> **Checklist for Electronic and Information Technology (EIT) Credit
> Card Purchases**
>
> ***Credit Card Purchase Information***
>
> ***This section to be completed by credit card holder.***

+---------------+------------------------------------------------------+
| R             | Requisition Number *(if applicable)* Date:           |
| equisitioner: |                                                      |
+---------------+------------------------------------------------------+
| Program       | Name of CIO & EIT Coordinator:                       |
| Office:       |                                                      |
|               | Name/Phone No. of Credit Card Holder:                |
+---------------+------------------------------------------------------+
| Product       |                                                      |
| Description   |                                                      |
| including     |                                                      |
| estimated     |                                                      |
| dollar value  |                                                      |
| of purchase   |                                                      |
| (attach pages |                                                      |
| as necessary) |                                                      |
+---------------+------------------------------------------------------+

***Pre-Award Action for EIT Credit Card Purchases***

***This section to be completed by OA CIO or designee.***

Subparts and Categories for Section 508 standards (36 CFR 1194
standards)

Check all

appropriate

boxes

+---+-------------------------------------------------------------+------+
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+---+-------------------------------------------------------------+------+
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+---+-------------------------------------------------------------+------+
|   | > Software applications and operating systems (1194.21)     |      |
+---+-------------------------------------------------------------+------+
|   | Web-based internet and intranet information and             |      |
|   | applications (1194.22)                                      |      |
+---+-------------------------------------------------------------+------+
|   | Telecommunication products (1194.23)                        |      |
+---+-------------------------------------------------------------+------+
|   | Video and multi-media products (1194.24)                    |      |
+---+-------------------------------------------------------------+------+
|   | > Self-contained, closed products - e.g., stand-alone       |      |
|   | > (1194.25)                                                 |      |
+---+-------------------------------------------------------------+------+
|   | Desktop and portable computers (1194.26)                    |      |
+---+-------------------------------------------------------------+------+
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+---+-------------------------------------------------------------+------+
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+---+-------------------------------------------------------------+------+
| > |                                                             | >    |
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+---+-------------------------------------------------------------+------+
|   | Back-office (computer room and data closet type equipment)  |      |
+---+-------------------------------------------------------------+------+
|   | Fundamental alteration (for example, pagers, PDAs)          |      |
+---+-------------------------------------------------------------+------+
|   | National Security System (No applicable systems in DOT)     |      |
+---+-------------------------------------------------------------+------+
| > |                                                             | >    |
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+---+-------------------------------------------------------------+------+
|   | Products available, but they do not meet any of the         |      |
|   | appropriate standards                                       |      |
+---+-------------------------------------------------------------+------+
|   | Product(s) compliant (i.e., previously approved as          |      |
|   | compliant)                                                  |      |
+---+-------------------------------------------------------------+------+
|   | Limited product availability (one product meets more        |      |
|   | standards than others (attach analysis)                     |      |
+---+-------------------------------------------------------------+------+
|   | Only one product meets standards (attach analysis)          |      |
+---+-------------------------------------------------------------+------+
|   | Purchase over \$2500 - additional certification attached    |      |
|   | (TAM 1239.2)                                                |      |
+---+-------------------------------------------------------------+------+
| A |                                                             | >    |
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| v |                                                             |      |
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| n |                                                             |      |
| t |                                                             |      |
+---+-------------------------------------------------------------+------+
|   | Complies with standards listed in TRM                       |      |
+---+-------------------------------------------------------------+------+
|   | Product available on enterprise licenses                    |      |
+---+-------------------------------------------------------------+------+
|   | Product not available on GSA/Smart BUY IT                   |      |
+---+-------------------------------------------------------------+------+
|   | Purchase waiver approved by DOT ARB                         |      |
+---+-------------------------------------------------------------+------+

> **[OA CIO/Designee]{.underline}**
>
> Purchase O Approved O Not Approved Date:

Name:

Signature:

Form DOT F 4263.1 (6/2005)

AUTHORIZED FOR REPRODUCTION