC CORPORATION

100 Main Street Anywhere, U.S.A. Zip+4 Name, Title, Phone Number, and E-mail Address of Contractor’s Point of Contact.

DUNS or DUNS+4: ____________________

TIN: ________________________________

(c) Invoice/Financing Request No.: ___________

(d) Date Invoice/Financing Request Prepared:

(e) Contract No. and Order No. (if applicable):

(f) Contract Title:

(g) Current Contract Period of Performance:

(h) Total Estimated Cost of Contract/Order:

(i) Total Fixed Fee (if applicable):_______________

(j) Two-Way Match: ____

Three-Way Match: ____

(k) Office of

Acquisitions:____________________________

(l) Central Point of Distribution:___________________

(m) This invoice/financing request represents reimbursable costs for the period from ________ to ________.

Expenditure Category:

(n) Amount Billed Current Period

(o) Amount Billed Cumulative

(p) Direct Costs

1) Direct Labor

2) Fringe Benefits ______%

3) Accountable Personal Property

Permanent Research General Purpose

4) Materials and Supplies

5) Premium Pay

6) Consultant Fee: Dr. Jones, 1 day @ $100 (COA #3)

7) Travel (Domestic)

(Foreign)

8) Subcontract Costs

9) Other

Total Direct Costs

(q) Cost of Money (Factor) of (Appropriate Base)

(r) Indirect Costs______% of IDC Base (Formula)

(s) Fixed Fee (Formula)

(t) Total Amount Claimed

(u) Adjustments

Outstanding Suspensions

(v) Grand Totals

$ 3,400

3,000 2,000 2,000

-0-

_ -0- $11,600

2,400 4,000 _ 700

$18,700

$18,700

$ 6,800

1,200

6,000 2,000 4,000

-0-

___-0- $20,650

3,600 6,000

__1,400 $31,650

(1,700)

$29,250

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

(Name of Official (Title)

*Attach additional details as specified in the contract or requested by the Contracting Officer

NIH(RC)-2

Revised 7/2013

INVOICE INSTRUCTIONS FOR NIH FIXED-PRICE CONTRACTS, NIH(RC)-2

Format: Submit payment requests on Standard Form 1034, Public Voucher for Purchases and Services Other Than Personal, or the Contractor’s self-generated form provided it contains all of the information prescribed herein. DO NOT include a cover letter with the payment request.

Number of Copies: Submit payment requests in the quantity specified in the Invoice Submission Instructions in Section G of the Contract Schedule.

Frequency: Submit payment requests upon delivery and acceptance of goods or services unless otherwise authorized by the Contracting Officer.

Currency: All NIH contracts are expressed in United States dollars. When the Government pays in a currency other than United States dollars, billings shall be expressed, and payment by the Government shall be made, in that other currency at amounts coincident with actual costs incurred. Currency fluctuations may not be 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.

Preparation and Itemization of the Payment Request: Prepare payment requests as follows:

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

(a) Designated Billing Office Name and Address: Enter the designated billing office name and address, as identified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(b) Contractor's Name, Address, Point of Contact, TIN, and DUNS or DUNS+4 Number: Show 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 Acquisition 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.

(c) Invoice/Voucher 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:

8675309-05). 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: 8675309-05R).

(d) Date Invoice/Voucher Prepared: Insert the date the payment request is prepared.

(e) Contract Number and Order Number (if applicable): Insert the contract number and order number (as applicable).

(f) Contract Title: Insert the contract title listed on the cover page of the contract and/or Section G of the Contract Schedule.

(g) Current Contract Period of Performance: Insert the contract start date/effective date through the current completion date of the contract.

(h) Total Fixed-Price of Contract/Order: Insert the total fixed-price of the contract/order.

(i) Two-Way/Three-Way Match: Identify whether payment is to be made using a two-way or three-way match. To determine required payment method, refer to the Invoice Submission Instructions in Section G of the Contract Schedule.

(j) Office of Acquisitions: Insert the name of the Office of Acquisitions, as identified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(k) Central Point of Distribution: Identify the Central Point of Distribution, as specified in the Invoice Submission Instructions in Section G of the Contract Schedule.

(l) Billing Period: Insert the beginning and ending dates (month, day, and year) of the period in which costs were incurred and for which reimbursement is claimed.

(m) Description of Supplies or Services: Provide a description of the supplies or services, by line item (if applicable), quantity, unit price (where appropriate), and total amount. The item description, unit of measure, and unit price must match those specified in the contract. For example, if the contract specifies 1 box of hypodermic needles (100/box) with a unit price of $50.00, then the invoice must state 1 box, hypodermic needles (100/box), $50.00, not 100 syringes at $0.50 each. Invoices that do not match the line item pricing in the contract will be considered improper and will be returned to the Contractor.

(n) Amount Billed - Current Period: Insert the amount claimed for the current billing period, including any adjustments, if applicable. If the Contract Schedule contains separately priced line items, identify the contract line item(s) on the payment request.

(o) Amount Billed - Cumulative: Insert the cumulative amounts claimed to date, including any adjustments as applicable. If the Contract Schedule contains separately priced line items, identify the contract line item(s) on the payment request.

(p) Freight or Delivery Charges: Identify all charges for freight or express shipments, other than f.o.b. destination, as a separate line item on the invoice. (If shipped by freight or express, and charges are more than $25, attach prepaid bill.)

(q) Government Property: If the contract authorizes the purchase of any item of Government Property (e.g., equipment), the invoice must list each item for which reimbursement is requested. Include reference to the following (as applicable):

- item number for the specific piece of equipment listed in the Property Schedule, and

- Contracting Officer Authorization (COA) Number, if the equipment is not covered by the

Property Schedule.

Privacy Act Systems of Records Notices (SORNs) or System Notices

There are three types of System Notices that can be cited to cover record systems: Internal, Government and Central.

Internal Notices:

1. Owned by each federal agency to cover their internal records (e.g., HHS, NIH and other OPDIVs);

2. Often referred to as “umbrella” system notices;

3. National Institutes of Health SORNs begin with 09-25-xxxx; and

4. Department of Health & Human Services SORNs begin 09-90-xxxx.

Government Notices:

1. All federal agencies may use these notices to cover government-wide record systems (e.g., OPM, OGE, EEOC, FEMA, GSA, etc.);

2. The physical records contained within the record system belong to the respective…