If you submit your invoice via E-mail, there is no need to mail a paper copy. You may send the single invoice attachment directly to OAS (cpbapinv@cdc.gov), and cc the DACEB procurements mailbox (daebproc@cdc.gov) and your state’s assigned COR/Vital Statistics Specialist (see task order for name and email address). Or you may send via mail/courier to CDC, PO Box 15580, Atlanta, GA 30333. But do not duplicate submissions.
Due to upgrades to the NCHS invoice imaging process, we ask that you submit only one invoice attachment per E-mail, to ensure vendor invoices are received and recorded properly in our system. E-mails submitted as a single file containing multiple invoices or emails submitted with multiple invoice attachments will not import properly due to our new system changes. Additional pages with the invoice, such as cover letters or associated paperwork, will not cause any issues; it is
only mandatory that the E-mail contains only one attachment, and that the attachment contains only
one invoice.
Please include the contract number and task order number in the subject line of the email. By submitting one invoice per email, clearly labeled in the subject line, you will ensure faster processing of vendor invoices and their subsequent payment.
Submitting an invoice to cover a full year is acceptable but quarterly invoicing is encouraged.
Invoice/Voucher number
US Department, Bureau, or Establishment and Location
Date Voucher prepared
Contract Number
Payee name and address
DUNS
EIN
Item Number
Date of Delivery
Supplies and Services
Quantity
Unit Price
Amount
Total
LINK TO FORM: http://www.gsa.gov/portal/forms/download/115462
Please use these instructions when completing invoices to avoid delay in payment. Invoice numbers cannot be duplicated. Please use consecutive invoice numbers. Public Vouchers submitted with an invoice must be numbered the same as the invoice. Do not use different numbers for the Public Voucher and the invoice.
US Department, Bureau, or Establishment and Location must show:
A current date must be added indicating when the invoice was prepared.
Enter your state specific purchase order number in the block for CONTRACT NUMBER. The purchase order number can be found on page 3 in the far right hand corner for NDI data purchase.
Example: 200-2012-M-30986
Enter Payee’s name and address (state/jurisdiction)
The DUNS number is a unique nine digit identification number, for each physical location of your business. Dun & Bradstreet (D&B) provides a D-U-N-S Number. Enter this information in the block for the PAYEE’S ACCOUNT NUMBER.
The TIN/EIN number is the employer identification number, or EIN, and is also known as a taxpayer identification number, or TIN. Enter this information in the block for GOVERNMENT B/L NUMBER.
For the item number and date of order, use the CLIN/ITEM number. It can be found on page 3 of 16 of the purchase order.
The Date of Delivery is the same as the Period of Performance or PoP. Please see your purchase order for the Period of Performance. If you are not invoicing for all four quarters of data included in the data collection period, please do *not* use the entire date range.
Articles or Service should specifically indicate for what data you are requesting payment. Examples:
1st Quarter:
NDI Data Months: January - March 2012 Performance Period: April - June 2012
All data months:
NDI Data Months: January 2012 - December 2012 Performance Period: April 16, 2012 - April 15, 2013
The quantity is the number of quarters you are requesting payment. For example, if you are requesting payment for one quarter, enter such in this field:
QTY / UNIT |
1 Quarter |
The unit price is the amount for each quarter of death data. This information can also be found on page 3 of your NDI purchase order. This amount is entered under the Unit Price on the invoice.
The Amount is the Quantity multiplied by the Unit Price.
QTY / UNIT | UNIT PRICE | AMOUNT |
1 Quarter | $12,912.75 | $12,912.75 |
4 Quarters | $12,912.75 | $51,651.00 |
The Total represents the grand total of the voucher OR the sum of all Amounts.
Example: Using the figures from instruction 13 above your total for 1 quarter would be the same as the Amount, $12,912.75.
The NCHS goal for processing invoices is to have the payment made within 30 days of the date NCHS receives the invoice (not the date on the invoice). If it has been over 30 days since your invoice was submitted to NCHS, our suggestion is to send an E-mail to your state’s assigned Vital Statistics Specialist. Include a copy of the invoice and any necessary dates and information on it, including the original E-mail it was attached to, if available. Your Vital Statistics Specialist will look into it and let you know what they find out.
Standard Form 1034 Revised October 1987 Department of the Treasury 1 TFM 4-2000 | PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL | VOUCHER NO. REQ #1 | ||||
U.S. DEPARTMENT, BUREAU, OR ESTABLISHMENT AND LOCATION REQ #2 | DATE VOUCHER PREPARED REQ #3 | SCHEDULE NO. | ||||
CONTRACT NUMBER AND DATE REQ #4 | PAID BY | |||||
REQUISITION NUMBER AND DATE | ||||||
PAYEE'S NAME AND ADDRESS REQ #5 | ||||||
DATE INVOICE RECEIVED | ||||||
DISCOUNT TERMS | ||||||
PAYEE'S ACCOUNT NUMBER REQ #6 | ||||||
SHIPPED FROM TO WEIGHT | GOVERNMENT B/L NUMBER REQ #7 | |||||
NUMBER AND DATE OF ORDER | DATE OF DELIVERY OR SERVICE | ARTICLES OR SERVICES (Enter description, item number of contract or Federal supply schedule, and other information deemed necessary) | QUANTITY | UNIT PRICE | AMOUNT | |
COST | PER | (1) | ||||
REQ #8 | REQ #9 | REQ #10 | REQ #11 | REQ #12 | REQ #13 | |
(Use continuation sheet(s) if necessary) (Payee must NOT use the space below) | TOTAL | REQ #14 | ||||
PAYMENT: PROVISIONAL COMPLETE | APPROVED FOR =$ | EXCHANGE RATE =$1.00 | DIFFERENCES | |||
PARTIAL FINAL PROGRESS | ||||||
BY 2 | ||||||
ADVANCE | ||||||
Amount verified; correct for payment | ||||||
TITLE | (Signature or initials) | |||||
Pursuant to authority vested in me, I certify that this voucher is correct and proper for payment. (Date) (Authorized Certifying Officer) 2 | (Title) | |||||
ACCOUNTING CLASSIFICATION | ||||||
P A I D B Y | CHECK NUMBER ON ACCOUNT OF U.S. TREASURY | CHECK NUMBER | ON (Name of bank) | |||
CASH DATE $ | PAYEE 3 | |||||
| PER | |||||
TITLE |
Previous edition usable NSN 7540-00-900-2234
PRIVACY ACT STATEMENT |
The information requested on this form is required under the provisions of 31 U.S.C. 82b and 82c, for the purpose of disbursi ng Federal money. The information requested is to identify the particular creditor and the amounts to be paid. Failure to furnish this information will hinder discharge of the payment obligation. |