IAA Number
GT&C # Amendment # / Mod # Order #
DEPARTMENT AND/OR AGENCY
1. Requesting Agency of Products / Services Servicing Agency Providing Products / Services
Name
Address
2. Servicing Agency Tracking Number (Optional) :
3. Assisted Acquisition Agreement Yes No
4. GT&C Action (Check action being taken)
New
Amendment - Complete only the GT&C blocks being changed and explain the changes being made.
Cancellation - Provide a brief explanation for the IAA cancellation and complete the effective End Date.
5. Agreement Period Start Date End Date of IAA or effective cancellation date
MM-DD-YYYY MM-DD-YYYY
6. Recurring Agreement (Check One) A Recurring Agreement will continue, unless a notice to discontinue is received
Yes If Yes, this is an: Annual Renewal
Other Renewal State the other renewal period:
No
7. Agreement Type (Check One) Single Order IAA Multiple Order IAA
8. Are Advance Payments Allowed for this IAA (Check One) Yes No
If Yes is checked, enter Requesting Agency’s Statutory Authority Title and Citation
Note: Specic advance amounts will be captured on each related order.
LEAD. TRANSFORM. DELIVER.
FS Form 7600A (06-10) Department of the Treasury | Bureau of the Fiscal Service November 2016 - page 1 of 4
RESET FORM
IAA Number
GT&C # Amendment # / Mod # Order #
9. Estimated Agreement Amount (The ServicingAgency completes all information for the estimated agreement amount)
(Optional for assisted Acquisitions)
Direct Cost
Overhead Fees & Charges
Total Estimated Amount
Provide a general explanation of the Overhead Fees and Charges
10. STATUTORY AUTHORITY
a. Requesting Agency’s Authority (Check One)
Franchise Fund Revolving Fund Working Capital Fund Economy Act (31
U.S.C. 1535 / FAR 17.5
)
Other Authority
Fill in Statutory Authority Title and Citation for Franchise Fund, Revolving Fund, Working Capital Fund, or Other Authority
b. Servicing Agency’s Authority (Check One)
Franchise Fund Revolving Fund Working Capital Fund Economy Act (31
U.S.C. 1535 / FAR 17.5
)
Other Authority
Fill in Statutory Authority Title and Citation for Franchise Fund, Revolving Fund, Working Capital Fund, or Other Authority
11. Requesting Agency’s Scope (State and/or List Attachments that support Requesting Agency’s Scope.)
12. Roles and Responsibilities for the Requesting Agency and the Servicing Agency (State and/or list
attachments for the roles and responsibilities for the Requesting Agency and the Servicing Agency)
LEAD. TRANSFORM. DELIVER.
FS Form 7600A (06-10) Department of the Treasury | Bureau of the Fiscal Service November 2016 - page 2 of 4
$0.00
IAA Number
GT&C # Amendment # / Mod # Order #
13. Restrictions (Optional) (State and/or attach unique requirements and/or mission specic restrictions specic to this IAA).
14. Assisted Acquisition Small Business Credit Clause (The Servicing Agency will allocate the socio-economic
credit to the Requesting Agency for any contract actions it has executed on behalf of the Requesting Agency).
15. Disputes:
Disputes related to this IAA shall be resolved in accordance with instructions provided in the Treasury
Financial Manual (TFM) Volume I, Part 2, Chapter 4700, Appendix 10; Intragovernmental Transaction (IGT) Guide.
16. Termination (Insert the number of days that this IAA may be terminated by written notice by either the Requesting
or Servicing Agency.)
If this agreement is canceled, any implementing contract/order may also be canceled. If the IAA is terminated, the agencies
shall agree to the terms of the termination, including costs attributable to each party and the disposition of awarded and
pending actions.
If the Servicing Agency incurs costs due to the Requesting Agency’s failure to give the requisite notice of its intent
to terminate the IAA, the Requesting Agency shall pay any actual costs incurred by the Servicing Agency as a result
of the delay in notication, provided such costs are directly attributable to the failure to give notice.
17. Assisted Acquisition Agreements Requesting Agency’s Organizations Authorized to Request Acquisition
Assistance for this IAA (State or attach a list of Requesting Agency’s organizations authorized to request acquisition assistance for this IAA.
18. Assisted Acquisition Agreements Servicing Agency’s Organizations Authorized to Request Acquisition
Assistance for this IAA (State or attach a list of Servicing Agency’s organizations authorized to request acquisition assistance for this IAA.)
19. Requesting Agency Clause(s) (Optional) (State and/or attach any additional Requesting Agency clauses.)
20. Servicing Agency Clause(s) (Optional) (State and/or attach any additional Servicing Agency clauses.)
LEAD. TRANSFORM. DELIVER.
-
-
FS Form 7600A (06-10) Department of the Treasury | Bureau of the Fiscal Service November 2016 - page 3 of 4
IAA Number
GT&C # Amendment # / Mod # Order #
21. Additional Requesting Agency and/or Servicing Agency Attachments (Optional) (State and/or attach
any additional Requesting Agency and/or Servicing Agency Attachments)
22. Annual Review of IAA
By signing this agreement, the parties agree to annually review the IAA if the agreement period exceeds one year.
Appropriate changes will be made by amendment to the GT&C and/or modication to any affected Order(s).
AGENCY OFFICIAL
The Agency Ofcial is the highest level accepting authority or ofcial as designated by the Requesting Agency and
Servicing Agency to sign this agreement. Each Agency Ofcial must ensure that the general terms and conditions
are properly dened, including the stated statutory authorities, and, that the scope of work can be fullled as per the
agreement.
The Agreement Period Start Date (Block 5) must be the same as or later than the signature dates.
Actual work for this IAA may NOT begin until an Order has been signed by the appropriate individuals, as stated in the
Instructions for Blocks 37 and 38.
23. Requesting Agency Servicing Agency
Name
Title
Telephone Number(s)
Fax Number
Email Address
SIGNATURE
Approval Date
LEAD. TRANSFORM. DELIVER.
FS Form 7600A (06-10) Department of the Treasury | Bureau of the Fiscal Service November 2016 - page 4 of 4
