Office of the Budget Advance Payment Request Form Comptroller Operations Instructions: This form is to be utilized to request authorization for advance payments. Please submit the form as a Word document. The completed Word document must be emailed to: OB, ConsultingServices@state.pa.us (use Outlook global directory) Requesting Agency Information Date: Agency: Address: Telephone No: Requested By: Telephone No: Agency Contact: Procurement Information It is Commonwealth policy that payments are made on a reimbursement basis. Other methods must be approved by Comptroller Operations. Also, payments for services to be rendered in contingent fiscal years must be approved by the Office of the Budget. Reason and justification for the advance payment: Yes No Discount percentage: Is a price discount involved: Yes No Contract Number: Is there an existing contract: Yes No % federal funds: Are federal funds involved: $ Estimated spend: Fund number: Funding information: Begin End # of renewal years: Estimated dates of service: Will any single payment cover a Yes No How many months: service period of more than 12 months: Agency Authorization (type name - no signature required) Approved by: Title:
Office of the Budget Advance Payment Request Form Comptroller Operations Instructions: This form is to be utilized to request authorization for advance payments. Please submit the form as a Word document. The completed Word document must be emailed to: OB, ConsultingServices@state.pa.us (use Outlook global directory) Requesting Agency Information Agency: Date: Address: Requested By: Telephone No: Agency Contact: Telephone No: Procurement Information It is Commonwealth policy that payments are made on a reimbursement basis. Other methods must be approved by Comptroller Operations. Also, payments for services to be rendered in contingent fiscal years must be approved by the Office of the Budget. Reason and justification for the advance payment: Is a price discount involved: Yes No Discount percentage: Is there an existing contract: Yes No Contract Number: Are federal funds involved: Yes No % federal funds: Funding information: Estimated spend: $ Fund number: Estimated dates of service: Begin End # of renewal years: Will any single payment cover a service period of more than 12 months: Yes No How many months: Agency Authorization (type name - no signature required) Approved by: Title:
Advance%20Payment%20Request%20Form.docx