Figure A7.C6.F1. Request for Resolution of Problem Disbursement in Excess of $2,500

 

Section 1 – Overview

The following supply and services complete FMS case is hereby submitted to DSCA Comptroller for resolution of a problem disbursement in excess of $2,500 as detailed below.

Request Submission Date

 

Implementing Agency 
(Organization Name)

 

Implementing Agency Point of Contact

Name:

 

Phone:

 

E-mail:

 

Case Identifier: 
(Country/IA/Identifier (XX-X-XXX))

 

Supply/Services Completion Date: 
(MM/YYYY)

 

Amount of Problem Disbursement:

 

 

Section 2 – Detailed Information

  1. Summary of Issue

     

  2. Actions Taken

     

  3. Other Relevant Information

     

 

Section 3 – Authoritative Guidance 

  1. DoD FMR Volume 3, Chapter 11, Sections 7 – 8.

  2. Other:

     

 

 

Section 4 - Approval

FOR DSCA USE ONLY

 



 

 

 

 

SIGNATURE 
Comptroller 
Defense Security Cooperation Agency