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:

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

All efforts to amend 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.

Background Justification

IA Legal Opinion

Notes from IA

Contracting Officer Determination

Contract

Bill or Invoice

Purchasing Requisition

Other

Draft LOA Amendment - Expired Funds Request

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