Form Fms 2958 - Delegation Of Authority - Kansas Department Of The Treasury Page 2
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1
2Instructions for Form FMS 2958
1.
This form is for use in delegating individuals to have authority to designate individuals and/or re-delegate
authority to the Financial Management Service. Such delegations/designations are valid for a period of two
years from the effective date. At the end of that period they will expire, unless a re-delegation is submitted to the
Financial Management Service. This form may be used for original delegations, re-delegations and revocations.
2.
Only one individual may be delegated authority or revoked per form.
Section I
More than one block may be checked for type of authority to be delegated.
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All ‘Authority’ blocks should be checked for Head of Agency (HOA) Self-Delegations.
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For each block checked, authority to re-delegate must be indicated by checking either the “MAY” or “MAY
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NOT” block, for that item, as appropriate. Either the “MAY” or “MAY NOT” block must be checked for
each type of delegation authority checked! For HOA Self-Delegations, the “MAY” block should be
checked for ALL authorities.
Enter pertinent information in the Comments field, such as Designee Name Change, etc.
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List all application(s) for which this delegation will be applicable.
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Check the appropriate block for “Type of Delegation or Revocation Action”. Only one block may be checked.
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- Check “Original Delegation” for new delegations.
- Check “Re-Delegation” for renewals of existing delegations.
- Check “Revocation” to revoke all authority that was originally delegated. If partial authority is to be
retained from the original delegation, a new form FMS 2958 must be received re-delegating that
authority.
Section II
The Full Legal Name of the designee must be entered for designee name.
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The Head of Agency will be interpreted to mean the head of an Executive Agency, as appointed by the
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President.
Only the HOA will check the “Yes”
[Refer to the TFM, Part 4, Chapter 1100 for additional HOA information.]
block and sign the signature boxes in Section III & IV to self–delegate. A signed letter on agency letterhead
must also accompany this completed FMS 2958 indicating the individual is the Head of Agency.
For “Effective Date” enter the date that the delegation is to be effective on. Delegations are good for a
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period of two years from the effective date. The actual effective date will be the latter of, the requested
effective date and the date the delegation is actually accepted by FMS.
Section III
Designee must sign within all four boxes.
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All signatures must be handwritten originals.
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All signatures must be clearly legible in BLACK INK for reproduction purposes.
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Designee must sign in the same manner as he/she will be using on future documents to be submitted to
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FMS.
Section IV
All forms FMS 2958 must be signed in this section by an authorized delegator, whose authority will be
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substantiated by FMS prior to processing of the action requested in Section I.
Signature must be within the box and clear and legible, using BLACK INK for reproduction purposes.
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An accomplished copy of form FMS 2958 will be returned directly to the delegator, at the address specified
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in Section V.
Delegators are cautioned to review accomplished copies to ensure no changes to form FMS 2958 have
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occurred between signature and acceptance by FMS.
Section V
Must be completed to reflect the return address of the delegator signing in Section IV.
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Section VI
Will be completed by FMS.
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If accomplished date is later than the effective date, the accomplished date will become the effective date.
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