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Figure C15.F4.

 

 

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:

 

Contract

 

Bill or Invoice

 

Purchasing Requisition

 

Other

 

Draft LOA Amendment - Expired Funds Request

 

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