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USDA FOREST SERVICE FS-6500-224(6/2006) 1 Commitment & Obligation Request Form Non-IAS/I-WEB G & A Fax Number: 1-866-879-1764 (One Request per Package) CONTACT INFORMATION 1. TRANSMITTING UNIT Washington Office – Fire and Aviation Management 2. NAME OF REQUESTOR PHONE TITLE E-MAIL SIGNATURE DATE TYPE OF REQUEST 3. TYPE COMMITMENT ($100,000 OR GREATER) ONLY UNDELIVERED ORDER MODIFICATION Increase Decrease 4. Action Required New CANCELLATION/DE-OBLIGATION 5. Commitment Document # (i.e. RQ): 6. Obligation Document # (i.e. MO) 7. Purpose of cancellation/de-obligation 8. ATTACHMENTS (CHECK ALL THAT ARE APPLICABLE) SF-182 WORK PLAN FORM FS 6500-46 OTHER (DESCRIBE) RCA or other attachments 9. ACCOUNTING DATA ORGANIZATION CODE JOB CODE BUDGET OBJECT CODE AMOUNT TOTAL 10. VENDOR NAME 11. VENDOR CODE (INCLUDE ALPHA SUFFIX) NA 12. BOAC ACCOUNT # (SUFFIX FED CODE) NA 13. CERTIFICATIONS (COMPLETE ONLY FOR TRANSACTION OF $100,000 OR GREATER) I CERTIFY THAT THE PROPERTY ITEMS LISTED ABOVE ARE NOT AVAILABLE ON THE EXCESS PROPERTY LIST AND THAT THE BUDGET OBJECT CODES FOR PROPERTY ITEMS ARE CORRECT NA PROPERTY MANAGEMENT OFFICER’S SIGNATURE DATE I CERTIFY THAT THE FUNDING SOURCE IS APPROPRIATE FOR THIS PURCHASE, FUNDS ARE AVAILABLE FOR OBLIGATION, AND THE BUDGET OBJECT CODE IS CORRECT. BUDGET OFFICER SIGNATURE (OR DESIGNEE) TITLE DATE PHONE NUMBER: DATA FAX NUMBER: EMAIL SHORT NAME: FAM-
