<table>
<colgroup>
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 9%" />
<col style="width: 2%" />
<col style="width: 5%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 5%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="27"><p>OFFICE OF THE CHIEF PROCUREMENT OFFICER</p>
<p><strong>REQUEST FOR CONTRACT SERVICES (Short Form</strong>)</p></td>
</tr>
<tr class="even">
<td colspan="7"><strong>HPS Request Number:</strong></td>
<td colspan="7">     </td>
<td colspan="5"><strong>Requesting Office:</strong></td>
<td colspan="8">     </td>
</tr>
<tr class="odd">
<td colspan="5"><strong>Contract Number</strong>:</td>
<td colspan="9">     </td>
<td colspan="6"><strong>Task Order Number:</strong></td>
<td colspan="7">     </td>
</tr>
<tr class="even">
<td colspan="5"><strong>Contractor’s Name:</strong></td>
<td colspan="22">     </td>
</tr>
<tr class="odd">
<td colspan="4"><strong>Type of Action:</strong></td>
<td colspan="23">(Complete the information requested below for the type
of action requested)</td>
</tr>
<tr class="even">
<td></td>
<td><strong>1)</strong></td>
<td colspan="9"><strong>Key Personnel Changes</strong>:</td>
<td colspan="16">     </td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="25">     </td>
</tr>
<tr class="even">
<td colspan="27"></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>2)</strong></td>
<td colspan="25"><strong>GTR/GTM Change in accordance with attached
letter:</strong>:</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Current GTR </td>
<td colspan="18">GTM (check one)</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="13">     </td>
<td colspan="12">(Type name of the GTR or GTM)</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="6">New GTR </td>
<td colspan="19">GTM (check one)</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="13">     </td>
<td colspan="12">(Type name of the GTR or GTM)</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="14">Date new GTR/GTM completed GTR training:</td>
<td colspan="11">     </td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="15">Request enrollment into next GTR training session:</td>
<td colspan="6"> Yes</td>
<td colspan="3"> No</td>
<td></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="15">(Training is required for all GTRs/GTMs)</td>
<td colspan="9">(check one)</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="27"></td>
</tr>
<tr class="even">
<td></td>
<td><strong>3)</strong></td>
<td colspan="25"><strong>Change in Contractor Information (address,
phone number, etc.) Not for Novation Agreements</strong></td>
</tr>
<tr class="odd">
<td colspan="2" rowspan="4"></td>
<td colspan="25">Change the following contractor information in
accordance with contractor’s request attached (see page 2):</td>
</tr>
<tr class="even">
<td colspan="25">     </td>
</tr>
<tr class="odd">
<td colspan="25">     </td>
</tr>
<tr class="even">
<td colspan="25">     </td>
</tr>
<tr class="odd">
<td></td>
<td><strong>4)</strong></td>
<td colspan="25"><strong>Notice of Intent to Exercise Option (HPS
request not required):</strong></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="5"></td>
<td colspan="25">Preliminary notice to be issued to the Contractor,
within <u>     </u> days of the expiration of the current contract
period.</td>
</tr>
<tr class="odd">
<td colspan="11">Current Contract expiration date:</td>
<td colspan="14">     </td>
</tr>
<tr class="even">
<td colspan="12">Requested Contract Option period:</td>
<td> (1)</td>
<td colspan="3"> (2)</td>
<td colspan="3"> (3)</td>
<td colspan="3"> (4)</td>
<td colspan="3">(check one)</td>
</tr>
<tr class="odd">
<td colspan="10">Length of requested option:</td>
<td colspan="6">     </td>
<td colspan="9">(indicate number of months)</td>
</tr>
<tr class="even">
<td colspan="25"></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>5)</strong></td>
<td colspan="25"><strong>Change in Paying Office (Provide location
addresses)</strong></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="8">Current Appropriation Data/Paying Office:</td>
<td colspan="17">     </td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="4">Change to:</td>
<td colspan="21">     </td>
</tr>
<tr class="even">
<td colspan="27"></td>
</tr>
<tr class="odd">
<td></td>
<td><strong>6)</strong></td>
<td colspan="25"><strong>Other (extensions to performance period;
deobligation of funds; partial payment schedule; administrative
changes/corrections, see page 2):</strong></td>
</tr>
<tr class="even">
<td colspan="2" rowspan="3"></td>
<td colspan="25">     </td>
</tr>
<tr class="odd">
<td colspan="25">     </td>
</tr>
<tr class="even">
<td colspan="25">     </td>
</tr>
<tr class="odd">
<td colspan="27"></td>
</tr>
<tr class="even">
<td colspan="8">Requestor’s Name &amp; Title:</td>
<td colspan="14">     </td>
<td colspan="3">Date:</td>
<td colspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="8"></td>
<td colspan="19">(Government Technical Representative)</td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="19">     </td>
<td colspan="3">Date:</td>
<td colspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="24">(Government Technical Monitor)</td>
</tr>
<tr class="even">
<td colspan="3">Approval:</td>
<td colspan="19">     </td>
<td colspan="3">Date:</td>
<td colspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="24">(Name and Title) (See Instructions for minimum
signatory authority)</td>
</tr>
</tbody>
</table>

INSTRUCTIONS FOR RCS SHORT FORM

**(The RCS Short Form may be used only when a HUD-720 is not required
for the action)**

The **minimum approval signatory authority** for submission for the RCS
Short Form is either the Office Director level or the Procurement
Management Division Director level (if appropriate).

This form may be used **[only]{.underline}** for purposes described
below. If in doubt, advance consultation with the Contracting Officer is
recommended. OSDBU review is **[not]{.underline}** required.

**RCS Short Form Usages**:

1.  **Extensions to Performance Period**:

    -   **Excusable Delay**: A delay that is no fault of the contractor
        or the Government. May be due to labor strikes, acts of God,
        closure of facilities, etc. Usually does not involve monetary
        compensation to the contractor of consideration flowing to the
        Government. If monetary compensation is required, this form
        [cannot]{.underline} be used, use the HUD-720 form instead.

    -   **Government Delay**: A delay that is due to the Government
        delaying or interrupting the contractor in the performance of
        the work. Must be asserted, in writing, by the contractor, as
        soon as practicable, after the delay or interruption. May or may
        not affect the contract price, but the contractor may request
        monetary compensation for the delay. If the extension involves a
        funded HUD-720, this form [cannot]{.underline} be used.

    -   **No Additional Cost**: Under a labor-hour or time-and-materials
        contract, the performance period may be due to expire, but funds
        remain on the contract. An extension could be accomplished, for
        a limited period of time, for the same work as prescribed in the
        Statement of Work (SOW), for the purpose of exhausting the
        remaining funds. May be used when it is necessary to keep the
        performance period intact while awaiting a particular action
        under the contract, such as review and revision, if necessary,
        of a final deliverable, the processing of a final performance
        evaluation, etc. Does [not]{.underline} involve addition funds.

    -   **Deliverable Due Date Change**: There may be times when
        deliverables, or their due dates, must be changed due to
        unforeseen circumstances during contract performance. Such a
        change could impact the actual performance period of the
        contract. Does [not]{.underline} involve addition funds.

2.  **Deobligation of Funds**: May be used at completion of work to
    request a modification to deobligate funding from the contract that
    was not utilized. This does [not]{.underline} in include a closeout
    action.

3.  **Partial Payment Schedule**: May be used following award to request
    incorporation of a partial payment schedule.

4.  **Administrative Changes and/or Corrections**: Administrative
    changes are "unilateral" contract changes that do [not]{.underline}
    affect the substantive rights of the parties (changes in the paying
    office or appropriation data, etc.). Does [not]{.underline} include
    instances when major changes are made that require extensive
    negotiations and revamping of the deliverable schedule.

5.  **Changes in Contractor Information (except for Novation
    Agreements)**: The contractor must notify the Contracting Officer of
    changes in contractor information (address; phone numbers, payment
    locations, etc.). It is the contractor's responsibility to maintain
    its own correct and current contractor information in the Central
    Contractor Registration (CCR) system. If there is a discrepancy
    between the contractor's information as contained in CCR system and
    that which is listed on the contract document, the contractor must
    notify the Government. The RCS short form may be used for these
    changes.