RFP 283-22-0568_Attachment 4 Voucher Review Sheet.docx
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- Solicitation number
- 283-22-0568
About this file
This document contains a voucher review sheet template and details of a federal contract opportunity for the 2023-2027 National Surveys on Drug Use and Health. The voucher review sheet is used by the contracting officer's representative to review vouchers submitted by the contractor and recommend approval or suspension of payment. It requests confirmation that costs are reasonable and commensurate with efforts, deliverables are acceptable, and payment is recommended.
The federal contract opportunity is to design and conduct the annual National Surveys on Drug Use and Health through 2027 to provide prevalence data on substance use and mental health for the US population and each state. The contractor will be required to design multi-mode data collection, provide sufficient field staff to screen 152,000 units and conduct 68,460 interviews annually using computer-assisted methods, develop training programs, employ a 50-state sample design and small area estimation techniques to develop state-level estimates, and perform technical writing and analyses. The solicitation is issued by the Department of Health and Human Services Substance Abuse and Mental Health Services Administration.
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Text version
RFP No. 283-22-0568 Attachment 4: 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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