+--------------------------------------------------+-------------------+
| UNITED STATES                                    | 1\. Fiscal Year   |
|                                                  | (s)               |
| DEPARTMENT OF THE INTERIOR                       |                   |
|                                                  | (Period of Fund   |
| BUREAU OF LAND MANAGEMENT                        | Availability)     |
|                                                  |                   |
| REIMBURSABLE WORK AUTHORIZATION (RWA),           | FY                |
| INTER/INTRA-AGENCY AGREEMENT (IA)                | [\                |
|                                                  | _\_\_\_\_]{.mark} |
| \_[**X**]{.underline} REIMBURSABLE WORK \_\_\_\_ |                   |
| INTER-AGENCY/INTRA-AGENCY                        |                   |
|                                                  |                   |
| AUTHORIZATION AGREEMENT                          |                   |
|                                                  |                   |
| (BLM to perform work as described herein for the |                   |
| (To have work performed for BLM                  |                   |
|                                                  |                   |
| agency named in item 6) by the agency named in   |                   |
| item 6a)                                         |                   |
+--------------------------------------------------+-------------------+

  -----------------------------------------------------------------------
  SEE INSTRUCTIONS ON PAGE 2

  -----------------------------------------------------------------------

+------------------+---------------------------------------------------+
| 2\. BLM RWA      | 3\. Check appropriate box                         |
| Project No./BLM  |                                                   |
| IA No.           | \_**[X]{.underline}**\_ Original \_\_\_           |
|                  | Modification No. \_\_\_\_\_\_\_\_\_\_\_\_\_       |
|                  | \_\_\_Task Order No. \_\_\_\_\_\_\_\_\_\_\_\_\_   |
+------------------+---------------------------------------------------+

+------------------------+-------------------+-------------------------+
| 4\. Under the          |                   |                         |
| authority of (Cite     |                   |                         |
| authorities):          |                   |                         |
|                        |                   |                         |
| \_[\_]{.underline}\_   |                   |                         |
| 43 U.S.C. 1701 et      |                   |                         |
| seq., (FLPMA)          |                   |                         |
| \_[                    |                   |                         |
| **X**\_]{.underline}\_ |                   |                         |
| 31 U.S.C. 1535 (the    |                   |                         |
| Economy Act)           |                   |                         |
|                        |                   |                         |
| \_[\_]{.underline}\_   |                   |                         |
| Department of the      |                   |                         |
| Interior Appropriation |                   |                         |
| Act for FY \_\_\_\_    |                   |                         |
| Other\_                |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
+------------------------+-------------------+-------------------------+
| 5\. Description of     |                   |                         |
| Work (If more space is |                   |                         |
| needed, attach         |                   |                         |
| additional sheets):    |                   |                         |
|                        |                   |                         |
| **Incident / Project   |                   |                         |
| Name                   |                   |                         |
| [\_\_\_\_\_            |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_]{.mark}** |                   |                         |
|                        |                   |                         |
| **Incident / Project   |                   |                         |
| Number                 |                   |                         |
| [\_\_\_\_              |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_]{.mark}** |                   |                         |
|                        |                   |                         |
| **Miscellaneous        |                   |                         |
| supplies/services      |                   |                         |
| ordered by resource    |                   |                         |
| order from BLM/NIFC to |                   |                         |
| billed through IPAC**  |                   |                         |
+------------------------+-------------------+-------------------------+
| 6\. BLM Office:        |                   |                         |
| **BUREAU OF LAND       |                   |                         |
| MANAGEMENT** 6a.       |                   |                         |
| Participating Agency:  |                   |                         |
| [\_\_\_\_\_\_          |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_]{.mark} |                   |                         |
|                        |                   |                         |
| Address: **3833 S.     |                   |                         |
| Development Avenue**   |                   |                         |
| Address:               |                   |                         |
| [\_\_\_\_\_\_          |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_]{.mark} |                   |                         |
|                        |                   |                         |
| **Boise ID 83705**     |                   |                         |
| [\_\_\_\_\_\_          |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_]{.mark} |                   |                         |
|                        |                   |                         |
| Point of Contact:      |                   |                         |
| **Deborah Bidaburu**   |                   |                         |
| Phone:                 |                   |                         |
| **208/387-5588** Point |                   |                         |
| of Contact:            |                   |                         |
| [\_\_\_\_\_            |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_]{.mark} |                   |                         |
| Phone:                 |                   |                         |
| [\_                    |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_]{.mark} |                   |                         |
|                        |                   |                         |
| **Deborah_b            |                   |                         |
| idaburu@nifc.blm.gov** |                   |                         |
| Fax: **208/387/5359    |                   |                         |
| e-ma**il**:            |                   |                         |
| [\_\_\_                |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_]{.mark}** |                   |                         |
| Fax**:                 |                   |                         |
| [\_\_\_                |                   |                         |
| \_\_\_\_\_\_\_\_\_\_\_ |                   |                         |
| \_\_\_\_\_\_]{.mark}** |                   |                         |
+------------------------+-------------------+-------------------------+
| BILLING DATA           | BLM               | PARTICIPATING AGENCY    |
+------------------------+-------------------+-------------------------+
| 7\. Agency Location    | 7a.               | 7b.                     |
| Code                   | **14-11-0008**    |                         |
+------------------------+-------------------+-------------------------+
| 8\. Treasury Account   | 8a. **14X1125**   | 8b.                     |
| Symbol                 |                   |                         |
+------------------------+-------------------+-------------------------+
| 9\. Account/Cost       | 9a.               | 9b.                     |
| Structure              |                   |                         |
+------------------------+-------------------+-------------------------+
| 10\. Procurement       | 10a.              | 10b.                    |
| Document Number        |                   |                         |
+------------------------+-------------------+-------------------------+
| 11\. Duns Number       | 11a**.            | 11b.                    |
|                        | 037801664**       |                         |
+------------------------+-------------------+-------------------------+
| 12\. Standard General  | 12a.              | 12b.                    |
| Ledger                 |                   |                         |
+------------------------+-------------------+-------------------------+
| 13\. Contract line     | 13a.              | 13b.                    |
| Number                 |                   |                         |
+------------------------+-------------------+-------------------------+

+------------------------------------+---------------------------------+
| 14\. For RWA: Participating        | 15\. For IA's: Amount Obligated |
| Agency's \$ Amount Obligated       | by BLM                          |
+------------------------------------+---------------------------------+
| a\. Current Amount **\$            | a\. This obligation             |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_**     |                                 |
+------------------------------------+---------------------------------+
| b\. Modification: Amount of        | b\. Previous obligation         |
| Increase or                        |                                 |
|                                    |                                 |
| Decrease (circle one) .**00**      |                                 |
+------------------------------------+---------------------------------+
|                                    | c\. Total obligation            |
+------------------------------------+---------------------------------+
| c\. Total amount available **\$    | d\. Not to exceed total amount  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_**     | obligated by BLM: \$            |
+------------------------------------+---------------------------------+
| d\. Over-run                       | 16\. Method of Payment :        |
| allowed\_\_\_\_\_\_\_\_\_% or      | (Applies to IAs only)           |
| \$\_\_\_\_\_\_                     |                                 |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_ Advance \_\_ Reimbursement |
|                                    | \_\_ Progress                   |
| Billing for Federal Agencies and   |                                 |
| DOD will be processed via IPAC.    |                                 |
|                                    |                                 |
| "Automatic" billing will be done   |                                 |
| annually by the BLM/NIFC           |                                 |
|                                    |                                 |
| unless specified. \_ \_\_ Other    |                                 |
| (identify)\_\_ \_\_                |                                 |
+------------------------------------+---------------------------------+

+-----------------------------------------------------------------------+
| 17\. Bill To (Name and Address, including zip code of **[Finance      |
| Office]{.underline}**):                                               |
|                                                                       |
| **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\             |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** |
+-----------------------------------------------------------------------+
| Upon Approval, this agreement constitutes an obligation against BLM   |
| if requesting the work; or authority to proceed with work by BLM for  |
| the herein named agency in anticipation of reimbursement.             |
+-----------------------------------------------------------------------+

+-------------------+--------------+---------------------+------------+
| 18\. Approved for |              | 19\. Approved for   |            |
| the Bureau of     |              | \_\_\               |            |
| Land Management   |              | _\_\_\_\_\_\_\_\_\_ |            |
| by:               |              | \_\_\_\_\_\_\_\_\_\ |            |
|                   |              | _\_\_\_\_\_\_\_\_\_ |            |
| \_\               |              | by:                 |            |
| _\_\_\_\_\_\_\_\_ |              |                     |            |
| \_\_\_\_\_\_\_\_\ |              | \_\                 |            |
| _\_\_\_\_\_\_\_\_ |              | _\_\_\_\_\_\_\_\_\_ |            |
| \_\_\_\_\_\_\_\_\ |              | \_\_\_\_\_\_\_\_\_\ |            |
| _\_\_\_\_\_\_\_\_ |              | _\_\_\_\_\_\_\_\_\_ |            |
| \_\_\_\_\_\_\_\_\ |              | \_\_\_\_\_\_\_\_\_\ |            |
| _\_\_\_\_\_\_\_\_ |              | _\_\_\_\_\_\_\_\_\_ |            |
|                   |              | \_\_\_\_\_\_\_[\_\_ |            |
| (Authorized       |              | \_\_\_]{.underline} |            |
| Signature)        |              |                     |            |
|                   |              | (Participating      |            |
|                   |              | Agency's            |            |
|                   |              | Contracting         |            |
|                   |              | Officers Signature  |            |
|                   |              | )                   |            |
+-------------------+--------------+---------------------+------------+
| 18a. Name (Type): |              | 19a. Name (Type):   |            |
+-------------------+--------------+---------------------+------------+
| 18b. Title:       | 18c. Date:   | 19b. Title:         | 19c. Date: |
+-------------------+--------------+---------------------+------------+

**INSTRUCTIONS FOR REIMBURSABLE WORK AUTHORIZATION (RWA),
INTER/INTRA-AGENCY AGREEMENT (IA)**

*NOTE: Information [highlighted]{.mark} is to be completed by, or
obtained from, the Participating Agency*

**A. RWA - BLM TO PERFORM WORK FOR ANOTHER AGENCY**

Mark the box for Reimbursable Work Authorization (RWA)

**[1. Enter the four digit fiscal year(s) for which funds are
available.]{.mark}**

2\. Enter the four digit BLM RWA number (project number) obtained from
the National Business Center (NBC) Finance.

3\. Check "Original" if first submission or "Modification" if revision
to an existing RWA. Enter the project number and a sequential revision
number (4000-1) if necessary.

4\. Check "43 U.S.C. 1701" and "Department of Interior Appropriation
Act".

**[5. Complete Project Name and Number from Resource Order. Provide a
description of the work to be performed.]{.mark}**

6\. Enter the BLM office name, city, State, organization (State and
office) code, BLM contact name and phone number with area code.

**[6a. Enter the Participating Agency name, city, State, contact names
and phone numbers with are code.]{.mark}**

BLM: Items 7a, 8a, 9a, 10a, 11a, 12a and 13a will be used to update the
BLM Federal Financial System.

7a. 14-11-0008 is the BLM Agency Location Code (ALC) assigned by
Treasury.

8a. Enter the fund account symbol for BLM from the Fund Coding Handbook,
H-1684.

9a. Enter the account cost structure for BLM: State and office (org)
code; activity/program element from the Fund Coding Handbook, H-1684;
and RWA (project) number. (Note: This cost structure **must** be charged
with time or expenditures for billing to occur.)

10a. Enter the IA or MOU number if assigned by BLM.

11a. Enter Duns Number.

12a. Enter Standard General Ledger.

13a. Enter the Contract Line #.

**[PARTICIPATING AGENCY: This data will be on your IPAC bill.]{.mark}**

**[The information in blocks 1, 5, 6a, 7b, 8b, 9b, 10b, 11b, 12b, 13b,
14, 17, and 19 should be completed by the finance office of the agency
for which BLM will perform the work.]{.mark}**

[]{.mark}

**[7b. Enter the eight-digit Agency Location Code (ALC) as assigned by
Treasury for your paying office.]{.mark}**

**[8b. Enter the Treasury Account Symbol (TAS)]{.mark}**

**[9b. Enter the cost structure/accounting classification for bills
against this agreement.]{.mark}**

**[10b.Enter the procurement document number (e.g., IA number, PO
number, MO number)]{.mark}**

**[11b. Enter your agency's DUNS number]{.mark}**

**[12b. Enter Standard General Ledger (SGL)]{.mark}**

**[13b. Enter Contract Line Number (CLIN)]{.mark}**

**[14. For an "original" RWA, enter the \$ amount in blocks a, c, and d.
For a "modification", enter the \$ amount in block b, circle increase or
decrease, and adjust blocks a and c accordingly.]{.mark}**

**[17. Enter the complete billing address for the Participating Agency
finance office.]{.mark}**

**[19. Signature of Participating Agency's Contracting Officer or Grants
& Agreement Officer.]{.mark}**

[]{.mark}

**B. IA - TO HAVE WORK PERFORMED FOR BLM BY A PARTICIPATING AGENCY**

Mark the box for INTER-AGENCY/INTRA-AGENCY AGREEMENT

1\. Enter the four-digit fiscal year(s) for which funds are available.

2\. Enter the 15-digit BLM IA number.

3\. Check "Original" if first submission, "Modification" and enter
modification number if modification, or "Task Order" and enter task
order number if task order.

4\. Check 31 U.S.C. 1535" unless another specific legislative authority
exists, in which case that authority is shown under "other". If 31
U.S.C. 1535 is checked, an Economy Act Determination **must** be
prepared by the project manager and approved by a warranted Contracting
Officer with delegated authority.

5\. Provide a description of the work to be performed in accordance with
BLM Manual 1510, Acquisition, Section 1510-17.5.

6\. Enter the BLM office name, city, State, organization (State and
Office) code, BLM contact name and phone no. with area code.

**6a. Enter the participating agency name, city, state, contact names,
and phone nos. with area codes.**

7a. 14-11-0008 is the BLM (ALC) assigned by Treasury.

8a. Leave this item blank.

9a. Enter the account cost structure for BLM: State and office code,
activity/program element from the fund coding handbook, H-1684, budget
object class code, and project number.

10a. Leave blank (Same as block 2).

**7b-13b. Participating Agency completes these items. This data will be
used to cross-reference BLM's IA with the Participating Agency's RWA.**

14\. For RWAs only. Do not enter any information for IAs.

15\. For an original IA; complete items a, c, and d. For modification or
task order; complete items a, b, c, and d.

16\. Check appropriate box.

17\. Enter NBC Finance Office address. (Bureau of Land Management,
National Business Center, P.O. Box 25047, Denver, CO 80225).

18\. IA must be signed by a warranted Contracting Officer with delegated
authority. IA is not signed by BLM until approved in block 19 by the
participating agency.

19\. Signature of approving official for the participating agency**.**