Va Form 0896a - Report Of Subcontracts To Small And Veteran-Owned Business

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OMB Approved No. 2900-0741

Respondents Burden: 2 Hours

Expiration Date: Sept. 30, 2019

REPORT OF SUBCONTRACTS TO SMALL AND VETERAN-OWNED BUSINESS

PAPERWORK REDUCTION ACT NOTICE: The Department of Veterans Affairs (VA), Office of Small and Disadvantaged Business Utilization (OSDBU) is required to collect details on subcontracts awarded to Service-

Disabled Veteran-Owned Small Business and Veteran-Owned Small Business in accordance with Public Law (P.L.) 109-461(a)(4). This form is required annually for VA's large prime contractors with Commercial and Individual

Subcontracting Plans

and includes the collection of information on all small business subcontractors.

The collection of information meets the requirement of 38 USC 8127(a)(4). We estimate the time to fill out the form to be about 2 hours. VA cannot conduct or sponsor a collection of information unless a valid OMB control number

is displayed. You are not required to respond to a collection of information if this number is not displayed. Your obligation to respond to this form is mandatory.

If additional reporting space is needed in section 9., please attach a second form.

This form is to be submitted at the same time the prime contractor reports annual subcontracting achievements in the Electronic Subcontract Reporting System (eSRS), , see FAR 19.704(a)(10)(iii) and

19.704 (d)(4). The form must be emailed to each VA Contracting Officer listed in Item 9.O., of this form with a copy to VA OSDBU at vacoosdbusub@va.gov. It is the responsibility of the prime contractor to ensure the correct email

address is utilized.

PRIME CONTRACTORS' INFORMATION

1. NAME AND ADDRESS OF PRIME CONTRACTOR

2. OFFICE TELEPHONE NO.

(Provide street, city, state, and ZIP code)

3. E-MAIL ADDRESS

4. INDIVIDUAL RESPONSIBLE FOR SUBCONTRACT ADMINISTRATION

5. PRIME CONTRACTOR'S DUNS NO.

6. NAME AND TITLE OF PERSON CERTIFYING INFORMATION

7. SIGNATURE OF CERTIFYING OFFICIAL

8. TYPE OF SUBCONTRACTING PLAN(S)

NAME OF AGENCY HOLDING