2. Servicing (Contracting) Bureau

7. Requestor Information

18. Amount 

10. Performance end date 

Section I: Administrative Information 

3. Requesting (Funding) Bureau

4. Type of Request

6. TIPR Number

7a. Name

7b. Email

7c. Phone

Form rev. 04/15/2013

Treasury Intra-departmental Purchase Request (TIPR)

For purchase of goods and/or services by one Treasury Bureau on behalf of another Treasury Bureau

27a. Bureau Chief Financial Officer (or delegate) 27b. Date

5. Project Title

8. Description of requirement 

13. Contracting Officer Representative (COR) Information

13a. Name

13b. Certification

13c. Email

13d. Phone

9. Date requested/needed:

1. Date of Request

23. Other Fund Information

Section II: Requisition Information

15. Fiscal Year

14. Business Object Class

17. Reporting Category

Section III: Funding Information

16. Product or Service Code

12. Ship to Address

11. Payment Office

25a. Requestor 25b. Date

26a. Bureau Chief Procurement Officer 26b. Date

I certify that this is a bona fide need of the program office for the fiscal year in which good and/or services are requested:

I approve this request to purchase the goods and/or services identified above from the designated Contracting Bureau:

Section IV: Certifications and approvals

I hereby certify that the funds identified herein are available for obligation:

24. Method of payment

20. ALC

21. BPN/DUNS

22. TAS

19. BETC
Instructions for completion of the Treasury Intra-departmental Purchase Request (TIPR) Form

Section I. Administrative Information 

Box 1 Enter the date of the Purchase request

Box 2 Select the Bureau awarding/administering the contract for which the purchase is requested

Box 3 Select the Bureau requesting the purchase

Box 4 Select whether this is a new request or an amendment to an existing request

Box 5 Enter a short title for the acquisition, project or contract

Box 6 Enter the TIPR number in the following format: YYYY-FB-CB-Number-Amd, where:

YYYY = Fiscal Year of funding

FB = acronym of requesting bureau

CB = acronym of Contracting Bureau

Number = sequential three digit number

Amd = sequential two-digit number representing amendments to TIPR

Box 7 Enter the name of the individual requesting the purchase

Section II. Requisition Information

Box 8 Enter the description of the required goods or services, including item numbers, quantities, and prices 

Box 9 Enter the date that contract award is requested or required by

Box 10 Enter the date of final delivery or performance under the contract

Box 11 Enter the name and address of the payment office

Box 12 Enter the address to which goods are to be delivered or performance rendered

Box 13 Enter the name, certification level, email address, and phone number of the Contracting Officer representative or nominee

Section III. Funding Information

Box 14 Enter the Object Object Classification of the purchase

Box 15 Enter the fiscal year of the funding

Box 16 Enter the Product or Service Code for the purchase

Box 17 Enter the Reporting Category of the funding

Box 18 Enter the amount of funds committed by this Purchase Request

Box 19 Enter the Business Event Type Code (BETC)

Box 20 Enter the requesting Bureau customer's Agency Location Code (ALC) 

Box 21 Enter the requesting bureau's Business Partner Network (BPN) / data Universal Numbering System (DUNS) number 

Box 22 Enter the requesting bureau's Treasury account Symbol (TAS) 

Box 23 Enter any additional funding information required to execute the transaction

Box 24 Select the Method by which the servicing Bureau will be funded: advance of obligation, as reimbursement for services rendered, or by direct cite 

Section IV. Certifications and approvals

Box 20 Signature and date of the requestor 

Box 21 Signature and date of the Bureau Chief Procurement Officer

Box 22 Signature and Date of the Funding Bureau Chief Financial Officer (or delegate)