United States Government
Interagency Agreement (IAA) – Agreement Between Federal Agencies
General Terms and Conditions (GT&C) Section
IAA Number__________________ - 0000 - _________________
GT&C # Order # Amendment/Mod #
FMS 7600A DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 1 of 4
Form
6-10
DEPARTMENT AND/OR AGENCY
Requesting Agency of Products/Services Servicing Agency Providing Products/Services
Name
1.
Address
2. Servicing Agency Agreement Tracking Number (Optional)_________________________________________________________
3. Assisted Acquisition Agreement Yes No
4. GT&C Action (Check action being taken)
New
Amendment – Complete only the GT&C blocks being changed and explain the changes being made.
Cancellation – Provide a brief explanation for the IAA cancellation and complete the effective End Date.
5. Agreement Period Start Date ______________ End Date _____________ of IAA or effective cancellation date
MM-DD-YYYY MM-DD-YYYY
6. Recurring Agreement (Check One) A Recurring Agreement will continue, unless a notice to discontinue is received.
Yes
If Yes, is this an: Annual Renewal
Other Renewal State the other renewal period: _____________________________________
No
7. Agreement Type (Check One) Single Order IAA Multiple Order IAA
8. Are Advance Payments Allowed for this IAA (Check One) Yes No
If Yes is checked, enter Requesting Agency’s Statutory Authority Title and Citation
Note: Specific advance amounts will be captured on each related Order.
✔
RESET FORM
Always Check No. Do not include any other info. in block 6
Assisted Acquisitions must be approved by Contract Law
Division, prior to General Law Division review/clearance.
GT&C numbers allow identification
of Amendments, Orders (and Mods)
entered into under the agreement
Check Yes or No
For start date, insert "when signed"
DOC IAA Instructions attachment:
Specific IAA blocks requiring attention (in red)
United States Government
Interagency Agreement (IAA) – Agreement Between Federal Agencies
General Terms and Conditions (GT&C) Section
IAA Number__________________ - 0000 - _________________
GT&C # Order # Amendment/Mod #
FMS 7600A DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 2 of 4
9. Estimated Agreement Amount (The Servicing Agency completes all information for the estimated agreement amount.)
(Optional for Assisted Acquisitions)
Direct Cost ________________________________
Overhead Fees & Charges _____________________
Total Estimated Amount ______________________
Provide a general explanation of the Overhead Fees & Charges
11. Requesting Agency’s Scope (State and/or list attachments that support Requesting Agency’s Scope.)
12. Roles & Responsibilities for the Requesting Agency and Servicing Agency (State and/or list attachments for the roles and
responsibilities for the Requesting Agency and the Servicing Agency.)
10. STATUTORY AUTHORITY
a. Requesting Agency’s Authority (Check One)
Franchise Revolving Working Economy Act Other
Fund Fund Capital Fund (31 U.S.C. 1535/FAR 17.5) Authority
Fill in Statutory Authority Title and Citation for Franchise Fund, Revolving Fund, Working Capital Fund, or Other Authority
b. Servicing Agency’s Authority (Check One)
Franchise Revolving Working Economy Act Other
F
und Fund
Capital Fund (31 U.S.C. 1535/FAR 17.5) Authority
Fill in Statutory Authority Title and
Citation for Franchise Fund, Revolving Fund, Working Capital Fund, or Other Authority
Form
6-10
$0.00
Add non-Economy Act authority here and in 10.b
Add non-Economy Act authority here and in 10.a
Requesting agency's programmatic authority
Servicing agency's programmatic authority
Check identical box in 10.a and 10.b
Attachments! Attachments may be used to supplement several blocks within the GT&C.
For example: "See attached Statement of Work."
Attachments should include the GT&C number for identification purposes.
United States Government
Interagency Agreement (IAA) – Agreement Between Federal Agencies
General Terms and Conditions (GT&C) Section
IAA Number__________________ - 0000 - ________________
GT&C # Order # Amendment/Mod #
FMS 7600A DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 3 of 4
Form
6-10
13. Restrictions (Optional) (State and/or attach unique requirements and/or mission specific restrictions specific to this IAA).
14. Assisted Acquisition Small Business Credit Clause (The Servicing Agency will allocate the socio-economic credit to the
Requesting Agency for any contract actions it has executed on behalf of the Requesting Agency.)
15. Disputes: Disputes related to this IAA shall be resolved in accordance with instructions provided in the Treasury Financial
Manual (TFM) Volume I, Part 2, Chapter 4700, Appendix 10; Intragovernmental Business Rules.
16. Termination (Insert the number of days that this IAA may be terminated by written notice by either the Requesting or Servicing
Agency.)
If this agreement is canceled, any implementing c
ontract/order may also be canceled. If the IAA is terminated, the agencies shall
agree to the terms of the termination, including costs attributable to each party and the disposition of awarded and pending action
s.
If the Servicing Agency incurs costs due to the Requesting Agency’s failure to give the requisite notice of its intent to terminate the IAA, the
Requesting Agency shall pay any actual costs incurred by the Servicing Agency as a result of the delay in notification, provided such costs
are directly attributable to the failure to give notice.
17. Assisted Acquisition Agreements – Requesting Agency’s Organizations Authorized To Request Acquisition Assistance for
this IAA. (State or attach a list of Requesting Agency’s organizations authorized to request acquisition assistance for this IAA.)
18. Assisted Acquisition Agreements – Servicing Agency’s Organizations authorized to Provide Acquisition Assistance for
this IAA. (State or attach a l
ist of Servicing Agency’s organizations authorized to provide acquisition for this IAA.)
19. Requesting Agency Clause(s) (Optional) (State and/or attach any additional Requesting Agency clauses.)
United States Government
Interagency Agreement (IAA) – Agreement Between Federal Agencies
General Terms and Conditions (GT&C) Section
IAA Number__________________ - 0000 - ________________
GT&C # Order # Amendment/Mod #
FMS 7600A DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 4 of 4
Form
6-10
20. Servicing Agency Clause(s) (Optional) (State and/or attach any additional Servicing Agency clauses.)
21. Additional Requesting Agency and/or Servicing Agency Attachments (Optional) (State and/or attach any additional
Requesting Agency and/or Servicing Agency attachments.)
22. Annual Review of IAA
By signing this agreement, the parties agree to annually review the IAA if the agreement period exceeds one year. Appropriate
changes will be made by amendment to the GT&C and/or modification to any affected Order(s).
AGENCY OFFICIAL
The Agency Official is the highest level accepting authority or official as designated by the Requesting Agency and Servicing Agency
to sign this agreement. Each Agency Official must ensure that the general terms and conditions are properly defined, including the
stated statutory authorities, and, that the scope of work can be fulfilled per the agreement.
The Agreement Period Start Date (Block 5) must be the same as or later than the signature dates.
Actual work for this IAA may NOT begin until an Order has been signed by the appropriate individuals, as stated in the Instructions
for Blocks 37 and 38.
23. Requesting Agency Servicing Agency
Name
Title
Telephone
Number(s)
Fax Number
Email Address
SIGNATURE
Approval Date
United States Government
Interagency Agreement (IAA) – Agreement Between Federal Agencies
Order Requirements and Funding Information (Order) Section
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 1 of 5
Form
04/12
PRIMARY ORGANIZATION/OFFICE INFORMATION
24.
Requesting Agency
Servicing Agency
Primary Organization/Office
Name
Responsible Organization/Office
Address
ORDER/REQUIREMENTS INFORMATION
25. Order Action (Check One)
New
Modification (Mod) – List affected Order blocks being changed and explains the changes being made. For Example: for
a performance period mod, state new performance period for this Order in Block 27. Fill out the Funding Modification
Summary by Line (Block 26) if the mod involves adding, deleting or changing Funding for an Order Line.
Cancellation – Provide a brief explanation for Order cancellation and fill in the Performance Period End Date for the
effective cancellation date.
26. Funding Modification
Summary by Line
Line # ______ Line # _____ Line # ______
Total of All
Other Lines
(attach funding
details)
Total
Original Line Funding
$
$
$
$
$
Cumulative Funding Changes
From Prior Mods [addition (+) or
reduction (-)]
$ $ $ $ $
Funding Change for This Mod
$
$
$
$
$
TOTAL Modified Obligation
$
$
$
$
$
Total Advance Amount (-)
$
$
$
$
$
Net Modified Amount Due
$
$
$
$
$
27. Performance Period
Start Date
End Date
For a performance period mod, insert
the start and end dates that reflect the
new performance period.
MM-DD-YYYY
MM-DD-YYYY
RESET FORM
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
For start date, insert "when signed" or actual start date
For each separate new order under a GT&C
To modify an existing order
Block #26 only concerns existing orders. Leave block #26 blank for new orders!
DOC IAA Instructions attachment:
Specific IAA blocks requiring attention (in red)
The first Order
should be #1
(e.g., 0001);
not zero (0000)
IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 2 of 5
Form
04/12
28. Order Line/Funding Information
Line Number __________
Requesting Agency Funding
Information
Servicing Agency Funding Information
ALC
Component
TAS Required
by 10/1/2014
SP
ATA
AID
BPOA
EPOA
A
MAIN
SUB
SP
ATA
AID
BPOA
E POA
A
MAIN
SUB
OR Current TAS format
BETC
Object Class Code (Optional)
BPN
BPN + 4 (Optional)
Additional Accounting
Classification/Information
(Optional)
Requesting Agency Funding Expiration Date
______________
MM-DD-YYYY
Requesting Agency Funding Cancellation Date
______________
MM-DD-YYYY
Project Number & Title
Description of Products and/or Services, including the Bona Fide Need for this Order (State or attach a description of
products/services, including the bona fide need for this Order.)
North American Industry Classification System (NAICS) Number (Optional) _______________________________________
Breakdown of Reimbursable Line Costs OR Breakdown of Assisted Acquisition Line Cost:
Unit of Measure
Contract Cost
$
Quantity
Unit Price
Total
Servicing Fees
$
$
Total
Obligated Cost
$
Overhead Fees & Charges
$
Advance for
Line (-)
$
Total Line Amount Obligated
$
Net Total Cost
$
Assisted Acquisition Servicing Fees Explanation
Advance Line Amount (-)
$
Net Line Amount Due $
Type of Service Requirements
Severable Service Non-severable Service Not Applicable
0.00
0.00
0.00
0.00
0.00
For services, must check one: Severable or Non-severable
Insert date that is 5 years after expiration date of funds
IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 3 of 5
Form
04/12
BILLING & PAYMENT INFORMATION
32. Payment Method (Check One) [Intra-governmental Payment and Collection (IPAC) is the Preferred Method.]
If IPAC is used, the payment method must agree with the IPAC Trading Partner Agreement (TPA).
Requesting Agency Initiated IPAC Servicing Agency Initiated IPAC
Credit Card Other – Explain other payment method and reasoning ______________________
33. Billing Frequency (Check One)
[An Invoice must be submitted by the Servicing Agency and accepted by the Requesting Agency BEFORE funds are
reimbursed (i.e., via IPAC transaction)]
Monthly Quarterly Other Billing Frequency (include explanation)____________________________________
34. Payment Terms (Check One)
7 days Other Payment Terms (include explanation): ___________________________________________________
29. Advance Information (Complete Block 29 if the Advance Payment for Products/Services was checked “Yes” on the GT&C.)
Total Advance Amount for the Order $
_________________________ [All Order Line advance amounts (Block 28) must sum to this total.]
Revenue Recognition Methodology (according to SFFAS 7) (Identify the Revenue Recognition Methodology that will be used to
account for the Requesting Agency’s expense and the Servicing Agency’s revenue)
Straight-line – Provide amount to be accrued $_________________ and Number of Months _______
Accrual Per Work Completed – Identify the accounting posting period:
Monthly per work completed & invoiced
Other – Explain other regular period (bimonthly, quarterly, etc.) for posting accruals and how the accrual
amounts will be communicated if other than billed.
30. Total Net Order Amount: $______________________________
[All Order Line Net Amounts Due for reimbursable agreements and Net Total Costs for Assisted Acquisition Agreements (Block 28)
must sum to this total.]
31. Attachments (State or list attachments.)
Key project and/or acquisition milestones (Optional except for Assisted Acquisition Agreements)
Other Attachments (Optional)
Check appropriate box in blocks 32, 33, and 34! Add any required explanation!
IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 4 of 5
Form
04/12
35. Funding Clauses/Instructions (Optional) (State and/or list funding clauses/instructions.)
36. Delivery/Shipping Information for Products (Optional)
Agency Name
Point of Contact (POC) Name & Title
POC Email Address
Delivery Address /Room Number
POC Telephone Number
Special Shipping Information
APPROVALS AND CONTACT INFORMATION
37. PROGRAM OFFICIALS
The Program Officials, as identified by the Requesting Agency and Servicing Agency, must ensure that the scope of work is
properly defined and can be fulfilled for this Order. The Program Official may or may not be the Contracting Officer depending on
each agency’s IAA business process.
Requesting Agency
Servicing Agency
Name
Title
Telephone Number
Fax Number
Email Address
SIGNATURE
Date Signed
38. FUNDING OFFICIALS - The Funds Approving Officials, as identified by the Requesting Agency and Servicing Agency, certify
that the funds are accurately cited and can be properly accounted for per the purposes set forth in the Order. The Requesting
Agency Funding Official signs to obligate funds. The Servicing Agency Funding Official signs to start the work, and to bill, collect,
and properly account for funds from the Requesting Agency, in accordance with the agreement.
Requesting Agency
Servicing Agency
Name
Title
Telephone Number
Fax Number
Email Address
SIGNATURE
Date Signed
IAA Order
IAA Number __________________ - _______ - ________________ Servicing Agency’s Agreement
GT&C # Order # Amendment/Mod # Tracking Number (Optional) __________________
FMS 7600B DEPARTMENT OF THE TREASURY
FINANCIAL MANAGEMENT SERVICE
Page 5 of 5
Form
04/12
CONTACT INFORMATION
FINANCE OFFICE Points of Contact (POCs)
The finance office points of contact must ensure that the payment (Requesting Agency), billing (Servicing Agency), and
advance/accounting information are accurate and timely for this Order.
39.
Requesting Agency (Payment Office)
Servicing Agency (Billing Office)
Name
Title
Office Address
Telephone Number
Fax Number
Email Address
Signature & Date (Optional)
40. ADDITIONAL Points of Contacts (POCs) (as determined by each Agency)
This may include CONTRACTING Office Points of Contact (POCs).
Requesting Agency
Servicing Agency
Name
Title
Office Address
Telephone Number
Fax Number
Email Address
Signature & Date (Optional)
Name
Title
Office Address
Telephone Number
Fax Number
Email Address
Signature & Date (Optional)
Name
Title
Office Address
Telephone Number
Fax Number
Email Address
Signature & Date (Optional)
