Date:

To:	Deputy Director for Intramural Research (DDIR) or Radiologist in Chief, Clinical Center

From:	[End User Name and IC, telephone and FAX numbers and email address] _______ (initial)

Reference:	NIH Director Memo. Dtd. May 7, 2008: Capital Equipment Purchases Exceeding $1M

Subject:	Request for Approval to Purchase Capital Equipment in Excess of $1,000,000.00 and/or Request for Approval to Purchase a Maintenance Contract for Capital Equipment Valued in Excess of $1,000,000.00

This request is for the purchase of capital equipment valued in excess of $1,000,000.00.

Purchase Description/Detailed Specification (attach quotations, if available):

Reason for purchase (replace obsolete equip., special initiative, increase capacity, etc.):

Intended usage:

Estimated cost:

Identification of users:

Accountable Property & Reutilization Clearance* (include copy of clearance with request)

I have communicated with other ICs (e.g., Special Interest Groups (SIGs), Scientific Directors (SDs), or Principal Investigators (PIs)) to consolidate new equipment purchases and/or usage of existing equipment, and I have communicated with my Office of Acquisition (OA) (formerly COAC) / Contracting Officers (COs) to address the feasibility of consolidating purchases of equipment. Yes	No

This request is for the purchase of a maintenance contract for capital equipment valued in excess of

$1,000,000.00.

Purchase Description/Statement of Work (attach quotations, if available):

Estimated cost of maintenance contract:

Suggested source of maintenance contract:

Period of Performance:

I have communicated with the Acquisition Planning and Specifications Branch, Division of Simplified Acquisition Policy & Services, OAMP (301.496.4814) and my Office of Acquisition (OAs) (formerly COAC) / Contracting Officers to address the feasibility of consolidating maintenance contracts. Yes	No

This request is:	Approved _________	Disapproved ________

____________________________________	_____________

DDIR or Radiologist-in-Chief	Date

Effective May 7, 2008, this memorandum must be approved prior to and included with the transmission of a purchase request to an Office of Acquisition and must be maintained in the resulting contract file. This approval process will be incorporated into the NIH “Clearance Manual” NIH Policy Manual Chapter 6307-3 / 26307-3 Appendix 1 upon its next revision.

*Property Clearance: Request Accountable Property and Reutilization Clearance via FAX 301.496.8428

DDIR: Submit request to: FAX 301-480-4825 or adamsl@mail.nih.gov

Radiologist-in-Chief: (Human Imaging Equipment) Submit request to FAX 301.480.0055 or ellist@mail.nih.gov