Building Partner Capacity

Prior Year Adjustment Request Form
Obtain Current/Expired Year Funds and/or Request Change to Period of Performance

Case ID: ___________

BPC Program: ___________

Suspense Date: ___________


Requested By: ___________

Phone #: ___________

Please list all lines that are changing and label them as either a change to: Period of Performance and/or Amount.

Line Item:

Change (Period of Performance and/or Amount):

Purpose of change:













Please confirm all statements below are true by placing an "X" in the boxes:


All funds for the case were obligated prior to the funds expiration date.


All efforts to amend/modify this case are within the scope of these funds.


I have confirmed that my legal department and/or contracting officer has reviewed the material and agrees that all issues meet purpose, time and amount laws. Legal concurrence and/or contracting officer determination is attached.


All supporting documentation for review is included in this request package.


I agree that all the information provided in this document is true and accurate to the best of my ability. DSCA is able to start the review process.

Documents Attached:


Background Justification


IA Legal Opinion


Notes from IA


Contracting Officer Determination

Supporting Documents:




Bill or Invoice


Purchasing Requisition




Draft LOA Amendment - Expired Funds Request


Basic LOA (with all Amendments and Modifications) - Cancelled Funds Request