<table>
<colgroup>
<col style="width: 1%" />
<col style="width: 8%" />
<col style="width: 14%" />
<col style="width: 5%" />
<col style="width: 19%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 5%" />
<col style="width: 15%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 0%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="16"><blockquote>
<p>United State Department of Agriculture</p>
<p><strong>INVOICE COVER SHEET FOR IAS PAYMENTS (IAS-001)</strong></p>
<p><strong>AD-838-I</strong></p>
</blockquote></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3" rowspan="2"><blockquote>
<p><strong>1. IAS Order Number</strong></p>
</blockquote>
<p>AG-     </p></td>
<td colspan="4" rowspan="2"><blockquote>
<p><strong>2. Prompt Pay Type / Commodity Code:</strong></p>
<p><strong>Select one of the following:</strong></p>
</blockquote>
<table>
<colgroup>
<col style="width: 9%" />
<col style="width: 4%" />
<col style="width: 68%" />
<col style="width: 17%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td>C</td>
<td>Construction</td>
<td>14 days</td>
</tr>
<tr class="even">
<td></td>
<td>D</td>
<td>Dairy Products</td>
<td>10 days</td>
</tr>
<tr class="odd">
<td></td>
<td>M</td>
<td>Meat or Meat Food Products</td>
<td>7 days</td>
</tr>
<tr class="even">
<td></td>
<td>O</td>
<td>Other or Construction Final Payment</td>
<td>30 days</td>
</tr>
<tr class="odd">
<td></td>
<td>P</td>
<td>Perishable Agricultural Commodities</td>
<td>10 days</td>
</tr>
</tbody>
</table>
<blockquote>
<p>(if blank APB will default to ‘O’ Other)</p>
</blockquote></td>
<td colspan="6"><blockquote>
<p><strong>3. Date Goods Recvd / Accepted / Service Period End
Date</strong></p>
</blockquote></td>
<td colspan="3"><blockquote>
<p><strong>4. Date Invoice Received at Billing Address (Invoice should
be date stamped when rec’d)</strong></p>
</blockquote></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="6"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="3"><blockquote>
<p>     </p>
</blockquote></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="3"><blockquote>
<p><strong>5. Vendor Invoice No:</strong></p>
<p>     </p>
</blockquote></td>
<td colspan="8"><blockquote>
<p><strong>6a. Vendor Name:</strong></p>
<p>     </p>
</blockquote></td>
<td colspan="5"><blockquote>
<p><strong>6b. FFIS Vendor ID Code</strong></p>
<p>     </p>
</blockquote></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p><strong>7a.</strong></p>
<p><strong>Award</strong></p>
<p><strong>Line Number</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>8a.</strong></p>
<p><strong>IAS</strong></p>
<p><strong>Receipt Number</strong></p>
</blockquote></td>
<td colspan="2"><blockquote>
<p><strong>9a.</strong></p>
<p><strong>Dollar Amount</strong></p>
</blockquote></td>
<td colspan="2"><blockquote>
<p><strong>7b.</strong></p>
<p><strong>Award</strong></p>
<p><strong>Line Number</strong></p>
</blockquote></td>
<td colspan="4"><blockquote>
<p><strong>8b.</strong></p>
</blockquote>
<p><strong>IAS</strong></p>
<p><strong>Receipt Number</strong></p></td>
<td colspan="6"><blockquote>
<p><strong>9b.</strong></p>
<p><strong>Dollar Amount</strong></p>
</blockquote></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2">    </td>
<td colspan="4"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6">     </td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>    </p>
</blockquote></td>
<td><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>     </p>
</blockquote></td>
<td colspan="6"><blockquote>
<p>Total</p>
</blockquote></td>
<td colspan="6"><blockquote>
<p>10. $ 0.00</p>
</blockquote></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="16"><blockquote>
<p><strong>11.Notes:</strong></p>
<p>     </p>
</blockquote></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="5" rowspan="5"><blockquote>
<p><strong>16. Attach one invoice per form and fax to (504) 426-8247 or
mail to: (<em>Use of Window Envelope is Optional)</em></strong></p>
<p>USDA, OCFO, COD, APB</p>
<p>P.O. Box 60075</p>
<p>New Orleans, Louisiana 70160</p>
</blockquote></td>
<td colspan="11"><blockquote>
<p><strong>AUTHORIZED OFFICIAL</strong></p>
</blockquote></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="11"><blockquote>
<p><strong>12. Name, Title and Address of Agency Official</strong></p>
<p>     </p>
</blockquote></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="11"><blockquote>
<p><strong>13. Signature</strong></p>
</blockquote></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4" rowspan="2"><blockquote>
<p><strong>14. Date</strong></p>
<p>     </p>
</blockquote></td>
<td colspan="7" rowspan="2"><blockquote>
<p><strong>15. Phone Number</strong></p>
<p>     </p>
</blockquote></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="15"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="15"><blockquote>
<p><strong>INSTRUCTIONS/SAMPLE</strong></p>
</blockquote></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3" rowspan="2"><blockquote>
<p><strong>1. IAS Order Number</strong></p>
</blockquote>
<p>AG-3100-P-06-0001</p></td>
<td colspan="5" rowspan="2"><blockquote>
<p><strong>2. Prompt Pay Type / Commodity Code:</strong></p>
<p><strong>Select one of the following:</strong></p>
</blockquote>
<table>
<colgroup>
<col style="width: 9%" />
<col style="width: 4%" />
<col style="width: 69%" />
<col style="width: 16%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td>C</td>
<td>Construction</td>
<td>14 days</td>
</tr>
<tr class="even">
<td></td>
<td>D</td>
<td>Dairy Products</td>
<td>10 days</td>
</tr>
<tr class="odd">
<td></td>
<td>M</td>
<td>Meat or Meat Food Products</td>
<td>7 days</td>
</tr>
<tr class="even">
<td></td>
<td>O</td>
<td>Other or Construction Final Payment</td>
<td>30 days</td>
</tr>
<tr class="odd">
<td></td>
<td>P</td>
<td>Perishable Agricultural Commodities</td>
<td>10 days</td>
</tr>
</tbody>
</table>
<blockquote>
<p>(if blank APB will default to ‘O’ Other)</p>
</blockquote></td>
<td colspan="5"><blockquote>
<p><strong>3. Date Goods Recvd / Accepted / Service Period End
Date</strong></p>
</blockquote></td>
<td colspan="4"><blockquote>
<p><strong>4. Date Invoice Received at Billing Address (Invoice should
be date stamped when rec’d)</strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td></td>
<td colspan="5"><blockquote>
<p>10/27/2005</p>
</blockquote></td>
<td colspan="4"><blockquote>
<p>11/1/2005</p>
</blockquote></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="3"><blockquote>
<p><strong>5. Vendor Invoice No:</strong></p>
<p>54321</p>
</blockquote></td>
<td colspan="9"><blockquote>
<p><strong>6a. Vendor Name:</strong></p>
<p>Our Construction Company</p>
</blockquote></td>
<td colspan="5"><blockquote>
<p><strong>6b. FFIS Vendor ID Code</strong></p>
<p>123111487B</p>
</blockquote></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p><strong>7a.</strong></p>
<p><strong>Award Line Number.</strong></p>
</blockquote></td>
<td><blockquote>
<p><strong>8a.</strong></p>
<p><strong>IAS</strong></p>
<p><strong>Receipt Number</strong></p>
</blockquote></td>
<td colspan="2"><blockquote>
<p><strong>9a.</strong></p>
<p><strong>Dollar Amount</strong></p>
</blockquote></td>
<td colspan="2"><blockquote>
<p><strong>7b.</strong></p>
<p><strong>Award Line Number</strong></p>
</blockquote></td>
<td colspan="4"><blockquote>
<p><strong>8b.</strong></p>
</blockquote>
<p><strong>IAS</strong></p>
<p><strong>Receipt Number</strong></p></td>
<td colspan="7"><blockquote>
<p><strong>9b.</strong></p>
<p><strong>Dollar Amount</strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td></td>
<td><blockquote>
<p>0001</p>
</blockquote></td>
<td><blockquote>
<p>50760</p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>2000.00</p>
</blockquote></td>
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td></td>
<td><blockquote>
<p>0002</p>
</blockquote></td>
<td><blockquote>
<p>50762</p>
</blockquote></td>
<td colspan="2"><blockquote>
<p>1500.00</p>
</blockquote></td>
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="7"></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="6"><blockquote>
<p>_ Total</p>
</blockquote></td>
<td colspan="7"><blockquote>
<p>10. $3,500.00</p>
</blockquote></td>
</tr>
<tr class="even">
<td></td>
<td colspan="17"><blockquote>
<p><strong>11. Notes:</strong></p>
</blockquote></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="5" rowspan="5"><blockquote>
<p><strong>16. Attach one invoice per form and fax to (504) 426-8247 or
mail to: (<em>Use of Window Envelope is Optional)</em></strong></p>
<p>USDA, OCFO, COD, APB</p>
<p>P.O. Box 60075</p>
<p>New Orleans, Louisiana 70160</p>
</blockquote></td>
<td colspan="12"><blockquote>
<p><strong>AUTHORIZED OFFICIAL</strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td></td>
<td colspan="12"><blockquote>
<p><strong>12. Name, Title and Address of Agency Official</strong></p>
<p>M. Y. Job, Contracting Officer</p>
<p>123 Mi Casa Street</p>
<p>My City, State Zip</p>
</blockquote></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="12"><blockquote>
<p><strong>13. Signature</strong></p>
<p><strong>M. Y. Job</strong></p>
</blockquote></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4" rowspan="2"><blockquote>
<p><strong>14. Date</strong></p>
<p>11/4/2005</p>
</blockquote></td>
<td colspan="8" rowspan="2"><blockquote>
<p><strong>15. Phone Number</strong></p>
<p>(505) 123-4567</p>
</blockquote></td>
</tr>
<tr class="odd">
<td></td>
</tr>
</tbody>
</table>

**BLOCK NUMBER**

1\. Enter the IAS Order Number. If the order has both a contract number
and an order number, enter the order number.

2\. Enter a mark next to the Prompt Pay Type appropriate for the IAS
award.

3\. Enter the date the goods / services were received and accepted or
the date the service period ended. When multiple receipts have occurred,
always enter the latest date. The date should match the receipt date
entered in IAS.

4\. Enter the date the invoice was received by the Agency.

5\. Enter the Vendor\'s Invoice Number. If none, enter \"NONE.\" **If
more than one invoice, submit a separate Invoice Cover Sheet for each.**

6\. Enter the vendor's name in **6a** and enter in **6b** the FFIS
Vendor Identification Number (9-character TIN plus 1-character alpha
code) from address line 3 on the IAS Award Document.

**FOLLOW BLOCK NUMBER 7 THROUGH 9 FOR EACH LINE ITEM RECEIVED.**

7\. Enter the IAS award line number for each IAS receipt associated with
this invoice.

8\. Enter the IAS Receipt Number that you want to be paid by this
invoice. This is optional information.

9\. Enter the dollar amount of the receipt for the award line. (Received
Quantity x Unit Price)

**BLOCK NUMBER**

10\. Enter the total amount of the invoice.

11\. Record receipt exception and other notes to NFC.

12\. Enter the name, title and address of the authorized official.

13\. Enter signature of authorized official.

14\. Enter the date this form is prepared.

15\. Enter the phone number where the authorized official can be reached
for additional information.

16\. Fax or mail to this NFC address. Attach a single invoice to the
back of each Invoice Cover Sheet for IAS Payments.