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Staff Manual Guide f:2620.2, Attachment B

RETURN TO: DCGM, HFA-505AGENT NAME: _____________________
FAX NO. 443-3651 (B. Brooks)FIELD OFFICE: ___________________
 AREA CODE & NO. _________________

CODE SHEET FOR DELIVERY ORDERS OFF GSA SCHEDULE OR
OTHER FEDERAL SOURCE OTHER THAN AN INTERAGENCY AGREEMENT
(Over $25,000) - FOR INPUT TO DCGM DATABASE

Please keep in mind that the information you provide on this code sheet should be as accurate as possible since it will be used for management reports within the Division and by organizations that are external to the Division.

Check the reason that you are submitting this code sheet:

_____ Delivery Order

_____ Correction to Inaccurate or Missing Data in System

_____ Other Reason or Note Related to Data Entry

_____________________________________________________________________

_____________________________________________________________________

NOTE: THE FOLLOWING ITEMS ARE FOR THE GSA DATA ENTRY SCREEN

1. (M-1)* Item Name: TYPE OF PROCUREMENT ACTION

Definition: Identifies type of procurement action being reported.

Entry: Circle appropriate code below.

Code:Description
GDelivery Order Against GSA Federal Supply Schedule or other agency's contract.
NProcurement from a Federal source other than an interagency agreement.
2. (M-2) Item Name: GSA/FSS/OTHER AGENCY'S CONTRACT IDENTIFICATION NUMBER

Definition: For Delivery Orders off the GSA Federal Supply Schedule or other schedules, or other agency contracts, enter the FDA Identification number.

Entry: Provide Number.

Number: ____________________

3. (M-33) Item Name: TRADE DATA

Definition: Applicable only to procurements which are subject to the Buy American Act. Under the requirements of the Buy American Act (FAR 25.1), for all procurements, identify these items (blank accepted for zeros).

Entry: Enter appropriate data below.

 BytesTrade Data
____________1-2Number of offerors who offer foreign items.
____________3-4Percentage of difference: the difference between weighted foreign price and domestic price expressed as a percentage of domestic price.
____________5-6Estimate the percent of the foreign content of the item or service being procured as a percentage of the contract award price.
____________7-8Code of the foreign country that provided at least 51 percent of the value of the contract. See Appendix G for valid alphabetic entries. This subitem is also required for purchases off GSA and FSS schedules when applicable.
4. (M-30) Item Name: WOMAN-OWNED SMALL BUSINESS

Definition: A woman-owned business is a business which is at least 51 percent owned, controlled, and operated by a woman or women. Controlled is defined as exercising the power to make policy decisions. Operated is defined as actively involved in the day-to-day management. For the purposes of this definition, the following businesses are exempt: nonprofit institutions, publicly owned, joint stock associations, and business trusts.

Interrelationship Edit: If this Item is coded "1," then "Type of Business" [Item 6 (M-13)] must be coded A1, A2, or A3.

Entry: Circle appropriate code below.

CodeMeaning
0Exempt
1Yes
2No
3Not Certified
5. (M-27) Item Name: PROCUREMENT PURPOSE CODE (FPDS CODE)

Definition: Select a purpose code for the contract or purchase order from the list of "Product and Service Codes" from Appendix C, Section II, of the PHSCIS Manual. The Appendix is an extract from the FPDS Codes and only those codes in the Appendix will be considered valid.

Entry: Enter appropriate code.

Code: _______________________

6. (M-13) Item Name: TYPE OF BUSINESS

Definition: A code assigned to the general type of organization and/or its function.

Entry: Circle appropriate code below.

CodeDescription
 Small Business
A1Disadvantaged business - 8(a)
A2SB owned by minority group members
A3Other small business
  
 Large Business
B1Minority business
B2Other large business
  
 Nonprofit Organization or Institution
C1Educational
C2Hospital
C3Research inst./foundations/labs.
C4Other nonprofit org. or institution
C5Sheltered workshops
  
 State/Local Government Agency
D1Educational
D2Hospital
D3Research organizations
D4Other State/local
  
 Foreign
E1Acquired and used outside U.S. outlying areas
E2Acquired outside U.S. outlying areas, and used inside U.S./outlying areas
7. (M-10) Item Name: CONGRESSIONAL DISTRICT

(For more details, see HHS Geographical Location Codes Book)

Definition: The congressional district in which the contractor/vendor of
record is located. For multiple districts, use code "099." For
states with at-large representatives use code "000." This item is
not required for foreign countries.

Entry: Enter code.

Code: ________________

8. Item Name: CENTER/OFFICE OF AGENCY/FIELD OFFICE

(Used for DCGM reports - not part of PHSCIS)

Definition: Provides the abbreviation for the Center/Office sponsoring
the contract such as CFSAN, CBER, etc.

Entry: Enter appropriate abbreviation for the sponsoring Center/Office.

Center/Office: _________________

9. (M-3) Item Name: PURCHASE ORDER NUMBER

Definition: The agency purchase order number for delivery orders off the
GSA or Federal Supply Schedule, or against other agency contract.

Entry: Enter number below.

Number: ___________________

10. Item Name: OBJECT CLASS CODE

(For FDA use - not part of PHSCIS Manual)

Definition: The FDA accounting code used to designate object class.

Entry: Enter code below.

Code: ______________________________

11. (M-15) Item Name: TYPE OF CONTRACT

Definition: Identifies contracts according to the method of reimbursement
and contractual format.

Entry: Circle appropriate code below.

CodeDescription
10Firm fixed price
11Fixed price with economic price adjustment
12Fixed price incentive
13Fixed price with prospective price redetermination
14Fixed price with retroactive price redetermination
20Cost no fee
21Cost sharing
22Cost plus incentive fee
23Cost plus fixed fee
24Cost plus award fee
30Time and materials
31Labor-hour
12. Item Name: VENDOR NAME, STREET ADDRESS, CITY, STATE, ZIP CODE

Definition: Location of vendor.

Entry: Enter appropriate data below.

Vendor's name __________________________________

Street address _________________________________

City name ______________________________________

State/Country __________________________________

Zip Code _______________________________________

13. (M-2) Item Name: TITLE OF PROJECT

Definition: A brief title which is descriptive of the nature or purpose
of the project.

Entry: Enter title of order below.

Title:

________________________________________________________

________________________________________________________

14. (M-28) Item Name: PLACE OF PERFORMANCE

Definition:
1. Place of Performance Code:

Place of PerformanceDescription
Within U.S.

Two character FIPS 2-digit numeric State (& territories code. (See Appendix F of PHSCIS Manual.) 

FIPS publication 55.

OR contractor's final assembly point.

Outside U.S.

Two character FIPS alphabetic country code from FIPS Pub 10-3 (Appendix G).

OR contractor's final assembly point.

2. Ordering Point Code:

Description

Enter up to three digits to represent the point from which the order/call
is being placed. If this is the same as the procurement office, enter the
office code.

Interrelationship Edit: If more than one location is involved, report
only the code of the location involving the largest
dollar share of the contract. If the contract is a
labor surplus area set-aside, report the city or county
and state of the area that determine the preference.
Entry: Enter number and location where services are performed or
product assembled.

Code: _____________________(Number), _________________________(Location) 

15. Item Name: ACCOUNTING/APPROPRIATION, and PMS NUMBER

(Needed for DCGM Reports, not in PHSCIS Manual)

Definition: Numbers which identify the accounting information on the GSA
Order (does not include the CAN number).
Entry:
Enter numbers below.

Numbers:

Accounting and Appropriation:

________________________
________________________

PMS Number: __________________________________________

16. Item Name:

(Needed for DCGM reports - not in PHSCIS Manual)

Definition: The date the order was signed.

Entry: Enter date.

Date: _______________________ (DD, MM, YY)

17. (M-25) Item Name: CONTRACT START DATE

Definition: The date upon which work under an award action may begin
(effective date).

Entry: Enter date.

Date: _______________________ (DD, MM, YY)

18. (M-25) Item Name: COMPLETION DATE

Definition: The date upon which all activities under the specific award
action is to be completed.

Entry: Enter date.

Date: _______________________ (DD, MM, YY)

19. (M-34) Item Name: HHS-393 WAS RECEIVED IN PROCUREMENT OFFICE

Definition: Date the HHS-393 was received in the procurement office.

Entry: Enter date.

Date: _______________________ (DD, MM, YY)

20. (M-37, 39, and 41) Item Name: COMMON ACCOUNTING NUMBER & TRANSACTION NUMBER

Definition: Numbers from the accounting information on the HHS-393.

Entry: Enter appropriate numbers.

Numbers:

CAN No. _________________________

Transaction No. _________________

21. (M-38, 40, and 42) Item Name: DOLLAR VALUE
Definition: Identifies the total planned dollar value to be obligated during the life of the order.

Entry: Enter the total dollar amount of the order.

Dollar amount: $____________________________________

22. (M-51) Item Name: CONTRACT FOR FOREIGN GOVERNMENT OR INTERNATIONAL ORGANIZATION

Definition: Identifies if a foreign Government or international
organization bears any part of the cost of the action.

Entry: Circle appropriate code below.

CodeDescription
1Yes
2No
23. (M-62) Item Name: CICA APPLICABILITY

Definition: Identifies if the contract action is Pre or Post-CICA. For
this code sheet, this Item is always coded "A."

Entry: A - CICA Applicable

24. (M-58) Item Name: AIDS AFFILIATED CONTRACTS

Definition: Identifies whether or not the contract action is affiliated
with AIDS.

Entry: Circle appropriate code below.

CodeDescription
1Yes
2No
25. (M-59) Item Name: AIDS AFFILITATED CONTRACTS: DOLLARS

Definition: Reports the actual dollar amount that is affiliated with AIDS

Entry: Fill in dollar amount obligated.

Amount: $___________________________________

NOTE: BE SURE TO ATTACH A COPY OF THE REQUISITION (HHS-393)


Data Entered Into Computer:
_________
Initials

___________
Date

Data Entry Double Checked:

_________

Initials

___________
Date

*Refers to PHSCIS Manual Item Number.