# PGI 250.101-3 Records.

(1) Departments and agencies shall-

(i) Prepare a preliminary record when a request for a contract adjustment under FAR 50.103 is filed (see DFARS 250.103-5(1)).

(ii) Prepare a final record stating the disposition of the request (see PGI 250.103-6).

(iii) Designate the offices or officials responsible for preparing, submitting, and receiving all records required by DFARS Subpart 250.1. Records shall be maintained by the contract adjustment boards of the Army, Navy, and Air Force, respectively, and by the headquarters of the defense agencies.

(2) A suggested format for the record is the Record of Request for Adjustment shown at the end of this section. This format permits the information required for the preliminary and final records to be combined on one form. The following instructions are provided for those items in the format that are not self-explanatory:

(i) Extent of performance as of date of request. State the degree of completion of the contract; e.g., 50 percent completed or performance not yet begun. If work is completed, state the date of completion and whether final payment has been made.

(ii) Award procedure. State whether the contract was awarded under sealed bidding or negotiated procedures. Cite the specific authority for using other than full and open competition, if applicable, e.g., 10 U.S.C. 3204(a).

(iii) Type of contract. State the type of contract (see FAR Part 16); e.g., FFP (firm-fixed-price).

(iv) Category of case. State whether the request involves a modification without consideration, a mistake, or an informal commitment. If the case involves more than one category, identify both; list the most significant category first.

(v) Amount or description of request. If the request is expressed in dollars, state the amount and whether it is an increase or decrease. If the request cannot be expressed in monetary terms, provide a brief description; e.g., "Cancellation" or "Modification." Even if the adjustment is not easily expressed in terms of dollars, if the contractor has made an estimate in the request, that estimate should be stated.

(vi) Action below Secretarial level. State the disposition of the case, the office that took the action and the date the action was taken. The disposition should be stated as "Withdrawn," "Denied," "Approved," or "Forwarded." If the request was approved, in whole or in part, state the dollar amount or nature of the action (as explained in paragraph (2)(v) of this section). The date should correspond with the date of the memorandum of decision or of the letter forwarding the request to the contract adjustment board or other deciding body.

(vii) Action by contract adjustment board and date. State the disposition and date of disposition of the case by the contract adjustment board. Provide the same information as for paragraph (2)(vi) of this section.

(viii) Implementation and date. State the appropriate action; e.g., "Modification," "New Contract," or "Letter of Denial."

□ PRELIMINARY | RECORD OF REQUEST FOR ADJUSTMENT PUBLIC LAW 85-804 | FINAL □
DATE OF REQUEST |  |  |  |  |  |  | DATE RECEIVED BY GOVERNMENT
CONTRACTOR'S NAME AND ADDRESS □ SMALL BUSINESS
NAME AND ADDRESS OF CONTRACTOR'S REPRESENTATIVE, IF ANY
COGNIZANT CONTRACTING OFFICER OR OFFICE | PROCURING ACTIVITY
PROPERTY OR SERVICE INVOLVED | EXTENT OF PERFORMANCE AS OF DATE OF REQUEST
CONTRACT NUMBER | DATE | ADVERTISED OR NEGOTIATED | TYPE OF CONTRACT
CATEGORY OF CASE | AMOUNT OF DESCRIPTION OF REQUEST
ACTION BELOW SECRETARIAL LEVEL | DATE
ACTION BY CAB | DATE
IMPLEMENTATION | DATE
ADDITIONAL DATA OR REMARKS
DATE THIS RECORD SIGNED | SIGNATURE