FEDLINK           ACCOUNT ADJUSTMENT/IAG AMENDMENT FILL-IN FORM
                                                                                    Fiscal Year (Please use one form per fiscal year)
A: AGENCY IDENTIFICATION
Date (MM-DD-YYYY) IAG# (##-##-####) FEDLINK ID
Agency Name
Contact First Name Last Name
Title:
Branch/Office:
Address:
City: State Zip
Phone(commercial): Email
Fax (commercial): Library URL

B: TERMINATE SERVICE (Transfer Pay Account)
  Service ID and Name
I authorize FEDLINK to terminate the services provided under my IAG from the vendor specified above.
I certify that, as of the date of this request, my agency will no longer place orders with or use the service of the above vendor under the LC/FEDLINK BOA. Any additional charges accrued will be the responsibility of my agency.
I will complete Section C to instruct FEDLINK regarding any funds remaining in the terminated service account.

C: MOVE FUNDS (Decrease Funds) (Refund or Move Funds Out of a Transfer Pay Account)
Account Service ID and Name Action Service Dollars Amount
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Total Decrease $
Certification: I certifiy that I have checked with the vendor and that the balance that will remain in the above service account(s) after funds are removed or refunded will be sufficient to cover all outstanding and projected usage of the service(s) for the fiscal year indicated. My agency is responsible for any additional charge accrued under the LC/FEDLINK BOA.
Refund Address: Please do not send the refund to the official contact address on my agency's IAG. Send the refund to the following address:


D: MOVE FUNDS (Increase Funds) (Move Funds Into a Transfer Pay Account or Start New Current Year Transfer Pay Account)
Account Service ID and Name Action Fund Type Service Dollars Amount
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Transfer $
Total Increase $
Current Fiscal Year: I certify that an increase in funds is necessary to cover actual and/or planned agency commitments for the current fiscal year.
Prior Fiscal Year: I certify that my agency received goods/services from the vendor(s) identified above. An increase in funds is necessary to cover actual agency commitments for the prior fiscal year and I request LC C&L to consider ratification of this increase.

E: ADD FUNDS TO CREATE NEW SERVICE ACCOUNT (TRANSFER or DIRECT Pay Account - Current FY only)
Account Type Service ID and Name Action Service Dollars Fund Type
$
$
$
$
$
$
Serials Services: If a vendor listed above is for serials subscription services (EB, OB, RE, or SZ) check apppriate box(es) below.
Serials
Serials Renewal: Exercise my option to renew with the vendor chosen in my previous FEDLINK serials competition. That vendor's service ID and my funding for serials are in the boxes above.

Completed Competition: ...Competition for my agency's serials is complete. The service ID(s) and funding for the chosen vendor(s) are shownin the box(es) above under Section E.

New SZ/TZ Competition: ...Compete my agency's serials and register my agnecy temporarily for service SZ for Serials for the current fiscal year funding funding shown in the boxes above.

F: ADD NEW FUNDS TO EXISTING SERVICE ACCOUNT (Transfer Pay or Direct Pay Account)
Account Type Service ID and Name ActionService Dollars Fund Type
A $
A $
A $
A $
A $
A $
Current Fiscal Year: I certify that an increase in funds is necessary to cover actual and/or planned agency commitments for the current fiscal year.
Prior Fiscal Year: I certify that this agency received goods/services from the vendor(s) identified above and that an increase in funds is necessary to cover actual agency commitments for the prior fical year where indicated.

G: SIGNATURE (Yellow fields are required.)
I understand and accept the policies and procedures for using FEDLINK services described in the current FEDLINK Member Handbook. I authorize LC/FEDLINK to amend my IAG (and compete transfer pay services as necessary) and begin services whre specified (Direct Pay service order must also meet local procuement requirements.) When my agency signs the IAG amendment generated from this request, it will be obligated to LC/FEDLINK for the services, funding and fees specified. Signing this request form does not change my agency's obligation to LC/FEDLINK under the IAG, nor obligate funds to LC/FEDLINK or a vendor, but my authorization will initiate changes in the allocation of funds among services. I also confirm the certifications required above.
Name Phone (work)
Signature: ___________________________________ Date: ________________________________

Print, sign and fax this form to:

FEDLINK Fiscal Operations
Library of Congress
(202) 707-4999
(Note: Data entered on this form will disappear when the window closes.)

If you have any questions about this form, please contact
the FEDLINK Fiscal Hotline at (202) 707-4900; TTY (202) 707-4998 or
send email to fliccfpe@loc.gov.
To reach a serials contracting officer, call (202) 707-0461; fax (202) 707-0485; or
send email to flicc-CL@loc.gov.