Common Contracts

RESET FORM

September 16th, 2016

• Filed
  September 16th, 2016

PRIMARY ORGANIZATION /OFFICE INFORMATION 24. Requesting Agency Servicing Agency Primary Organization / Office Name Responsible Organization / Office Address ORDER REQUIREMENTS INFORMATION 25. Order Action (Check One)New Modification (Mod) - List affected Order blocks being changed and explain the changes being made.For Example: for a performance period mod, state the new performance period for this Order in Block 27. Fill out the Funding Modification Summary by Line (Block 26) if the mod involves adding, deleting, or changing Funding for an Order Line. Cancellation - Provide a brief explanation for Order cancellation and fill in the Performance Period End Date for the effective cancellation date. 26. Funding Modification Summary by Line Line # Line # Line # Total of All Other Lines (attach funding details) Total Original Line Funding Cumulative Funding Changes From Prior Mods[addition (+) or reduction (-)] Funding Change for This Mod TOTAL Modified