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U.S. Department of Health and Human Services
Indian Health Manual

Exhibit 8-77-A

Agency Agreement Format

IHS Exhibit 8-77-A
General Administration Manual
IHS Transmittal 96.01 (02/07/96)

INDIAN HEALTH SERVICE AGENCY AGREEMENT FORMAT

I-HP-96-0030-01

INTERAGENCY/INTRA-AGENCY AGREEMENT BETWEEN SPONSORING AGENCY AND SUPPORTING AGENCY/AGENCIES

  1. PURPOSE

    Indicate the purpose for which the agreement is established.  Briefly justify the reasons for entering into the agreement.

  2. AUTHORITY

    Provide the legislative authority under which this agreement is entered into, and any constraints or limitations upon the authority.  The Economy Act (31 USC 1535) of 1932, as amended, is often cited in most inter/intra-agency agreements.

  3. BACKGROUND

    Describe the antecedant circumstances or events that determined why the agencies enter into an agreement

  4. SCOPE OF WORK

    State what agency/program will be providing the services and the responsibilities of each agency under the agreement.  Indicate the category and specific kinds of services to be provided.

  5. DURATION OF AGREEMENT

    The effective and ending dates should be entered, only when the proposed effective date can receive proper review and approval.  The parties entering in the agreement can not agree on an effective date, the statement "upon approval" should be entered.  Specify provisions for qualifications and/or cancellation.

  6. LIAISON/PROJECT OFFICERS

    Provide the name, title, address, and telephone number of the persons from each participating agency who can obtain information concerning the provisions or administrative management of the agreement.

  7. FINANCE, ACCOUNTING, AND BILLING INFORMATION

    All agreements that require the transfer of funds between participating agencies must include this information:

    IHS (OTHER AGENCY)
    Appropriate Number ________________________________ ________________________________
    Common Accounting Number ________________________________ ________________________________
    Agency Location Code ________________________________ ________________________________
    Object classification Code ________________________________ ________________________________
  8. AUTHORIZING SIGNATURES AND DATES

    APPROVED AND ACCEPTED BY
    INDIAN HEALTH SERVICE     		APPROVED AND ACCEPTED BY
    (OTHER AGENCY)

Name and Title of Signatory Name and Title of Signatory
Date:______________ Date:______________

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