RFP 280-21-0561 Attachment 3_Voucher Review Sheet.docx
DOCX document 23 KB Posted
- Attached to
- Training and Technical Assistance to Native Connections Grantees Federal contract opportunity
- Solicitation number
- 280-21-0561
About this file
This document package includes a voucher review sheet template and a federal contract opportunity solicitation.
The voucher review sheet is a template for contracting officers to review vouchers submitted by contractors under cost reimbursement or fixed price contracts. It requires the contracting officer to confirm costs are reasonable and commensurate with efforts, deliverables are acceptable, and recommends approval or identifies any questioned costs.
The federal contract opportunity solicitation is for the Substance Abuse and Mental Health Services Administration to provide training and technical assistance services to grantees of the Native Connections program. The training and technical assistance will focus on evidence-informed practices to promote behavioral and mental health for Native American and Alaska Native youth. Offerors must submit any questions by February 26th and indicate intent to propose by that date using the provided form. Proposals must be submitted electronically by March 19th. The estimated value was not included.
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Text version
RFP No. 280-21-0561 Attachment 3: Voucher Review Sheet
VOUCHER REVIEW SHEET
Contract No.:
Ref. No.
Contractor:
DUNS:
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
(N/A if letter of credit)
To: __________________, Contracting Officer Representative (COR)
From: ____________________, Division of Contracts Management, OFR, SAMHSA, 5600 Fishers Lane
Subject: Voucher No. ________________ Period Covered: __________________________________ Contractor Point of Contract: ______________________ Telephone: _______________ Email: ________________
COR:
Please review the Voucher, answer the following question and return to DCM by the 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.)
COR sign and date here: ________________________________________ Date: __________________
| To: Program Support Center |
| PAY THIS AMOUNT: |
| _______________________ |
| DFO Accounting Operations |
| AMOUNT CLAIMED: |
| _______________________ |
| 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 NO 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 |
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