**U.S. Number range CHAPTERDEPARTMENT OF THE INTERIOR**

**ACQUISITION SCREENING AND REVIEW FORM**

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<tbody>
<tr class="odd">
<td colspan="18"><strong>ACQUISITION PLAN</strong> ACCOUNTING FUNDIING
CODE___________________________</td>
<td colspan="2">Page 1</td>
</tr>
<tr class="even">
<td colspan="2">1. Date Prepared:</td>
<td colspan="10">2. Purchasing Office Identification:</td>
<td colspan="8">3. Solicitation/Requisition No:</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="10"></td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="12">4. Description of Commodity or Service and
Quantity:</td>
<td colspan="8">4(a) Product Service Code</td>
</tr>
<tr class="odd">
<td colspan="12" rowspan="5"></td>
<td colspan="3">Code</td>
<td colspan="5">Title</td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="5"></td>
</tr>
<tr class="odd">
<td colspan="8">4(b) NAICS Codes</td>
</tr>
<tr class="even">
<td colspan="4">Code</td>
<td>Title</td>
<td colspan="3">Size Standard</td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="4">5. Competition</td>
<td colspan="5">6. Synopsis</td>
<td colspan="3">7. Cost/Price <em>(Estimate):</em></td>
<td colspan="4">8. Solicitation Date <em>(Estimate):</em></td>
<td colspan="4">9. Response/ Bid Opening Date <em>(Estimate)</em></td>
</tr>
<tr class="odd">
<td>Competitive</td>
<td colspan="2">Yes</td>
<td></td>
<td colspan="4">Yes</td>
<td></td>
<td colspan="3" rowspan="2"></td>
<td colspan="4" rowspan="2"></td>
<td colspan="4" rowspan="2"></td>
</tr>
<tr class="even">
<td><p>Non-Competitive</p>
<p>(Attach Justification unless 8(a))</p></td>
<td colspan="2">No</td>
<td></td>
<td colspan="4">No</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="7">10. A. Proposed Method of Procurement <em>check all
boxes <strong>(a)</strong> through <strong>(f)</strong> that
apply</em>.</td>
<td colspan="7">B. Small Business Preference Program (Check one box (g)
through (m))</td>
<td colspan="6">C. Other</td>
</tr>
<tr class="even">
<td colspan="5"><p>(a) GSA-FSS Award</p>
<p>(Add justification if large bus.)</p></td>
<td colspan="2"></td>
<td colspan="6">(g) 8(a) Program (FAR 19.8)</td>
<td></td>
<td colspan="5">(n) HBCU/Min. Serv. Institutions (FAR 26.300)</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5">(b) Commercial Item (FAR12.101)</td>
<td colspan="2"></td>
<td colspan="6"><p>(h) HUBZone Set-Aside</p>
<p>(FAR 19.1301)</p></td>
<td></td>
<td colspan="5">(o) Performance-Based Acquisition (FAR 37.6)</td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"><ol start="3" type="a">
<li><p>Simplified Acquisition Procedures</p></li>
</ol>
<p>(<a
href="http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/13.htm#P17_2144">FAR
13</a>.001)</p></td>
<td colspan="2"></td>
<td colspan="6"><p>(i) Service-Disabled Veteran-Owned Small</p>
<p>Business (FAR 19.14)</p></td>
<td></td>
<td colspan="5">(p) Sole Source (FAR6)</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5">(d) Sealed Bidding (FAR 14.101)</td>
<td colspan="2"></td>
<td colspan="6"><p>(j) Veteran Owned Small Business</p>
<p>(FAR 19.14)</p></td>
<td></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5">(e) Negotiated (FAR 15.001)</td>
<td colspan="2"></td>
<td colspan="6">(k)Total Small Business Set-Aside (FAR 19.502.2)</td>
<td></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5">(f) NOT Set-Aside</td>
<td colspan="2"></td>
<td colspan="6"><p>(l) Partial Small Business Set-Aside</p>
<p>(FAR 19.502.3)</p></td>
<td></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"></td>
<td colspan="2"></td>
<td colspan="6">(m) Buy Indian (FAR 52.226.1)</td>
<td></td>
<td colspan="5"></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20">11. Composition of bidders/sources list, including
results of <a
href="../SBA%20Dynamic%20Small%20Business%20%20%20%20%20%20%20%20%20Search">SBA
Dynamic Small Business Search</a>: (<a
href="http://dsbs.sba.gov/dsbs/search/dsp_dsbs.cfm">http://dsbs.sba.gov/dsbs/search/dsp_dsbs.cfm</a>)</td>
</tr>
<tr class="even">
<td colspan="6">(a) Number of Small Businesses</td>
<td colspan="4"></td>
<td colspan="9">(d) Number of Large Businesses</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="6">(b) Number of Small Disadvantaged Businesses</td>
<td colspan="4"></td>
<td colspan="9">(e) Number of Women-Owned Businesses</td>
<td></td>
</tr>
<tr class="even">
<td colspan="6">(c) Number of HUBZone Businesses</td>
<td colspan="4"></td>
<td colspan="9">(f) Number of Service-Disabled Veteran-Owned
Businesses</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="20">12. Basis for Proposed Method of Acquisition</td>
</tr>
<tr class="even">
<td colspan="11">(a) Not Set Aside for 8(a) because:</td>
<td colspan="9">(d) Not Set-Aside for Small Business because :</td>
</tr>
<tr class="odd">
<td colspan="11" rowspan="3"></td>
<td colspan="7">(1) Non-Competitive</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="7">(2) Insufficient number of qualified Small Bus.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="7">(3) Small Business Competitiveness Demonstration
Program</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="11">(b) Not Set Aside for HUBZone because:</td>
<td colspan="7">(4) Contract Bundling (FAR 7.107)</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="11" rowspan="2"></td>
<td colspan="7">(5) See Acquisition History Below</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="7">(e) Partial Small Business Set-Aside NOT Appropriate (<a
href="http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/19.htm#P375_88396">FAR-19.502-3</a>)</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="11">c) Not Set-Aside for SDVOSB because:</td>
<td colspan="9" rowspan="2"></td>
</tr>
<tr class="even">
<td colspan="11"></td>
</tr>
</tbody>
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  **ACQUISITION HISTORY** Solicitation/Requisition No.                                                                                                                                                     Page 2
  (Cont):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                                                                                                                                

  13\. Has similar item/service been procured within past 3                                                                                                                                                
  years? (If so, enter previous purchase order/contract                                                                                                                                                    
  number)                                                                                                                                                                                                  

  No                                                                     Yes                                                                                                                               

  If yes, indicate method of acquisition (use codes from                                                                                                                                                   
  Block 10 above) and place of performance:                                                                                                                                                                

  13a. Method of Procurement:                                                                                                                                                                              

  b\. Preference program or other:                                                                                                                                                                         

  c\. Place of Performance:                                                                                                                                                                                

  14\. If competitive, indicate number of responses received                                                                                                                                               
  from the following types of businesses for most recent                                                                                                                                                   
  procurement:                                                                                                                                                                                             

  Large                                                          Small         Min/Disadv.                       HUBZone                Woman-Owned   SDVOSB          Other                                
                                                                                                                                                                      (Specify)                            

                                                                                                                                                                                                           

  15\. Date of Award                                                           16\. Total                                  17\. Name,                                                                      
                                                                               Cost/Price                                  Address and                                                                     
                                                                                                                           DUNS of                                                                         
                                                                                                                           Contractor                                                                      

                                                                                                                                                                                                           

  18\. Type of Business of most recent awardee (check all                                                                                                                                                  
  that are applicable):                                                                                                                                                                                    

  Large                                                          Small         Min/Disadv              HUBZone                          Woman-owned   SDVOSB                      Other                    
                                                                                                                                                                                  (Specify)                

                                                                                                                                                                                                           

  19\. Signature and Date:                                                                                                                                                                                 

  Purchasing Agent/Contract Specialist *(complete if                                                                                                           Date                                        
  different than the Contracting Officer)*                                                                                                                                                                 

  Contracting Officer                                                                                                                                          Date                                        

  Business Utilization & Development Specialist                                                                                                                Date                                        

  SBA Procurement Center Representative (PCR)                                                                                                                  Date                                        
  ----------------------------------------------------------- -- ------- ----- ------------- ----- --- --------- --------- ------------ ------------- -------- ------ ----------- ----------- ------------ ------

NOTES:
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DI-1886

Instructions: DI Form1886

+----------+-----------------------------------------------------------+
|          | Enter the accounting or funding code assigned to this     |
|          | requirement at the top of the form.                       |
+----------+-----------------------------------------------------------+
| Block 1  | Enter the date that the DI Form 1886 was prepared         |
+----------+-----------------------------------------------------------+
| Block 2  | Enter a code, location, or phrase that identifies the     |
|          | office that originated the DI Form 1886.                  |
+----------+-----------------------------------------------------------+
| Block 3  | Enter the solicitation number, if known. Otherwise, enter |
|          | the requisition number.                                   |
+----------+-----------------------------------------------------------+
| Block 4  | Briefly describe what is being purchased.                 |
+----------+-----------------------------------------------------------+
|          | -   If a product, provide a plain English description,    |
|          |     quantity, and delivery date. If applicable, enter the |
|          |     part number, model number, and manufacturer.          |
+----------+-----------------------------------------------------------+
|          | -   If a service, provide a plain English description of  |
|          |     the type of service required, the period of           |
|          |     performance, and place of performance.                |
+----------+-----------------------------------------------------------+
|          | -   Use the 5 "Ws" (Who, What, Where, When and Why)       |
+----------+-----------------------------------------------------------+
| Block 4a | Enter the relevant Product or Service Code and its title  |
|          | from                                                      |
|          |                                                           |
|          | http://www. fpdsng.com/ downloads/service product         |
|          | codes.pdf or                                              |
|          |                                                           |
|          | http://www.fedbizopps.gov/classCodes1.html. Use the       |
|          | "notes" section or a continuation sheet for multiple line |
|          | items.                                                    |
+----------+-----------------------------------------------------------+
| Block 4b | Enter the relevant NAICS Code, title and size standard    |
|          | from http://www.census.gov/epcd.www.naics.html. Use the   |
|          | "notes" section or a continuation sheet for multiple line |
|          | items.                                                    |
+----------+-----------------------------------------------------------+
| Block 5  | Indicate whether the purchase is planned to be            |
|          | competitive or non-competitive. If non-competitive,       |
|          | attachment the Justification for Other than Full and Open |
|          | Competition, unless 8(a) procedures are being followed.   |
+----------+-----------------------------------------------------------+
| Block 6  | Indicate whether the purchase will be synopsized.         |
+----------+-----------------------------------------------------------+
| Block 7  | Enter the government's cost estimate                      |
+----------+-----------------------------------------------------------+
| Block 8  | Enter the date on which the solicitation is expected to   |
|          | be issued.                                                |
+----------+-----------------------------------------------------------+
| Block 9  | Enter the date by which the offers are expected to be     |
|          | received.                                                 |
+----------+-----------------------------------------------------------+
| Column   | Check all boxes (a) through (f) that apply regarding the  |
| 10A      | proposed method of solicitation.                          |
+----------+-----------------------------------------------------------+

+----------+-----------------------------------------------------------+
| Column   | Check one box (g) through (m) to indicate the Small       |
| 10B      | Business Preference Program applicable to the purchase.   |
+----------+-----------------------------------------------------------+
| Column   | Check all boxes (n) through (p) applicable to the         |
| 10C      | purchase.                                                 |
+----------+-----------------------------------------------------------+
| Block 11 | In boxes (a) through (f), specify the number of           |
|          | contractors in each category that have been identified.   |
+----------+-----------------------------------------------------------+
|          |                                                           |
+----------+-----------------------------------------------------------+
| Block 12 | In boxes (a) through (c), provide a brief rationale for   |
|          | the method of procurement being proposed. In boxes (d)    |
|          | and (e), indicate which rationales apply.                 |
+----------+-----------------------------------------------------------+
| Block 13 | Indicate whether the product or service has been          |
|          | purchased within the previous three years. Enter the      |
|          | contract/order number(s) for the last three purchases.    |
|          |                                                           |
|          | In box (a), enter the method of procurement for the most  |
|          | recent purchase using the codes from Block 10A.           |
|          |                                                           |
|          | In box (b), enter the preference program or other         |
|          | information applicable to the most recent purchase, using |
|          | the codes from Block 10B and 10C.                         |
|          |                                                           |
|          | In box (c), enter the place of performance for the most   |
|          | recent purchase.                                          |
+----------+-----------------------------------------------------------+
| Block 14 | If the most recent purchase was competitive, enter the    |
|          | number of offers received in the indicated categories of  |
|          | vendors.                                                  |
+----------+-----------------------------------------------------------+
| Blocks   | Enter the date of award, total cost/price, and the        |
| 15       | vendor's name and address, including their Data Universal |
| through  | Numbering System identifier, for the most recent          |
| 17       | purchase.                                                 |
+----------+-----------------------------------------------------------+
| Block 18 | Check all the boxes that describe the type of business    |
|          | that received the most recent award.                      |
+----------+-----------------------------------------------------------+
| Block 19 | The purchasing agent or contract specialist (if           |
|          | applicable) should sign the form first, and submit it for |
|          | review by the CO. After the CO's signature, forward the   |
|          | form to the local BUDS for review and signature. If PCR   |
|          | review is available, it will be obtained by the BUDS. PCR |
|          | signature is required only when the contracting office is |
|          | regularly serviced by a PCR, or when the SBA has sent a   |
|          | written notice of interest in the acquisition.            |
+----------+-----------------------------------------------------------+
| Notes    | This area may be used if additional space is needed for   |
|          | any blocks. It may also be used to document resolution of |
|          | any disagreements regarding use of set asides or          |
|          | application of the 8(a) program.                          |
+----------+-----------------------------------------------------------+
|          |                                                           |
+----------+-----------------------------------------------------------+